發(fā)布時(shí)間：2018-03-22 20:21

  本文選題：熱性驚厥　切入點(diǎn)：急驚風(fēng)　出處：《北京中醫(yī)藥大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：熱性驚厥是兒科驚厥中常見的一種,其確切的發(fā)病機(jī)制尚不清楚,其遺傳傾向已得到證實(shí),臨床上急性上呼吸道感染為主要促發(fā)因素。熱性驚厥患兒多數(shù)預(yù)后良好,隨著研究進(jìn)展亦發(fā)現(xiàn)驚厥反復(fù)發(fā)作或持續(xù)時(shí)間長可導(dǎo)致小兒智力降低,甚則繼發(fā)癲癇。而且,熱性驚厥對(duì)患兒及其家長的生活、心理均造成不良影響。故臨床對(duì)熱性驚厥治療得當(dāng),普及熱性驚厥預(yù)防措施及加強(qiáng)家庭健康教育有重要意義 熱性驚厥,俗稱抽風(fēng),屬祖國醫(yī)學(xué)之“急驚風(fēng)”范疇,由多種原因及多種疾病引起,現(xiàn)將其概括為“痰、熱、驚、風(fēng)”四證。治療以清熱、豁痰、鎮(zhèn)驚、熄風(fēng)為基本法則。中醫(yī)常以針灸、推拿及中醫(yī)三寶等中成藥口服以治療及預(yù)防急驚風(fēng)的發(fā)作及復(fù)發(fā)�，F(xiàn)代臨床上針對(duì)中成藥治療急驚風(fēng)研究眾多,報(bào)道中取得與西藥相當(dāng)?shù)寞熜�。并且中成藥物在�?duì)于急驚風(fēng)的預(yù)防方面有突出療效,副作用小。但臨床上患兒家長于急驚風(fēng)急性發(fā)作期間應(yīng)用中藥治療者明顯少于西醫(yī)治療者 本文針對(duì)熱性驚厥的病因詳細(xì)闡述,尤其是分子遺傳方面,目前發(fā)現(xiàn)的與熱性驚厥相關(guān)的染色體及基因有8q13-q21、19p13.3、2q23-q24、5q14-q15、6q22-q24、18p11.2及15q21.4-q23。部分熱性驚厥的發(fā)病與離子通道基因突變(電壓控制鈉離子、鉀離子通道基因突變)、神經(jīng)遞質(zhì)(源于氨基酸類的介質(zhì)、肽類介質(zhì)等)、免疫機(jī)制異常(體液免疫及細(xì)胞免疫低下等)、病毒感染等有關(guān)。部分熱性驚厥患兒發(fā)病前已存在圍產(chǎn)期及腦發(fā)育異常。臨床上熱性驚厥患兒表現(xiàn)多樣,多數(shù)呈全身強(qiáng)直-陣攣發(fā)作,少數(shù)可見驚厥持續(xù)狀態(tài)、肢體活動(dòng)障礙等不典型表現(xiàn)。熱性驚厥患兒復(fù)發(fā)率較高,但多數(shù)患兒6-7歲后不再發(fā)作。多數(shù)熱性驚厥患兒預(yù)后良好,臨床資料顯示熱性驚厥與癲癇及部分癲癇綜合征(全面性癲癇伴熱性驚厥附加癥、Dravet綜合征)密切相關(guān),并發(fā)現(xiàn)共同的基因突變位點(diǎn),本文中詳細(xì)列出其復(fù)發(fā)及發(fā)展為癲癇的危險(xiǎn)因素。有動(dòng)物實(shí)驗(yàn)及臨床資料顯示：多次發(fā)作熱性驚厥、長程熱性驚厥可導(dǎo)致腦損傷,致遠(yuǎn)期智力水平下降。故于驚厥發(fā)作時(shí)及時(shí)搶救,積極尋找誘發(fā)熱性驚厥的危險(xiǎn)因素并探討其可能的發(fā)病機(jī)制,可以合理地處理和預(yù)防熱性驚厥的再發(fā)。 臨床上,針對(duì)熱性驚厥病因及發(fā)病機(jī)制仍需要進(jìn)一步的探討和研究,目前發(fā)現(xiàn)的基因突變位點(diǎn)僅在部分家族中發(fā)現(xiàn),仍然需要大樣本的資料研究。中醫(yī)治療及預(yù)防急驚風(fēng)的臨床資料逐年增加,但普遍研究樣本量小,且關(guān)于中藥應(yīng)用過程的毒副作用待進(jìn)一步深入研究。針對(duì)驚厥發(fā)作止痙治療首選安定,對(duì)于有高危因素、頻繁發(fā)作的患兒提倡長程連續(xù)用藥治療,但臨床西藥治療副作用明顯。而臨床上西醫(yī)、中醫(yī)聯(lián)合治療熱性驚厥有很好的發(fā)展前景,應(yīng)進(jìn)一步提倡并發(fā)展,尤其是針對(duì)高�；純�,這為以后臨床研究也提供了新的方向。
[Abstract]:Febrile convulsion is a common type of febrile convulsion in pediatrics. The exact pathogenesis of febrile convulsion is not clear. Its genetic predisposition has been confirmed. Clinical acute upper respiratory tract infection is the main contributing factor. The prognosis of febrile convulsion is good in most of the children with febrile convulsion. As research progresses, it has also been found that repeated seizures or prolonged seizures can lead to reduced intelligence and even secondary epilepsy in children. Furthermore, febrile convulsions affect the lives of children and their parents. Therefore, it is important to treat febrile convulsion properly, popularize preventive measures of febrile convulsion and strengthen family health education. Febrile convulsion, commonly known as wind-pumping, belongs to the category of "sudden wind" in Chinese medicine. It is caused by various causes and diseases. It is now summed up as "phlegm, fever, shock and wind." the treatment is to clear away heat, exclude phlegm, and control shock. Traditional Chinese medicine often takes acupuncture, massage and three treasures of Chinese medicine orally to treat and prevent the attack and recurrence of acute convulsion. In modern medicine, there are many researches on the treatment of acute shock by traditional Chinese medicine, such as acupuncture and moxibustion, massage and traditional Chinese medicine. In the report, the curative effect is comparable with western medicine. And the Chinese patent medicine has outstanding curative effect on the prevention of sudden shock, and the side effect is small. But in clinic, the parents of children with acute convulsion are obviously less than those who are treated with traditional Chinese medicine during the acute attack of sudden shock. In this paper, the etiology of febrile convulsion is described in detail, especially in the aspect of molecular heredity. At present, the chromosomes and genes associated with febrile convulsion are found to be 8q13-q21n19p13.3 / 2q23-q244A5q14-q155q22-q24l18p11.2 and 15q21.4-q23.The pathogenesis of febrile convulsion and mutation of ion channel gene (voltage-controlled sodium ion), Potassium channel gene mutations, neurotransmitters (derived from amino acids), Peptide mediators and so on, abnormal immune mechanism (humoral immunity and cellular immunity, etc., virus infection, etc.) some febrile convulsions have perinatal period and abnormal brain development before the onset of febrile convulsion. The clinical manifestations of febrile convulsion children are various. Most of them showed generalized tonic-clonic seizures, a few of them showed convulsion, limb dysfunction and other atypical manifestations. The recurrence rate of febrile convulsions was higher, but most of them did not occur after 6-7 years of age. The prognosis of most febrile convulsions was good. Clinical data showed that febrile convulsion was closely associated with epilepsy and partial epilepsy syndrome (generalized epilepsy with febrile convulsion appended syndrome), and a common gene mutation site was found. In this paper, the risk factors for recurrence and development of epilepsy are listed in detail. Animal experiments and clinical data show that multiple febrile convulsions and long term febrile convulsions can lead to brain injury. In order to deal with and prevent the recurrence of febrile convulsion, the risk factors and possible pathogenesis of febrile convulsion can be explored. Clinically, the etiology and pathogenesis of febrile convulsion still need to be further studied. The gene mutation sites found at present are only found in some families. There is still a need for a large sample of data research. The clinical data of TCM treatment and prevention of acute shock are increasing year by year, but the sample size of general research is small. The toxic and side effects of traditional Chinese medicine application should be further studied. The first choice of diazepam for convulsive spasmolysis treatment, for children with high risk factors and frequent seizures, is to advocate long-term continuous medication treatment. But the side effect of clinical western medicine treatment is obvious, and the combination of western medicine and traditional Chinese medicine in treating febrile convulsion has a good development prospect, which should be further advocated and developed, especially for high-risk children, which provides a new direction for clinical research in the future.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R720.597

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