癫痫与心律紊乱相关性的临床及电生理研究

发布时间：2018-04-06 00:23

本文选题：癫痫　切入点：发作期　出处：《天津医科大学》2017年硕士论文

【摘要】：目的通过视频脑电图监测VEEG(video electroencephalography)及同步心电图ECG(electrocardiogram)描记对癫痫发作期及发作间期的患者进行脑电及心电分析,观察脑电图的异常放电以及不同的癫痫发作类型是否会影响到心电活动,导致心律失常,从而引起恶性心律失常,进而导致癫痫猝死SUDEP(Sudden Unexpected Death in Epilepsy)的发生。资料与方法收集2013年1月-2016年12月就诊于天津医科大学总医院神经内科门诊的已确诊为癫痫病的患者649例,均进行长程视频脑电图+同步心电监测(8~24h)。其中发作期患者453例(简单部分性发作患者187例,复杂部分性发作患者182例,全面强直阵挛性发作患者84例);发作间期患者196例,其中有异常放电者157例,无异常放电者39例。观察所有患者的脑电及同步心电变化,对数据进行统计学分析,并分组研究癫痫发作期不同发作类型与心律失常的相关性及发作间期脑部的异常放电与心律失常的相关性。结果癫痫患者发作间期视频脑电图监测到有异常放电组157例中,心电图出现窦性心动过速者40例,出现心动过缓者72例,出现房性早搏者32例。无异常放电组39例,心电图出现窦性心动过速者8例,出现窦性心动过缓者16例,出现房性早搏者6例。癫痫发作间期有异常放电组与无异常放电组心律异常的发生率比较差异无统计学意义(P0.05)。脑电图是否有异常放电与心电图是否有改变没有相关性(R2=0.007,P=0.238)。癫痫患者发作期,简单部分性发作,心电图出现窦性心律失常者87例,房性及室上性心律失常者42例,QT间期延长及室性心律失常者4例。复杂部分性发作,心电图出现窦性心律失常者78例,房性及室上性心律失常者43例,QT间期延长及室性心律失常者23例。全面强直阵挛性发作,心电图出现窦性心律失常者33例,房性及室上性心律失常者19例,QT间期延长及室性心律失常者15例。仅有发作间期放电组和简单部分性发作组的组间比较差异无统计学意义(P0.05),复杂部分性发作组和全面强直阵挛性发作组的组间比较差异无统计学意义(P0.05),复杂部分性发作组和全面强直阵挛性发作组分别与发作间期组或简单部分性发作组的组间比较差异均有统计学意义(P0.001)。结论癫痫发作期患者不同发作类型出现心律失常的情况不同:1.简单部分性发作患者对心律影响较小,可不出现或只出现窦性或房性心律失常;2.复杂部分性发作及全面强直阵挛性发作患者对心律影响较明显,可出现窦性、房性、室上性甚至室性心律失常。已经确诊为癫痫的患者无论癫痫是否完全控制,在癫痫发作间期:1.无论脑电图是否有异常放电,患者均无可导致癫痫猝死的恶性心律失常发生;2.癫痫发作间期的脑部异常放电,与引起心电活动异常,从而导致心律失常没有相关性。
[Abstract]:Objective to analyze the electroencephalogram (EEG) and electrocardiograms (ECG) of VEEG(video in patients with epilepsy and interictal period by video electroencephalography (EEG) monitoring, and to analyze the electroencephalogram (EEG) and electrocardiogram (ECG) of the patients in the interictal period.To observe whether abnormal EEG discharges and different epileptic seizure types will affect ECG activity, lead to arrhythmia, lead to malignant arrhythmia, and lead to sudden death of SUDEP(Sudden Unexpected Death in Epilepsys.Materials and methods from January 2013 to December 2016, 649 patients with epilepsy were enrolled in the Department of Neurology, General Hospital of Tianjin Medical University.Among them, 453 cases (187 cases of simple partial seizure, 182 cases of complex partial seizure, 84 cases of comprehensive tonic-clonic seizure), 196 cases of interictal phase, 157 cases of abnormal discharge, 39 cases of no abnormal discharge.The changes of EEG and synchronous ECG in all patients were observed and the data were analyzed statistically. The correlation between different types of seizures and arrhythmias and the relationship between abnormal discharges in the brain and arrhythmias in the interictal period were studied.Results in 157 patients with abnormal discharge, 40 patients had sinus tachycardia, 72 patients had bradycardia and 32 patients had atrial premature beats.In no abnormal discharge group, there were 8 cases of sinus tachycardia, 16 cases of sinus bradycardia and 6 cases of atrial premature beats.There was no significant difference in the incidence of arrhythmia between the patients with abnormal discharges and those without abnormal discharges during interictal seizures (P 0.05).There was no correlation between abnormal electroencephalogram (EEG) and electrocardiogram (ECG).There were 87 cases of sinus arrhythmia in electrocardiogram, 42 cases of atrial and supraventricular arrhythmia, 4 cases of prolonged QT interval and ventricular arrhythmia.There were 78 cases of sinus arrhythmia in electrocardiogram, 43 cases of atrial and supraventricular arrhythmias, 23 cases of prolonged QT interval and ventricular arrhythmia.There were 33 cases of sinus arrhythmia in ECG, 19 cases of atrial and supraventricular arrhythmias, 15 cases of prolonged QT interval and ventricular arrhythmia.There was no significant difference between the interictal discharge group and the simple partial seizure group, but there was no significant difference between the complex partial seizure group and the total tonic-clonic seizure group.There were significant differences between the seizure group and the total tonic-clonic seizure group and the interictal group or the simple partial seizure group (P 0.001).Conclusion the incidence of arrhythmia in patients with epileptic seizures varies from one to one.Simple partial attack patients have little effect on cardiac rhythm, can not appear or only sinus or atrial arrhythmia 2.Complex partial seizures and generalized tonic-clonic seizures have obvious effects on arrhythmias, including sinus, atrial, supraventricular and even ventricular arrhythmias.People who have been diagnosed with epilepsy, whether or not they have complete control of epilepsy, are at: 1. 1 during the interictal period.No matter whether EEG is abnormal or not, there is no malignant arrhythmia caused by sudden Epilepsy death.Abnormal discharges in the brain during interictal seizures have no correlation with abnormal electrocardiogram, which leads to arrhythmias.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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