脑卒中后癫痫发作的相关危险因素分析
发布时间：2018-08-07 08:35
【摘要】：背景:脑卒中是神经科的常见疾病,同时也是诱发中老年人群发作癫痫的常见病因。卒中后癫痫(PSE)发作可加重卒中原发病的病情,影响其疗效、转归。国内外虽有一些关于PSE发作的相关研究,但是危险因素的判定并不明确。通过对PSE的回顾性研究以找寻相关的危险因素,从而对预测PSE的发作起到一定的指导作用。目的:分析PSE发作的临床特点,探讨其发生率、发作形式、首次发作时间、脑电图(EEG)表现等情况,研究相关的危险因素。方法:选择自2014年1月至2015年12月就诊于我院神经内科的住院病人共1008例,均明确诊断脑卒中。采集所有病人的性别,年龄,卒中类型包括脑梗死、脑出血(ICH)、蛛网膜下腔出血(SAH),既往基础病史包括高血压、糖尿病、冠心病、高脂血症,合并症包括高同型半胱氨酸血症、肺部感染,不良嗜好包括吸烟、饮酒,病灶特点包括病灶部位、病灶范围。并详尽记录确诊为PSE发作病人的发生率、首次发作时间、发作形式、脑电图表现等情况。应用卡方检验和多因素Logistic回归分析的统计学方法,研究PSE发作的相关危险因素。结果:1.PSE发作的发生率总共约为5.36%(54/1008)。其中,脑梗死后PSE发作的发生率为4.54%(35/770),脑出血后PSE发作的发生率为7.62%(16/210),SAH后PSE发作的发生率为10.71%(3/28)。对比脑梗死后癫痫发作,脑出血后继发癫痫发作的发生率有增多趋势,但差异无统计学意义(?2=3.16,P=0.075)。2.卡方检验结果显示:性别(?2=4.117,P=0.042),糖尿病(?2=4.89,P=0.027),肺部感染(?2=8.95,P=0.003),病灶部位(?2=45.139,P0.001)和病灶范围(?2=23.316,P0.001)与PSE发作有关(P0.05);多元Logistic分析结果显示:性别(P=0.038,OR=1.946,95%CI:1.039~3.644),肺部感染(P=0.003,OR=3.618,95%CI:1.536~8.520),病灶部位(P0.001,OR=6.435,95%CI:3.353~12.349)和病灶范围(P=0.003,OR=2.513,95%CI:1.374~4.599)与PSE发作有关(P0.05)。3.早发型癫痫发作占63.11%(33/54),其中主要发作形式为单纯部分性发作(SPS)约36.36%(12/33);迟发型癫痫发作占38.89%(21/54),其中主要发作形式为全面强直痉挛发作(GTCS)约42.86%(9/21)。4.癫痫发作间歇期脑电图表现:脑电图正常或临界状态的有13.73%(7/51),双侧大脑半球呈弥漫性慢波的有23.53%(12/51),病灶侧呈局灶性慢波的27.45%(14/51),双侧大脑半球呈广泛痫样放电的15.69%(8/51),病灶侧痫样放电的有19.61%(10/51),结果显示痫样放电的总检出率是35.29%(18/51)。结论:1.不同类型的PSE发作的发生率不同,出血性卒中后PSE发作较缺血性卒中有增多趋势,但差异无统计学意义。2.男性,肺部有感染,病灶部位在皮质和病灶范围大是PSE发作的危险因素。3.PSE发作多发生于卒中后2周内,以SPS为主;迟发型癫痫发作主要以GTCS为主。4.大多数PSE发作患者,在癫痫发作间歇期的脑电图多表现为非特异性的慢波,痫样放电的检出率较低。
[Abstract]:Background: stroke is a common disease in neurology. The seizure of (PSE) after stroke can aggravate the primary condition of stroke, affect its curative effect and result. Although there are some related studies on PSE attack at home and abroad, the determination of risk factors is not clear. A retrospective study of PSE was carried out to find relevant risk factors for predicting the onset of PSE. Objective: to analyze the clinical characteristics of PSE attack, to investigate its incidence, attack form, first attack time and (EEG) manifestation of EEG, and to study the related risk factors. Methods: 1008 inpatients were selected from January 2014 to December 2015. Sex, age, stroke types of all patients were collected including cerebral infarction, (ICH), subarachnoid hemorrhage (ICH), basic history of (SAH), including hypertension, diabetes, coronary heart disease, hyperlipidemia, and complications including hyperhomocysteinemia. Lung infection, bad habits include smoking, drinking, lesions including location, focus range. The incidence, first attack time, attack form, electroencephalogram (EEG) of the patients diagnosed as PSE were recorded in detail. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors of PSE attack. The total incidence of PSE attack was about 5.36% (54 / 1008). The incidence of PSE attack after cerebral infarction was 4.54% (35 / 770), and that of PSE attack after cerebral hemorrhage was 7.62% (16 / 210). The incidence of PSE attack after cerebral infarction was 10.71% (3 / 28). The incidence of epileptic seizures after cerebral hemorrhage was higher than that after cerebral infarction, but the difference was not statistically significant (P 0.075). 鍗℃柟妫，
本文编号：2169480
[Abstract]:Background: stroke is a common disease in neurology. The seizure of (PSE) after stroke can aggravate the primary condition of stroke, affect its curative effect and result. Although there are some related studies on PSE attack at home and abroad, the determination of risk factors is not clear. A retrospective study of PSE was carried out to find relevant risk factors for predicting the onset of PSE. Objective: to analyze the clinical characteristics of PSE attack, to investigate its incidence, attack form, first attack time and (EEG) manifestation of EEG, and to study the related risk factors. Methods: 1008 inpatients were selected from January 2014 to December 2015. Sex, age, stroke types of all patients were collected including cerebral infarction, (ICH), subarachnoid hemorrhage (ICH), basic history of (SAH), including hypertension, diabetes, coronary heart disease, hyperlipidemia, and complications including hyperhomocysteinemia. Lung infection, bad habits include smoking, drinking, lesions including location, focus range. The incidence, first attack time, attack form, electroencephalogram (EEG) of the patients diagnosed as PSE were recorded in detail. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors of PSE attack. The total incidence of PSE attack was about 5.36% (54 / 1008). The incidence of PSE attack after cerebral infarction was 4.54% (35 / 770), and that of PSE attack after cerebral hemorrhage was 7.62% (16 / 210). The incidence of PSE attack after cerebral infarction was 10.71% (3 / 28). The incidence of epileptic seizures after cerebral hemorrhage was higher than that after cerebral infarction, but the difference was not statistically significant (P 0.075). 鍗℃柟妫，
本文编号：2169480
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