急性脑血管病继发早期痫性发作临床探究

发布时间：2018-09-13 09:42

【摘要】：目的：脑血管疾病发病后，患者会遗留严重的肢体功能障碍，并且部分患者还会发生继发癫痫，给患者造成严重的身心损害和经济负担。急性脑血管病早期痫性发作后，再次发作而被确诊的癫痫机率显著提升。因此，对该病发生、发展、转归进行研究意义重大。本研究旨在对急性脑血管病早期痫性发作患者的临床资料进行回顾性分析，以便深入了解该病的发作机制及特点，即患者的发病性别情况、发病年龄、发病时间、发作类型、发病部位、血肿体积与痫性发作的关系、EEG检查和TCD检查结果、以及治疗及预后情况等。方法：回顾性分析2012年12月~2014年1月收集的神经内科住院患者资料2348例，以及其中的56例早期痫性发作患者。对所有所选患者病变的性质、部位，患者年龄和性别，与痫性发作时间和类型，脑电图和TCD检测结果，以及患者治疗方案及治疗结果进行统计研究。结果： 1．本次共研究急性脑血管病患者2348例，其中，男1341例(占57%)，女1007例(占43%)。脑梗死2066例(占88%)，脑出血235例(占10%)，蛛网膜下腔出血47例(占2%)。痫性发作患者56例，其中男26例(占46%)，女30例(占54%)。患者性别对比无显著统计学意义（P0.05）。其中，脑梗死后继发发作26例(占46%)，脑出血后发作25例(占45%)，蛛网膜下腔出血后发作5例(占9%)。本组早期痫性发作的发生率为2%。不同的脑血管病早期痫性发作发生率占脑梗死1%，脑出血10%，蛛网膜下腔出血12%。结果显示，蛛网膜下腔出血发病率男性略低于女性，而蛛网膜下腔出血痫性发作患者男性则显著高于女性，对比有显著统计学意义（P0.05）。 2．在脑梗死病人中，年龄在50岁及50岁以下的早期痫性发作发生率为0.4%，50岁的该病发生率则为1.4%，约为前者的3倍，而经统计学处理后两者对比无统计学意义（P0.05）。此外，脑出血和蛛网膜下腔出血患者50岁患者数亦较≤50岁的患者多，但经统计学处理，差异亦无显著意义（P0.05）。这表明，脑血管病的发病率随人口年龄的增长而大量增加，造成早期痫性发作的患者比例亦随着年龄的增长而增多。 3．发病时间：脑血管病发病同时出现痫性发作有5例，发病l周内出现发作的有29例，l周~2周发作的有22例。 4．发作类型：部分性发作患者数量最多，为55例(约占98.2%)，其中单纯部分性发作28例(50.0%)，复杂部分性发作16例(28.6%)，部分性继发全身性发作11例(约占19.6%)，全面性发作仅l例(约占1.8%)。 5．发病部位：脑梗死后早期痫性发作，皮质梗死18例，占69%(18／26)，皮质下梗死占为31%(8／26)，两者对比差异有显著统计学意义(P0.01)。脑出血后早期痫性发作25例患者中，皮质19例，约占76%(19／25)，皮质下6例，占24%(13／49)，两者对比差异有统计学意义(P0.01)。总之，早期痫性发作皮质病变占64%，皮质下病变占36%，经统计学处理对比有显著统计学意义。 6．血肿体积与痫性发作的关系：脑出血早期痫性发作患者出血量大于35ml的占20%(5／25)，出血量小于35ml的占9.5%(20／210)，两者比较差异有显著性(P0.05)。 7．EEG检查：有31例患者进行脑电图检查，结果11例异常，占36%，其中，3例为广泛轻度异常改变（占27%），5例脑电图为中度异常伴局限性改变（占46%），3例为重度异常（占27%）。而在中度异常及重度异常脑电图中，5例可见到局限性的散发的尖波、棘波、尖慢复合波、棘慢复合波或爆发性的高波幅慢波节律，占43%，其他则均为用药所致的低波幅快波节律占66%。 8．TCD检查：TCD检查共21例，均为脑梗死患者，被检血管血流速度异常率为63%(92／147)，对照组40例普通脑梗死患者异常率为32%(89／280)，两组对比有统计学意义(P0.01)。 9.治疗及预后：未规律口服抗癫痫药者45例，其中40例发作1次，5例发作2次，临时静推安定，未再次发作。其余11例接受抗癫痫药物治疗，其中服用卡马西平6例(55%)，苯妥英钠2例(18%)，丙戊酸钠2例(18%)，卡马西平联合鲁米那治疗的患者1例(9%)。10例接受单一常规剂量治疗有效，，1例进展为癫痫持续状态。结论： 1.急性脑血管病早期痫性发作发生率为2%，其中，蛛网膜下腔出血早期痫性发作发生率最高为11%，脑出血发生率为10%，而脑梗死发生率最少，仅为1%。另外，在蛛网膜下腔出血发病率中，女性高于男性，而蛛网膜下腔出血痫性发作则男性多于女性[44]。 2.早期痫性发作发生率和急性脑血管病发病率有一定关系，即当急性脑血管病发病时，痫性发作的发生率会快速提升，且约在l~2周时趋于稳定[45]。 3.早期痫性发作的发作类型较多，并且以部分性发作为主要发作类型，全面性发作最低[46]。而脑部病变部位以皮质发生发作最高，皮质下最低。病灶大小和痫性发作的发生率有一定关系。 4.TCD提示脑梗死早期痫性发作的发生率和血管狭窄程度呈正相关，即表示早期痫性发作和脑部组织缺血缺氧有一定关系的病理学机理，为临床资料证明病理学机理提高了参考。 5.急性脑血管病后首次痫性发作是否需要抗癫痫药物治疗，仍有争议，反复发作时需要进行药物治疗[48]。
[Abstract]:Objective:
After the onset of cerebrovascular disease, patients will leave serious limb dysfunction, and some patients will also have secondary epilepsy, causing serious physical and mental damage to patients and economic burden. The purpose of this study is to retrospectively analyze the clinical data of patients with early epileptic seizures of acute cerebrovascular disease (ACVD), so as to understand the pathogenesis and characteristics of ACVD, including sex, age, time, type, location, volume of hematoma and epileptic seizures, EEG and TC. D findings, treatment and prognosis.
Method:
A retrospective analysis of 2348 neurological inpatients and 56 of them with early epileptic seizures from December 2012 to January 2014 was carried out. Conduct statistical research.
Result:
1. A total of 2348 patients with acute cerebrovascular disease were studied, including 1341 males (57%) and 1007 females (43%). 2066 patients with cerebral infarction (88%), 235 patients with cerebral hemorrhage (10%), 47 patients with subarachnoid hemorrhage (2%). 56 patients with epileptic seizures, 26 males (46%) and 30 females (54%). There was no significant gender difference (P 0.05). The incidence of early epileptic seizures was 2%. The incidence of early epileptic seizures was 1% in cerebral infarction, 10% in cerebral hemorrhage and 12% in subarachnoid hemorrhage. Men were slightly lower than women, while men with subarachnoid hemorrhage epileptic seizures were significantly higher than women, the difference was statistically significant (P 0.05).
2. Among the patients with cerebral infarction, the incidence of early epileptic seizures was 0.4% in the age of 50 and under, and 1.4% in the age of 50, which was about three times that of the former. There was no statistically significant difference between the two groups (P 0.05). There was no significant difference between the two groups (P 0.05). This indicated that the incidence of cerebrovascular disease increased with the increase of population age, and the proportion of patients with early epileptic seizures increased with the increase of age.
3. Time of onset: There were 5 cases of cerebral vascular disease accompanied by epileptic seizures, 29 cases of epileptic seizures within 1 week and 22 cases of epileptic seizures between 1 week and 2 weeks.
4. Seizure types: The number of patients with partial seizures was the highest, accounting for 55 cases (about 98.2%), including 28 cases of simple partial seizures (50.0%), 16 cases of complex partial seizures (28.6%), 11 cases of partial secondary systemic seizures (about 19.6%) and only 1 case of comprehensive seizures (about 1.8%).
5. Location of onset: 18 cases of early epileptic seizures after cerebral infarction, cortical infarction accounted for 69% (18/26), subcortical infarction accounted for 31% (8/26), the difference was statistically significant (P 0.01). In 25 cases of early epileptic seizures after cerebral hemorrhage, 19 cases of cortex accounted for 76% (19/25), 6 cases of subcortex accounted for 24% (13/49). In short, the early epileptic seizures of cortical lesions accounted for 64%, subcortical lesions accounted for 36%, statistically significant differences were statistically significant.
6. The relationship between hematoma volume and epileptic seizures: 20% (5/25) of the patients with early epileptic seizures had more than 35 ml of hemorrhage, and 9.5% (20/210) had less than 35 ml of hemorrhage, the difference was significant (P 0.05).
7. EEG examination: 31 patients underwent electroencephalogram examination, 11 cases were abnormal, accounting for 36%, of which 3 cases were mild abnormal changes (27%), 5 cases were moderate abnormal with localized changes (46%) and 3 cases were severe abnormalities (27%). The rhythms of high amplitude slow wave, sharp slow complex wave, spike slow complex wave or explosive slow wave accounted for 43%, while those of other low amplitude fast wave caused by drugs accounted for 66%.
8. TCD examination: 21 patients with cerebral infarction were examined by TCD. The abnormal rate of blood flow velocity was 63% (92/147), and the abnormal rate was 32% (89/280) in the control group.
9. Treatment and prognosis: 45 cases of irregular oral antiepileptic drugs, including 40 cases of seizures once, 5 cases of seizures twice, temporary intravenous injection of diazepam, no recurrence. The remaining 11 cases received antiepileptic drugs, including 6 cases of carbamazepine (55%), 2 cases of phenytoin sodium (18%), 2 cases of sodium valproate (18%) and 1 case of carbamazepine combined with lumina (9%). One case received routine single dose therapy, and 1 cases progressed to status epilepticus.
Conclusion:
1. The incidence of early epileptic seizures in acute cerebrovascular diseases was 2%. The highest incidence of early epileptic seizures in subarachnoid hemorrhage was 11%. The incidence of cerebral hemorrhage was 10%. The incidence of cerebral infarction was the lowest, only 1%. In addition, the incidence of subarachnoid hemorrhage was higher in women than in men, while the incidence of epileptic seizures in subarachnoid hemorrhage was higher in men than in men. Female [44].
2. The incidence of early epileptic seizures is related to the incidence of acute cerebrovascular diseases, that is, when acute cerebrovascular diseases occur, the incidence of epileptic seizures will rapidly increase, and tend to be stable about l~2 weeks [45].
3. There are many types of epileptic seizures in the early stage, and partial seizures are the main type of seizures, while total seizures are the lowest [46].
4. TCD indicated that the incidence of early epileptic seizures was positively correlated with the degree of vascular stenosis, which indicated that there was a certain relationship between early epileptic seizures and cerebral ischemia and hypoxia, which could provide a reference for clinical data to prove the pathological mechanism.
5. Whether antiepileptic drugs are needed for the first epileptic seizure after acute cerebrovascular disease is still controversial. Drug therapy is needed for recurrent seizures [48].
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743;R742.1

【参考文献】