老年自发性蛛网膜下腔出血后癫痫发作危险因素及治疗效果

发布时间：2019-06-14 06:17

【摘要】：目的分析老年自发性蛛网膜下腔出血(SAH)后癫痫发作危险因素及临床治疗效果。方法老年SAH后癫痫发作患者42例为观察组,同期老年SAH未发作癫痫45例为对照组,分析可能影响老年SAH后并发癫痫发作的相关因素及危险因素。结果 SAH后癫痫发作以大发作为主,其次为精神运动性发作和小发作,发作时间集中在蛛网膜下腔出血后1 w内,其次为3 w及以上和1~3 w。相关因素分析显示,性别、年龄、饮酒、出血后就诊时收缩压170 mm Hg、格拉斯哥昏迷评定(GCS)评分、Fisher评分、Rankin评分、出血后脑血管痉挛、再出血、脑积水、脑梗死与老年SAH后并发癫痫相关(P0.05)。多因素Logistic回归分析显示,脑梗死、Rankin 3~4分、再出血、Fisher 3~4评分是SAH后癫痫独立危险因素。经托吡酯治疗19例,经丙戊酸钠治疗23例,1年内两种治疗方法患者死亡率、癫痫发作率差异无统计学意义(P0.05)。但托吡酯治疗药物不良反应明显低于丙戊酸钠(P0.05)。结论老年SAH后癫痫发作的影响因素较多,独立危险因素与脑损伤相关。对于有相关影响因素和独立危险因素的患者,应提早预防性应用抗癫痫药物,以期降低癫痫发作,在选择抗癫痫药物时,应充分考虑药物副作用的影响。
[Abstract]:Objective to analyze the risk factors and clinical effect of epileptic seizures after (SAH) in elderly patients with spontaneous subarachnoid hemorrhage. Methods 42 elderly patients with epileptic seizures after SAH were selected as observation group and 45 patients with non-epileptic seizures in elderly SAH at the same time as control group. The related factors and risk factors of epileptic seizures after elderly SAH were analyzed. Results after SAH, the seizures were mainly large seizures, followed by psychomotor seizures and small seizures. The seizure time was concentrated within 1 week after subarachnoid hemorrhage, followed by 3 weeks and more and 1 鈮，

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