小儿热性惊厥的中西医研究进展（附156例病历分析）

发布时间：2018-03-22 20:21

本文选题：热性惊厥　切入点：急惊风　出处：《北京中医药大学》2011年硕士论文　论文类型：学位论文

【摘要】：热性惊厥是儿科惊厥中常见的一种,其确切的发病机制尚不清楚,其遗传倾向已得到证实,临床上急性上呼吸道感染为主要促发因素。热性惊厥患儿多数预后良好,随着研究进展亦发现惊厥反复发作或持续时间长可导致小儿智力降低,甚则继发癫痫。而且,热性惊厥对患儿及其家长的生活、心理均造成不良影响。故临床对热性惊厥治疗得当,普及热性惊厥预防措施及加强家庭健康教育有重要意义热性惊厥,俗称抽风,属祖国医学之“急惊风”范畴,由多种原因及多种疾病引起,现将其概括为“痰、热、惊、风”四证。治疗以清热、豁痰、镇惊、熄风为基本法则。中医常以针灸、推拿及中医三宝等中成药口服以治疗及预防急惊风的发作及复发。现代临床上针对中成药治疗急惊风研究众多,报道中取得与西药相当的疗效。并且中成药物在对于急惊风的预防方面有突出疗效,副作用小。但临床上患儿家长于急惊风急性发作期间应用中药治疗者明显少于西医治疗者本文针对热性惊厥的病因详细阐述,尤其是分子遗传方面,目前发现的与热性惊厥相关的染色体及基因有8q13-q21、19p13.3、2q23-q24、5q14-q15、6q22-q24、18p11.2及15q21.4-q23。部分热性惊厥的发病与离子通道基因突变(电压控制钠离子、钾离子通道基因突变)、神经递质(源于氨基酸类的介质、肽类介质等)、免疫机制异常(体液免疫及细胞免疫低下等)、病毒感染等有关。部分热性惊厥患儿发病前已存在围产期及脑发育异常。临床上热性惊厥患儿表现多样,多数呈全身强直-阵挛发作,少数可见惊厥持续状态、肢体活动障碍等不典型表现。热性惊厥患儿复发率较高,但多数患儿6-7岁后不再发作。多数热性惊厥患儿预后良好,临床资料显示热性惊厥与癫痫及部分癫痫综合征(全面性癫痫伴热性惊厥附加症、Dravet综合征)密切相关,并发现共同的基因突变位点,本文中详细列出其复发及发展为癫痫的危险因素。有动物实验及临床资料显示：多次发作热性惊厥、长程热性惊厥可导致脑损伤,致远期智力水平下降。故于惊厥发作时及时抢救,积极寻找诱发热性惊厥的危险因素并探讨其可能的发病机制,可以合理地处理和预防热性惊厥的再发。临床上,针对热性惊厥病因及发病机制仍需要进一步的探讨和研究,目前发现的基因突变位点仅在部分家族中发现,仍然需要大样本的资料研究。中医治疗及预防急惊风的临床资料逐年增加,但普遍研究样本量小,且关于中药应用过程的毒副作用待进一步深入研究。针对惊厥发作止痉治疗首选安定,对于有高危因素、频繁发作的患儿提倡长程连续用药治疗,但临床西药治疗副作用明显。而临床上西医、中医联合治疗热性惊厥有很好的发展前景,应进一步提倡并发展,尤其是针对高危患儿,这为以后临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.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R720.597

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