急性幕上脑出血患者不同时期痫性发作与预后的关系研究

doi:10.3969/j.issn.1673-5765.2019.07.006

摘要/Abstract

摘要：

目的分析脑出血后住院期间不同时期痫性发作患者临床特点，评价不同时间段卒中后痫性发作与预后的关系。方法本研究为回顾性研究，入组人群选自中国卒中登记中既往无癫痫病史的2382例的自发性幕上脑出血患者。根据患者住院期间脑出血后伴发痫性发作的时间将患者分为无痫性发作组，脑出血发病同时（发病24 h内）出现的痫性发作（seizures at onset，SAO）组与发病后住院期间出现的痫性发作（seizures during hospitalization，SDH）组。收集入组患者性别、年龄、既往病史、入院时GCS评分和出血部位等临床特点及1年后是否死亡的随访信息，对不同时间段发生卒中后痫性发作与1年死亡率的关系进行分析。结果入组患者中无痫性发作患者共2271例，SAO组61例，SDH组50例。SAO组（55.7%）及SDH组（44％）患者入院时低GCS评分（3～8分）患者比例高于无痫性发作患者组（21.1%），SAO及SDH组患者出血部位多数集中在单纯脑叶或脑叶合并深部白质，而无痫性发作组患者出血部位多位于底节区或丘脑的深部位置，差异有统计学差异（P <0.0001）。无痫性发作患者组1年死亡率最低（25.1%），SDH组死亡率最高（56.0%），差异有统计学差异（P <0.0001）。多因素Logistic分析发现，与无痫性发作患者相比，SDH是患者一年后死亡的独立危险因素（OR 2.145，95%CI 1.084～4.245，P＝0.029）。结论与脑出血后无痫性发作患者相比，发病后住院期间出现的痫性发作是影响患者1年死亡的独立危险因素。

文章导读： 本研究利用中国卒中登记数据库，对较大样本量的脑出血患者住院期间痫性发作的相关因素进行了分析，结果显示发病24 h后住院期间出现的痫性发作是幕上性脑出血患者1年死亡的独立预测因素。

关键词: 脑出血; 痫性发作; 死亡率

Abstract:

Objective To investigate the clinical features of epileptic seizures in patients with spontaneous supratentorial intracerebral hemorrhage (SICH), and the relation of early and delayed-onset seizures during hospitalization to the 1-year outcome. Methods Patients with acute spontaneous SICH and without epilepsy history from the China National Stroke Registry (CNSR) data from September 2007 to August 2008 were included. According to the onset time of epileptic seizure, the subjects were divided into the no-seizure group, the seizures at hemorrhage onset (SAO) group and seizures during hospitalization (SDH) group. Baseline data and the 1-year follow-up results were collected. The relation of early and delayedonset seizure after hemorrhage to the 1-year mortality were analyzed. Results Of all the enrolled patients, 2271 patients having no seizures, 61 patients in SAO and 50 patients in SDH group. Compared to no-seizure group (21.1%), SAO (55.7%) and SDH (44%) groups had lower GCS (3-8), and the hemorrhagic foci in both the seizure groups mostly lied in the lobes and deep white matter, the difference had statistical significance (P <0.0001). While hemorrhage in the no-seizure group mostly lied in basal ganglia and deep thalamus. 1-year mortality was lowest in no-seizure group, and highest in SDH group (P <0.0001). Logistic regression analysis showed that SDH was an independent risk factor for 1-year mortality (OR 2.145, 95%CI 1.084- 4.245, P =0.029). Conclusions Epileptic seizures after hemorrhage during hospitalization was an independent risk factor for 1-year mortality in patients with acute spontaneous SICH.

Key words: Intracerebral hemorrhage; Seizure; Mortality

刘茅茅，王丹丹，李子孝，赵性泉. 急性幕上脑出血患者不同时期痫性发作与预后的关系研究[J]. 中国卒中杂志, 2019, 14(07): 660-664.

LIU Mao-Mao, WANG Dan-Dan, LI Zi-Xiao, ZHAO Xing-Quan. Impact of Post-hemorrhage Seizures on 1-year Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2019, 14(07): 660-664.

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