惊厥性癫痫持续状态的临床特征及其预后影响因素分析
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摘要
目的分析影响惊厥性癫痫持续状态(CSE)患者预后的相关因素,为提高和改进CSE治疗提供参考。方法回顾性分析2010年1月至2017年5月我科收治的202例CSE患者的临床资料。采用多元Logistic回归评估CSE死亡及功能恶化的危险因素。结果 202例CSE患者中死亡32例(15. 8%)。多因素分析提示发作后昏迷,难治性癫痫持续状态(RSE),机械通气,并发肺炎、呼吸衰竭、消化道出血是短期死亡的独立危险因素;发作后昏迷,并发肺炎、呼吸衰竭、酸中毒是功能恶化的独立危险因素。远期症状性病因与短期死亡呈负相关。癫痫病史与功能恶化呈负相关。结论影响CSE预后的因素较多,其中发作后昏迷、并发症、机械通气、RSE与预后不良相关;远期症状性病因、癫痫病史与CSE较好结局相关。同时及早识别预后不良的危险因素,及时院前干预,加强气道管理对改善CSE预后具有重要的意义。
Objective To analyze the factors that affect the prognosis of convulsive status epilepticus( CSE),so that to provide reference for the improvement of CSE treatment.Methods A retrospective analysis of 202 patients with CSE who were hospitalized from January 2010 to May 2017 in our department was performed.Multiple logistic regression analysis was applied to identify independent risk factors for mortality and deterioration of function.Results Of the 202 CSE patients,there were 32 deaths( 15. 8%).Multivariate analysis showed that coma after onset,refractory status epilepticus( RSE),mechanical ventilation,concurrent pneumonia,respiratory failure and gastrointestinal bleeding were independent risk factors for short-term death.Coma after onset,concurrent pneumonia,respiratory failure and acidosis were independent risk factors of functional deterioration. Remote symptomatic etiology was negatively related to short-term death.The history of epilepsy was negatively correlated with deterioration of CSE function.Conclusion There were many factors affecting the prognosis of CSE,of which coma after onset,mechanical ventilation and RSE are associated with negative prognosis.Remote symptomatic etiology and epilepsy history were related to positive outcome of CSE.Early identification of risk factors for poor prognosis,and timely pre-hospital intervention and enhancement of airway management are important for improving prognosis of CSE in clinical practice.
Objective To analyze the factors that affect the prognosis of convulsive status epilepticus( CSE),so that to provide reference for the improvement of CSE treatment.Methods A retrospective analysis of 202 patients with CSE who were hospitalized from January 2010 to May 2017 in our department was performed.Multiple logistic regression analysis was applied to identify independent risk factors for mortality and deterioration of function.Results Of the 202 CSE patients,there were 32 deaths( 15. 8%).Multivariate analysis showed that coma after onset,refractory status epilepticus( RSE),mechanical ventilation,concurrent pneumonia,respiratory failure and gastrointestinal bleeding were independent risk factors for short-term death.Coma after onset,concurrent pneumonia,respiratory failure and acidosis were independent risk factors of functional deterioration. Remote symptomatic etiology was negatively related to short-term death.The history of epilepsy was negatively correlated with deterioration of CSE function.Conclusion There were many factors affecting the prognosis of CSE,of which coma after onset,mechanical ventilation and RSE are associated with negative prognosis.Remote symptomatic etiology and epilepsy history were related to positive outcome of CSE.Early identification of risk factors for poor prognosis,and timely pre-hospital intervention and enhancement of airway management are important for improving prognosis of CSE in clinical practice.
引文
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[23]Sutter R,Kaplan PW,Ruegg S.Outcome predictors for status epilepticus-what really counts[J].Nat Rev Neurol,2013,9(9):525-534.
[24]Jayalakshmi S,Vooturi S,Chepuru R,et al.Aetiology and outcome of generalized convulsive status epilepticus in elderly[J]. Seizure,2015,29:104-108.
[2]Rohracher A,Reiter DP,Brigo F,et al.Status epilepticus in the elderly-A retrospective study on 120 patients[J]. Epilepsy Res,2016,127:317-323.
[3]Chin RF,Neville BG,Peckham C,et al.Incidence,cause,and shortterm outcome of convulsive status epilepticus in childhood:prospective population-based study[J]. Lancet,2006,368(9531):222-229.
[4]Tiamkao S,Pranboon S,Thepsuthammarat K,et al. Incidences and outcomes of status epilepticus:A 9-year longitudinal national study[J].Epilepsy Behav,2015,49:135-137.
[5]Jayalakshmi S,Vooturi S,Sahu S,et al.Causes and outcomes of new onset status epilepticus and predictors of refractoriness to therapy[J].J Clin Neurosci,2016,26:89-94.
[6]Zhou B,Huang Y,Wang J,et al. The aetiology of convulsive status epilepticus:a study of 258 cases in Western China[J]. Seizure,2014,23(9):717-721.
[7]Stelzer FG,Bustamante GO,Sander H,et al.Short-term mortality and prognostic factors related to status epilepticus[J]. Arq Neuropsiquiatr,2015,73(8):670-675.
[8]Halawa EF,Draz I,Ahmed D,et al.Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital[J].J Child Neurol,2015,30(13):1736-1742.
[9]Belluzzo M,Furlanis G,Stragapede L,et al.Role of comorbidities and in-hospital complications in short-term status epilepticus outcome[J].Clin Neurol Neurosurg,2017,154:13-18.
[10]Sutter R,Semmlack S,Spiegel R,et al. Distinguishing in-hospital and out-of-hospital status epilepticus:clinical implications from a10-year cohort study[J].Eur J Neurol,2017,24(9):1156-1165.
[11]Dupont S,Crespel A.Satus epilepticus:epidemiology,definitions and classifications[J].Rev Neurol(Paris),2009,165:307-314.
[12]Mayer SA,Claassen J,Lokin J,et al. Refractory status epilepticus:frequency,risk factors,and impact on outcome[J]. Arch Neurol,2002,59(2):205-210.
[13]Shatirishvili T,Kipiani T,Lomidze G,et al.Short-term outcomes and major barriers in the management of convulsive status epilepticus in children:a study in Georgia[J]. Epileptic Disord,2015,17(3):292-298.
[14]Trinka E,Cock H,Hesdorffer D,et al.A definition and classification of status epilepticus-Report of the ILAE Task Force on Classification of Status Epilepticus[J]. Epilepsia,2015,56(10):1515-1523.
[15]Bonita R,Beaglehole R. Modification of Rankin Scale:recovery of motor function after stroke[J].Stroke,1998,19:1497-1500.
[16]Rathakrishnan R,Sidik N P,Huak C Y,et al.Generalised convulsive status epilepticus in Singapore:clinical outcomes and potential prognostic markers[J].Seizure,2009,18(3):202-205.
[17]Rossetti AO,Logroscino G,Bromfield EB.A clinical score for prognosis of status epilepticus in adults[J]. Neurology,2006,66(11):1736-1738.
[18]Dham BS,Hunter K,Rincon F. The epidemiology of status epilepticus in the United States[J]. Neurocrit Care,2014,20(3):476-483.
[19]Lv RJ,Wang Q,Cui T,et al.Status epilepticus-related etiology,incidence and mortality:A meta-analysis[J].Epilepsy Res,2017,136:12-17.
[20]Vilella L,Gonzalez CM,Quintana LM,et al.Prognosis of status epilepticus in elderly patients[J]. Acta Neurol Scand,2017,173(3):321-328.
[21]Komur M,Arslankoylu A E,Okuyaz C,et al.Management of patients with status epilepticus treated at a pediatric intensive care unit in Turkey[J].Pediatr Neurol,2012,46(6):382-386.
[22]Belluzzo M,Furlanis G,Stragapede L.Predictors of functional disability at hospital discharge after status epilepticus[J].Epilepsy Res,2015,110:179-182.
[23]Sutter R,Kaplan PW,Ruegg S.Outcome predictors for status epilepticus-what really counts[J].Nat Rev Neurol,2013,9(9):525-534.
[24]Jayalakshmi S,Vooturi S,Chepuru R,et al.Aetiology and outcome of generalized convulsive status epilepticus in elderly[J]. Seizure,2015,29:104-108.