65例新生儿惊厥的临床分析
|
摘要
目的探讨新生儿惊厥的发病原因、惊厥类型、临床表现、治疗措施及临床转归。方法对2015年12月至2017年12月期间在空军军医大学唐都医院医院儿科住院治疗的65例足月新生儿惊厥患儿的临床资料进行总结、归纳和分析。结果①发病原因:病因明确57例,病因未明8例。病因明确患儿中缺氧缺血性脑病26例,低血糖症13例,化脓性脑膜炎7例,败血症合并低钙血症1例,颅内出血4例,脑梗塞3例,脑发育异常2例,撤药综合征1例。②发作类型:微小型发作46例,阵挛型发作12例,强直型发作7例,未见肌阵挛型发作。③视频脑电图:轻度异常27例,中度异常22例,重度异常16例。④临床转归:临床控制理想59例,由于经济困难、惊厥难以控制等原因放弃治疗6例。结论新生儿惊厥是常见神经系统症状,临床表现不典型,以微小型发作最常见。多种病因均可导致惊厥发作,其中以缺氧缺血性脑病最常见。视频脑电图有助于惊厥诊断及分型。苯巴比妥钠可作为新生儿惊厥的首选药物,在控制惊厥前提下积极查找惊厥病因至关重要。
Objective To explore the causes, types, clinical manifestations, treatment measures and clinical outcomes of neonatal seizures. Methods The clinical data of 65 cases of neonatal seizures of full-term newborns admitted and treated in Pediatrics Department of Tangdu Hospital from December 2015 to December 2017 was summarized and analyzed. Results For etiological agent, there were 8 cases with unknown causes and 57 cases with definite causes, of which 26 cases of hypoxic ischemic encephalopathy, 13 cases of hypoglycemia, 7 cases of purulent meningitis, 1 case of sepsis combined with hypocalcemia, 4 cases of cerebral hemorrhage, 3 cases of cerebral infarction, 2 cases of cerebral dysplasia and 1 case of withdrawal syndrome were observed. In terms of type of seizures, there were 46 cases of subtle seizures, 12 cases of clonic seizures, 7 cases of tetanic seizures and no myoclonic seizures. Video-EEG examination showed that there were 27 cases of mild abnormality, 22 cases of moderate abnormality and 16 cases of severe abnormality. The outcomes of treatment were ideal in 59 cases, and 6 cases abandoned treatment because of economic hardship or refractory seizures. Conclusion Neonatal seizures is a common neurological symptom. Its clinical manifestations are not typical, and subtle seizure is most common. A variety of causes could lead to neonatal seizures, of which hypoxic ischemic encephalopathy is most common. Video-ECG is helpful for diagnosis and classification of neonatal seizures. Phenobarbital sodium is the first choice drug for treatment of neonatal seizures. Furthermore, it is very important to actively find the cause of seizures under precondition of controlling seizures.
Objective To explore the causes, types, clinical manifestations, treatment measures and clinical outcomes of neonatal seizures. Methods The clinical data of 65 cases of neonatal seizures of full-term newborns admitted and treated in Pediatrics Department of Tangdu Hospital from December 2015 to December 2017 was summarized and analyzed. Results For etiological agent, there were 8 cases with unknown causes and 57 cases with definite causes, of which 26 cases of hypoxic ischemic encephalopathy, 13 cases of hypoglycemia, 7 cases of purulent meningitis, 1 case of sepsis combined with hypocalcemia, 4 cases of cerebral hemorrhage, 3 cases of cerebral infarction, 2 cases of cerebral dysplasia and 1 case of withdrawal syndrome were observed. In terms of type of seizures, there were 46 cases of subtle seizures, 12 cases of clonic seizures, 7 cases of tetanic seizures and no myoclonic seizures. Video-EEG examination showed that there were 27 cases of mild abnormality, 22 cases of moderate abnormality and 16 cases of severe abnormality. The outcomes of treatment were ideal in 59 cases, and 6 cases abandoned treatment because of economic hardship or refractory seizures. Conclusion Neonatal seizures is a common neurological symptom. Its clinical manifestations are not typical, and subtle seizure is most common. A variety of causes could lead to neonatal seizures, of which hypoxic ischemic encephalopathy is most common. Video-ECG is helpful for diagnosis and classification of neonatal seizures. Phenobarbital sodium is the first choice drug for treatment of neonatal seizures. Furthermore, it is very important to actively find the cause of seizures under precondition of controlling seizures.
引文
[1]van Rooij L G,Hellstr?m-Westas L,de Vries L S.Treatment of neonatal seizures[J].Semin Fetal Neonatal Med,2013,18(4):209-215.
[2]刘奔科,胡越.新生儿惊厥的临床研究进展[J].中国医药科学,2018,8(8):24-26.
[3]Marti-Fabregas J,Delgado-Mederos R,Granell E,et al.Microbleed burden and hematoma expansion in acute intracerbral hemorrhage[J].Eur Neurol,2013,70(3-4):175-178.
[4]Thampatty B P,Sherwood P R,Gallek M J,et al.Role of endothelin-1 in human aneurysmal subarachnoid hemorrhage: associations with vasospasm and delayed cerebral ischemia[J].Neurocrit Care,2011,15(1):19-27.
[5]顾玉红.新生儿缺氧缺血性脑病患儿的临床治疗进展[J].医疗装备,2017,30(12):183-184.
[6]Balaka B,Assogba K,Touglo F A,et al.Neonatal seizures:Frequency, clinical forms, aetiology and outcome in tropical practice[J].American Journal of Obstetrics Gynecology,2015,188(2):517-523.
[7]白琼丹,张璋.出生1周内新生儿惊厥52例临床分析[J].中外医疗,2015(30):1674-0742.
[8]王秋霞,张婕,李玉勤,等.60例惊厥新生儿临床特点和视频脑电图分析[J].中国儿童保健杂志,2016,24(02):210-213.
[9]李婕,于方,陈曦.60例新生儿惊厥临床分析[J].中华实用诊断与治疗杂志,2016,30(8):798-799.
[10]Shah D K,Wusthoff C J,Clarke P,et al.Electrographicseizures are associated with brain injury in newborns undergoing therapeutic hypothermia[J].Archives of Disease in Childhood, Fetal andneonatal edition,2014,99(3):F219-F224.
[11]向入平,资晓宏,余辉云,等.新的良性家族性婴儿惊厥候选基因的突变筛查[J].中华临床医师杂志,2013,7(1):79-82.
[12]姜卫波,江艳丽,吴茹霞.新生儿缺氧缺血性脑病脑损伤的超声诊断及预后评价[J].中国中西医结合影像学杂志,2018,16(2):195-197.
[2]刘奔科,胡越.新生儿惊厥的临床研究进展[J].中国医药科学,2018,8(8):24-26.
[3]Marti-Fabregas J,Delgado-Mederos R,Granell E,et al.Microbleed burden and hematoma expansion in acute intracerbral hemorrhage[J].Eur Neurol,2013,70(3-4):175-178.
[4]Thampatty B P,Sherwood P R,Gallek M J,et al.Role of endothelin-1 in human aneurysmal subarachnoid hemorrhage: associations with vasospasm and delayed cerebral ischemia[J].Neurocrit Care,2011,15(1):19-27.
[5]顾玉红.新生儿缺氧缺血性脑病患儿的临床治疗进展[J].医疗装备,2017,30(12):183-184.
[6]Balaka B,Assogba K,Touglo F A,et al.Neonatal seizures:Frequency, clinical forms, aetiology and outcome in tropical practice[J].American Journal of Obstetrics Gynecology,2015,188(2):517-523.
[7]白琼丹,张璋.出生1周内新生儿惊厥52例临床分析[J].中外医疗,2015(30):1674-0742.
[8]王秋霞,张婕,李玉勤,等.60例惊厥新生儿临床特点和视频脑电图分析[J].中国儿童保健杂志,2016,24(02):210-213.
[9]李婕,于方,陈曦.60例新生儿惊厥临床分析[J].中华实用诊断与治疗杂志,2016,30(8):798-799.
[10]Shah D K,Wusthoff C J,Clarke P,et al.Electrographicseizures are associated with brain injury in newborns undergoing therapeutic hypothermia[J].Archives of Disease in Childhood, Fetal andneonatal edition,2014,99(3):F219-F224.
[11]向入平,资晓宏,余辉云,等.新的良性家族性婴儿惊厥候选基因的突变筛查[J].中华临床医师杂志,2013,7(1):79-82.
[12]姜卫波,江艳丽,吴茹霞.新生儿缺氧缺血性脑病脑损伤的超声诊断及预后评价[J].中国中西医结合影像学杂志,2018,16(2):195-197.