【摘要】：背景:腦卒中是神經(jīng)科的常見疾病,同時也是誘發(fā)中老年人群發(fā)作癲癇的常見病因。卒中后癲癇(PSE)發(fā)作可加重卒中原發(fā)病的病情,影響其療效、轉歸。國內外雖有一些關于PSE發(fā)作的相關研究,但是危險因素的判定并不明確。通過對PSE的回顧性研究以找尋相關的危險因素,從而對預測PSE的發(fā)作起到一定的指導作用。目的:分析PSE發(fā)作的臨床特點,探討其發(fā)生率、發(fā)作形式、首次發(fā)作時間、腦電圖(EEG)表現(xiàn)等情況,研究相關的危險因素。方法:選擇自2014年1月至2015年12月就診于我院神經(jīng)內科的住院病人共1008例,均明確診斷腦卒中。采集所有病人的性別,年齡,卒中類型包括腦梗死、腦出血(ICH)、蛛網(wǎng)膜下腔出血(SAH),既往基礎病史包括高血壓、糖尿病、冠心病、高脂血癥,合并癥包括高同型半胱氨酸血癥、肺部感染,不良嗜好包括吸煙、飲酒,病灶特點包括病灶部位、病灶范圍。并詳盡記錄確診為PSE發(fā)作病人的發(fā)生率、首次發(fā)作時間、發(fā)作形式、腦電圖表現(xiàn)等情況。應用卡方檢驗和多因素Logistic回歸分析的統(tǒng)計學方法,研究PSE發(fā)作的相關危險因素。結果:1.PSE發(fā)作的發(fā)生率總共約為5.36%(54/1008)。其中,腦梗死后PSE發(fā)作的發(fā)生率為4.54%(35/770),腦出血后PSE發(fā)作的發(fā)生率為7.62%(16/210),SAH后PSE發(fā)作的發(fā)生率為10.71%(3/28)。對比腦梗死后癲癇發(fā)作,腦出血后繼發(fā)癲癇發(fā)作的發(fā)生率有增多趨勢,但差異無統(tǒng)計學意義(?2=3.16,P=0.075)。2.卡方檢驗結果顯示:性別(?2=4.117,P=0.042),糖尿病(?2=4.89,P=0.027),肺部感染(?2=8.95,P=0.003),病灶部位(?2=45.139,P0.001)和病灶范圍(?2=23.316,P0.001)與PSE發(fā)作有關(P0.05);多元Logistic分析結果顯示:性別(P=0.038,OR=1.946,95%CI:1.039~3.644),肺部感染(P=0.003,OR=3.618,95%CI:1.536~8.520),病灶部位(P0.001,OR=6.435,95%CI:3.353~12.349)和病灶范圍(P=0.003,OR=2.513,95%CI:1.374~4.599)與PSE發(fā)作有關(P0.05)。3.早發(fā)型癲癇發(fā)作占63.11%(33/54),其中主要發(fā)作形式為單純部分性發(fā)作(SPS)約36.36%(12/33);遲發(fā)型癲癇發(fā)作占38.89%(21/54),其中主要發(fā)作形式為全面強直痙攣發(fā)作(GTCS)約42.86%(9/21)。4.癲癇發(fā)作間歇期腦電圖表現(xiàn):腦電圖正�；蚺R界狀態(tài)的有13.73%(7/51),雙側大腦半球呈彌漫性慢波的有23.53%(12/51),病灶側呈局灶性慢波的27.45%(14/51),雙側大腦半球呈廣泛癇樣放電的15.69%(8/51),病灶側癇樣放電的有19.61%(10/51),結果顯示癇樣放電的總檢出率是35.29%(18/51)。結論:1.不同類型的PSE發(fā)作的發(fā)生率不同,出血性卒中后PSE發(fā)作較缺血性卒中有增多趨勢,但差異無統(tǒng)計學意義。2.男性,肺部有感染,病灶部位在皮質和病灶范圍大是PSE發(fā)作的危險因素。3.PSE發(fā)作多發(fā)生于卒中后2周內,以SPS為主;遲發(fā)型癲癇發(fā)作主要以GTCS為主。4.大多數(shù)PSE發(fā)作患者,在癲癇發(fā)作間歇期的腦電圖多表現(xiàn)為非特異性的慢波,癇樣放電的檢出率較低。
[Abstract]:Background: stroke is a common disease in neurology. The seizure of (PSE) after stroke can aggravate the primary condition of stroke, affect its curative effect and result. Although there are some related studies on PSE attack at home and abroad, the determination of risk factors is not clear. A retrospective study of PSE was carried out to find relevant risk factors for predicting the onset of PSE. Objective: to analyze the clinical characteristics of PSE attack, to investigate its incidence, attack form, first attack time and (EEG) manifestation of EEG, and to study the related risk factors. Methods: 1008 inpatients were selected from January 2014 to December 2015. Sex, age, stroke types of all patients were collected including cerebral infarction, (ICH), subarachnoid hemorrhage (ICH), basic history of (SAH), including hypertension, diabetes, coronary heart disease, hyperlipidemia, and complications including hyperhomocysteinemia. Lung infection, bad habits include smoking, drinking, lesions including location, focus range. The incidence, first attack time, attack form, electroencephalogram (EEG) of the patients diagnosed as PSE were recorded in detail. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors of PSE attack. The total incidence of PSE attack was about 5.36% (54 / 1008). The incidence of PSE attack after cerebral infarction was 4.54% (35 / 770), and that of PSE attack after cerebral hemorrhage was 7.62% (16 / 210). The incidence of PSE attack after cerebral infarction was 10.71% (3 / 28). The incidence of epileptic seizures after cerebral hemorrhage was higher than that after cerebral infarction, but the difference was not statistically significant (P 0.075). 鍗℃柟媯，

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