惊厥性癫痫持续状态并发急性胰腺炎二例分析

Clinical characteristics and therapy of generalized convulsive status epilepticus associated with acute pancreatitis

目的探讨惊厥性癫痫持续状态（GCSE）并发急性胰腺炎的临床特点和治疗方法。方法 资料完整的GCSE住院患者二例，强直阵挛发作病史11、13年。急性胰腺炎诊断根据血尿淀粉酶化验和腹部超声波、CT检查。结果二例GCSE患者强直阵挛发作持续状态24h后出现继发性急性胰腺炎，经静脉应用地西泮癫痫状态停止，保守和支持治疗胰腺炎痊愈后出院。随访3个月未出现GCSE和腹痛。结论GCSE可以引起急性胰腺炎．GCSE后腹痛应进行急性胰腺炎有关指标的检查，明确诊断后避免使用具有胰腺毒性的抗癫痫药物。

Objective To analyze clinical characteristics and therapeutic methods of acute pancrea.titis induced by generalized convulsive status epilepticus （GCSE）. Methods Two patients with available previous hospital records admitted to our hospital, developed GCSE after 11 or 13 years of tonic-clonic seizures. Of the two cases, a 37-year-old man had symptomatic epilepsy and a 28-year-old woman had idiopathic epilepsy. The diagnosis of acute pancreatitis was based on the elevation of serum and urine amylase levels, and the findings of abdominal ultrasound and CT scans. Other possible causative factors of acute pancreatitis were excluded by a series of examinations. Clinical characteristics and therapeutic processes were retrospectively analyzed. Diagnostic and therapeutic methods were summarized based on previous literatures. Results Severe upper abdominal pain occurred 24 h after clonic status epilepticus in these 2 patients. They presented pancreatic symptoms and acute pancreatitis complicated by GCSE was confirmed. Status epilepticus was controlled with intravenous benzodiazepine. Pancreatitis subsided after conservative and supportive treatment and the patients were discharged. No recurrence of GCSE or abdominal pain was noted in 3 months after discharge. Pancreatitis induced by some traditional anticonvulsants has been described in a few reports. Conclusion GCSE can become the direct cause of the acute pancreatitis. Acute abdominal pain after GCSE deserves clinical evaluation for acute pancreatitis. Antiepileptic drugs with pancreatic toxicity should be excluded once pancreatitis was confirmed.