骨科术后癫痫持续状态21例临床分析

Status epilepticus after orthopedic surgery： a clinical analysis of 21 patients

目的探讨骨科术后发生癫痫持续状态（SE）的病因、临床表现及治疗方法，以提高对该病的诊治水平。方法回顾性分析北京积水潭医院神经内科自2000年8月至2008年9月骨科术后发生SE的21例患者的临床资料，其中既往有癫痫病史5例、急性缺血性脑血管病4例、脂肪栓塞综合征3例、瘤栓塞1例、代谢性脑病4例、低血糖1例、糖尿病酮症酸中毒1例、慢性肾功能不全2例，骨科手术情况：股骨干骨折术后8例、股骨颈骨折行髋关节置换术后7例、肱骨骨折术后3例、腰椎骨巨细胞瘤术后1例、胸椎爆裂性骨折术后合并肋骨骨折1例、糖尿病足截肢术后1例。结果21例患者中首选地西泮注射液控制SE11例，其中9例有效控制了癫痫发作；首选丙戊酸钠注射液控制SE10例，其中6例有效控制了癫痫发作。结论骨科术后出现SE的患者，其病因是多方面的，应具体分析。在围手术期控制好内科情况是基础，可明显减少SE的发生率及死亡率。抗癫痫药物的选择应结合患者的年龄、内科情况及药物不良反应等综合分析。

Objective To explore the etiology, clinical features and treatment of status epilepticus （SE） after orthopedic surgery and improve the diagnosis and treatment. Methods The data of 21 patients with SE after orthopedic surgery were retrospectively analyzed. Among these 21 patients, 5 with epilepsy before the orthopedic surgery, 4 with acute ischemic cerebrovascular diseases, 3 with fat embolism syndrome, 1 with tumor emboli, 4 with metabolic encephalopathy, 1 with hypoglycemia, 1 with diabetic ketoacidosis and 2 with chronic renal insufficiency were found. Orthopedic surgery was performed on these patients： fracture of the shaft of the femur was found in 8; hip arthroplasty was performed in 7 with fracture of femoral neck; fracture of the shaft of the humerus was noted in 3; giant cell tumors in the lumbar vertebra was found in 1; burst fracture in the thoracic vertebra was found in 1 and amputation was conducted in 1 with diabetic gangrene. Results Diazepam injection was employed to control the seizure in 11 patients with SE and 9 got good effect; valproate sodium injection was also used to control the seizure in 10 patients with SE and 6 showed good results. Conclusions Many reasons can result in the happening of SE after orthopedic surgery. The incidence and death rate of SE can be obviously decreased by good controlling the physical conditions in the perioperative period. The anti-epilepsy drugs should be chosen according to the age and physical conditions of the patient and the side effects of the anti-epilepsy drugs.