儿科重症监护室癫非惊厥性发作临床分析

Clinical Analysis of Non-Convulsive Seizures in Pediatric Intensive Care Unit

目的通过对儿科重症监护室(PICU)癫非惊厥性发作(NCS)患儿的临床分析,探讨儿科重症患儿NCS的EEG特征与病因。方法回顾性分析深圳市儿童医院PICU2007年6月-2009年12月收治的226例因意识水平改变而行连续EEG监护(24～76h)的患儿,根据发作期EEG特征诊断出NCS的病例;通过收集本组NCS患儿的病史,对年龄分布、既往史及病因进行总结分析;比较1岁前和1岁后2个年龄组的NCS患儿既往惊厥史有无统计学差异;并对发作期EEG行定位分析。结果在226例因意识水平改变而行连续EEG监护的患儿中,48例符合NCS的诊断标准(21.2%);1岁前的NCS患儿多数(16/22例)既往无惊厥病史;此次发病病因依次为颅内感染、癫相关性疾病、HIE、遗传代谢病及创伤。根据发作期EEG定位癫灶,定位于右侧者19例(39.6%),左侧者16例(33.3%),双侧或中央区或无法定位者13例(27.1%);从开始记录至监测到第1次NCS发作的时间平均为287min(13～907min)。结论在有意识改变的儿科重症患儿中,行连续EEG检测可及早明确NCS的诊断,并及早处理。

Objective To explore electroencephalogram（EEG） features and etiology of non-convulsive seizures（NCS） in the Pediatric Intensive Care Unit（PICU） through analysis of pediatric patients with NCS.Methods A retrospective review was conducted of all 226 pediatric patients who were admitted or transferred to the PICU,Shenzhen Children′s Hospital from Jun.2007 to Dec.2009 with decrease in the level of consciousness,and continuous electroencephalogram（CEEG） recordings were performed for 24 up to 76 hours.Diagnosis of NCS was based on EEG.Age distribution,previous history of NCS,and possible etiology of NCS for patients with a diagnosis of NCS were analyzed.The history of seizure of NCS patients 1 year old and that of NCS patients≥1 year old were compared.EEG recorded during seizure was analyzed for location of the foci of seizures.Results Forty-eight cases of 226 patients（21.2%）were found to have NCS.In the group of patients 1 year old,most of the cases（16/22 cases） had no preexisting epilepsy-related seizure prior to the onset of NCS.The etiology of NCS included intracranial infection,epilepsy-related seizure,hypoxic-ischemic encephalopathy,metabolic disorder,and trauma in turn.Epileptic foci was lateralized to the right side in 19 cases（39.6%）,to the left side in 16 cases（33.3%）,and were bilateral or localized in the central zone or could not be lateralized in 27.1% of cases according to the local EEG.The average duration between the start of EEG recording and the detection of first NCS seizure was 287 minutes（ranging from 13 to 907 minutes）.Conclusions This report highlights the importance of clinical awareness of NCS in PICU,including CEEG monitoring of pediatric patients with an altered state of consciousness,in early detection and management of NCS.