颅脑外科术后癫痫发作的相关危险因素及防治对策

Related risk factors and prevention strategies of postoperative epilepsy in patients after craniocerebral operations

目的探讨颅脑外科术后癫痫发作的相关危险因素及防治对策。方法收集2007年1月1日~2011年1月1日于我院神经外科行颅脑手术后存活患者临床资料,对所有入选患者进行电话随访。依据患者颅脑手术后是否发生癫痫分为术后癫痫组和非术后癫痫组。对所有患者资料进行组间单因素及多因素Logistic回归分析,评价各因素与患者行颅脑外科手术后发生癫痫的相关性,并根据结果提出防治对策。结果共382例患者纳入研究,基线资料比较显示,两组年龄、性别、手术时间、中央前后回或其周围脑组织手术、术后发生脑出血、术后感染及术后癫痫预防性用药指标差异有统计学意义（均P〈0.05）;对此7项指标进行多因素Logistic回归分析显示,中央前后回或其周围部位手术（OR=1.21,95%CI：1.17~1.25,P〈0.01）、术后发生脑出血（OR=1.17,95%CI：1.13~1.21,P〈0.01）、术后感染（OR=1.15,95%CI：1.12~1.18,P〈0.01）以及术后未预防性用药（OR=1.27,95%CI：1.24~1.32,P〈0.01）与患者术后发生癫痫有显著相关性。结论中央前后回及其周围部位手术、术后发生脑出血、术后感染以及术后未预防性用药是患者行颅脑手术后癫痫发生的相关危险因素,控制这些危险因素可减少颅脑手术后癫痫的发生。

Objective To explore the related risk factors and prevention strategies of postoperative epilepsy（PE） in patients after craniocerebral operations.Methods Clinical data of inpatients underwent craniocerebral operations in neurosurgery department of our hospital from January 1,2007 to January 1,2011 were analyzed retrospectively.Telephone follow-up was carried out for all patients,then all patients were divided into the PE group and no-PE group,according to the outcomes of follow-up.Methods of single factor analysis and multivariate Logistic regression analysis were used to evaluate the risk factors of PE.Results 382 caces of patients were included studies.Comparison of baseline data showed that age,gender,duration of operation,operation in precentral or postcentral gyrus,cerebral hemorrhage after operation,postoperative infection and postoperative prophylactic use of epilepsy drug were significantly different between the two groups（all P 0.05）.Multivariable Logistic analysis showed that operation in precentral or postcentral gyrus（OR=1.21,95%CI： 1.17-1.25,P 0.01）,cerebral hemorrhage after operation（OR=1.17,95%CI： 1.13-1.21,P 0.01）,postoperative infection（OR=1.15,95%CI：1.12-1.18,P 0.01） and postoperative non-prophylactic use of epilepsy drugs（OR= 1.27,95%CI： 1.24-1.32,P 0.01） were markedly correlated to PE in patients after craniocerebral operations.Conclusion Operation in precentral or postcentral gyrus,cerebral hemorrhage after operation,postoperative infection and postoperative non-prophylactic use of epilepsy drugs are the related risk factors to PE in patients after craniocerebral operations.Controlling these risk factors can reduce the incidence of PE in patients after craniocerebral operations.