心脏瓣膜置换术围术期合并癫痫的治疗体会

Experience with perioperative seizure in patients underwent valve replacement

目的:总结5例围术期合并癫痫的心脏瓣膜置换术患者的治疗经验。方法:回顾性分析5例围术期合并癫痫的心脏瓣膜置换术患者的临床资料。结果:术后出现癫痫发作3例,无围术期死亡病例;5例患者头部CT检查中3例发现脑梗死病灶,2例无阳性发现;3例术后出现癫痫发作的患者出院时无神经系统缺陷,随访3个月～2年,无晚期死亡病例。结论:对于术前即有癫痫病史的心脏瓣膜病患者,进行系统检查、制定有效的癫痫发作控制方案,围术期不中断抗癫痫药物的使用,可有助于患者平稳渡过围术期;对于术后新发癫痫患者,尽早进行头部CT检查,可有助于发现可治疗性脑部病变,针对病变制定有效的治疗方案,可取得满意的治疗效果。

Objective To summarize the experience of treatments of perioperative seizure in 5 cases. Methods We retrospectively analyzed the clinical data of 5 cases with perioperative seizure who underwent valve replacement from January 2010 to August 2012. Results Seizures occurred in 3 patients postoperatively. Head computed tomography was performed in all 5 patients, of whom ischemic strokes were identified in 3 cases. There was no acute positive findings in other 2 cases. All 3 patients, of whom seizures occurred postoperatively, were discharged without neurologic deficit. The follow-up ranged from 3 months to 2 years. There was no late death. Conclusion In patients with a history of well-controlled epilepsy, it is vital to avoid disruption of antiepileptic medication perioperatively. In patients of whom seizures occurred postoperatively, early head CT may be indicated to identify treatable pathology, and reasonable regimen play an important role in achieving satisfying therapeutic effect.