合并癫痫的病人心跳骤停复苏后亚低温治疗对预后的影响

The influence of therapeutic hypothennia on the prognosis of patients ofter resucitation from cardiac arrest

目的：评价癫痫病人对于心跳骤停复苏后接受亚低温治疗对预后的影响。方法：回顾首都医科大学大兴医院重症医学科于2012年1月～2014年1月收治的心脏骤停复苏成功后给予亚低温治疗并进行连续脑电监测的成年患者42例。其中男性22例（52％），女性20例（48％），年龄31～62岁，平均47岁。既往有癫痫病史的4例（10％）。通过医院电子病历信息系统查阅病历资料收集所需数据信息。结果：在纳入的42例患者中，有15例（36％，95％置信区间为21％～50％）发生了癫痫，其中7例（17％）发生在亚低温治疗过程中；34例（81％）死亡，其中26例死于医院内，8例存活出院但仍在心脏骤停发生后的28d内死亡。15例发生癫痫的患者均死亡，其中13例（87％）死于院内，2例（13％）存活出院但28d内死亡；未发生癫痫的27例患者中有11例（41％）死亡，16例（59％）存活超过28d。发生癫痫组的患者死亡率显著高于未发生癫痫者（P〈0．001）。结论：提示有癫痫发作症状的患者心肺复苏后接受亚低温治疗预后不良。应用连续脑电监测技术可能有利于早期发现癫痫并采取有效的措施改善患者预后。

Objective： To explore the iniluence of therapeutic hypothermia for the prognosis of seizures in patienls with cardiac arrest in order to provide the basis for its prevention. Methods：42 adult patients received the treatment of therapeutic hypothermia after resuscitation from cardiac arrest and were monitored with electroencephalography （EEG） from January 2012 to January 2014 in our department. The median age of the patients was 47 （range 24～71 years）, 22 cases （52%） were male,20（48%） were female,and 4 （10%） had a history of epilepsy medical records. All the patients were examined. Results： Fifteen patients （36 %, 95 % CI 21% - 50 % ） had epileptic seizures inlucling seisures of 7 patients （ 17 % ） during cooling. 34 patients （81%） died,includling 26 patients who died in hospital and 8 discharged patients did not survive over 28 days. The 15 patients （100%） with epileptic seizures died within 28 days, compared with 11 patients （41%） without seizures. The patients in epileptic group had a significantly higher mortality risk than those without epilepsy（P〈0. 001）. Conclusion. Prognosis unloward occurs after the treatment of thereapeutic hypotheimia for the por the patients with resuscitation from cardiac arrest Routine use of EEG monitoring could assist in early detection of epilepsy in this patient population, providing an opportunity for intervention to potentially improve outcomes.