难治性癫癎持续状态麻醉药物治疗失败相关因素分析

Analysis on the factors associated with treatment failure of using anesthetics in refractory status epilepticus

目的筛查难治性癫癎持续状态麻醉药物即刻治疗失败的相关因素。方法采用单因素和多因素前进法Logistic回归分析筛查难治性癫癎持续状态麻醉药物即刻治疗失败（治疗6 h仍未终止发作）危险因素,计算最终治疗失败率。结果单因素和多因素Logistic回归分析显示,在性别、年龄、病因、急性生理学和慢性健康状况评估Ⅱ、癫癎持续状态类型、初始抗癫癎药物种类、初始治疗总时间、院前初始治疗时间、院后初始治疗时间、难治性癫癎持续状态类型和首选麻醉药物种类等影响因素中,仅初始治疗总时间为即刻治疗失败的独立危险因素（OR=1.007,95%CI：1.000~1.014;P=0.047）。难治性癫癎持续状态麻醉药物即刻治疗失败率为50%（15/30）,最终治疗失败率约43.33%（13/30）且即刻治疗失败组高于即刻治疗成功组（10/15对3/15,P=0.025）。结论难治性癫癎持续状态麻醉药物即刻治疗的成败取决于初始治疗总时间,并与最终治疗成败密切相关。因此,在治疗原发疾病基础上,应尽早开始终止癫癎持续状态或难治性癫癎持续状态的抗癫癎药物治疗。

Objective To analyze the related factors associated with immediate treatment failure of using anesthetics in refractory status epilepticus（RSE）.Methods Thirty patients derived from Neurocritical Care Unit of Xuanwu Hospital from January 2004 to December 2013 were divided into 2 groups（acute treatment failure group and acute treatment success group） based on the treatment outcome 6 h after intravenous injection of anesthetics.Univariate and multivariate forward Logistic regression analyses were used to analyze and screen the risk factors associated with immediate treatment failure,and calculate the failure rate of final outcome.Results According to the results of univariate and multivariate Logistic regression analyses,among influencing factors such as sex,age,etiology,Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）,type of status epilepticus（SE）,type of antiepileptic drugs（AEDs）,total duration of primary treatment,duration of prehospital primary treatment,duration of posthospital primary treatment,type of RSE and primary choice of anesthetics,only total duration of primary treatment was the independent risk factor for immediate treatment failure（OR = 1.007,95%Cl：1.000-1.014;P=0.047）.The rate of immediate treatment failure of RSE by using anesthetics was 50%（15/30）,and the rate of final treatment failure was 43.33%（13/30）.The ratio of final treatment failure was much higher in acute treatment failure group than that in acute treatment success group（10/15 vs 3/15,P =0.025）.Conclusions The acute treatment result of RSE depends on the total duration of primary treatment,and determinates the final result of treatment.On the basis of treating primary disease,the therapy to terminate SE or RSE should be started as early as possible.