动脉瘤性蛛网膜下腔出血继发癫痫的危险因素分析

Risk factor analysis of seizures after aneurysmai subarachnoid hemorrhage

目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）患者继发癫痫发作的危险因素。方法回顾性分析2006年1月至2014年7月中山大学附属第三医院神经外科行显微手术夹闭的177例aSAH患者的临床资料。资料包括年龄、性别、原发性高血压病史、起病时意识障碍持续时间、人院时格拉斯哥昏迷评分（GCS）、Fisher分型、责任动脉瘤的部位、并发症（再出血、脑血管痉挛、脑积水）、手术时机以及格拉斯哥预后分级（GOS）。将aSAH继发性癫痫分为早期癫痫（蛛网膜下腔出血后24h内发作）和晚期癫痫（蛛网膜下腔出血24h后发作），分析aSAH患者继发早、晚期癫痫的危险因素。结果177例aSAH患者中，发生早期癫痫14例，晚期癫痫16例，早、晚期均有发作的共3例。原发性高血压病史为发生早期癫痫的影响因素（P〈0．05）；并发脑积水为发生晚期癫痫的影响因素（P〈0．05）。结论原发性高血压病史可能与aSAH继发早期癫痫有关，而脑积水则可能与晚期癫痫有关。

Objective To investigate the risk factors for seizures after aneurysmal subarachnoid hemorrhage （aSAH）. Methods From January 2006 to July 2014, the clinical data of 177 patients with aSAH treated by microsurgical clipping at the Department of Neurosurgery, the Third Affiliated Hospital, Sun Yat-sen University were analyzed retrospectively. The data included age, sex, history of hypertension, duration of disturbance of consciousness at the onset, Glasgow Coma Scale （ GCS ） on admission, Fisher grade, locations of guilty aneurysms, complications （rebleeding, cerebral vasospasm, and hydrocephalus） , timing of surgery, and Glasgow Outcome Scale （GOS）. The secondary epilepsies after aSAH were divided into early epilepsy （ onset within 24 h after subarachnoid hemorrhage） and late epilepsy （ onset at 24 h after subarachnoid hemorrhage）. The risk factors for early and late seizures in patients with aSAH were analyzed. Results In 177 patients with aSAH, 14 had early epilepsy, 16 had late epilepsy, and 3 had both early and late seizures. The history of hypertension might be an influencing factor of the occurrence of early epilepsy （ P 〈 0.05 ）. Concurrent hydrocephalus might be an influencing factor of the occurrence of late epilepsy（ P 〈 0.05）. Conclusion The history of hypertension may be associated with secondary early epilepsy after aSAH and hydrocephalus may be associated with late epilepsy.