儿童脑外伤后癫痫发作的临床特点及危险因素

Clinical characteristics and risk factors of post - traumatic seizures in children

目的 探讨儿童脑外伤后癫痫发作（PTS）的临床特点及危险因素,为临床预防PTS提供理论依据.方法 以2010年1月至2016年11月郑州大学第一附属医院儿科收治的388例脑外伤患儿为研究对象,根据有无癫痫发作,分为PTS组及脑外伤后非癫痫发作（nPTS）组.对PTS患儿的临床资料、辅助检查等进行回顾性分析,并对PTS的相关因素进行单因素分析及多因素Logistic回归分析.结果 388例脑外伤患儿中,PTS 72例,多见于1岁以内的婴儿,其中56.9％（41/72例）为外伤后立即发作,31.9％（23/72例）为外伤后早期发作,11.1％（8/72例）为外伤后晚期发作.全面性发作的发生率为51.4％（37/72例）,其中以全面强直阵挛发作多见;局限性发作的发生率为36.1％（26/72例）;局限性发作并全身性发作的发生率为2.8％ （2/72例）;9.7％（7/72例）发作类型不详.脑电图以慢波及棘波多见.PTS组和nPTS组年龄、格拉斯哥昏迷（GCS）评分、脑损伤严重程度、脑挫伤、硬膜下血肿、治疗方式差异均有统计学意义（Z=4.717,χ^2=13.079、17.852、5.664、17.457、5.496,均P＜0.05）;经单因素及多因素分析发现年龄、GCS评分、脑损伤严重程度、硬膜下血肿、治疗方式与PTS的发生有相关性（均P＜0.05）.结论 儿童PTS是脑外伤的严重并发症.低龄、GCS≤8分、重度脑损伤、并硬膜下血肿、手术治疗是PTS发生的危险因素.

Objective To analyze the clinical characteristics and risk factors for post-traumatic seizures （PTS） in children,so as to provide a theoretical evidence for clinicians to prevent PTS.Methods From January 2010 to November 2016,the clinical data and auxiliary examination of 388 post-traumatic patients hospitalized at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.According to the presence of epileptic seizure,these patients were divided into PTS group and non post-traumatic seizures （nPTS）group.The risk factors associated PTS were investigated by univariate analysis.Results Among the 388 post-traumatic children,72 cases had seizures,which occurred almost predominantly less than 1 year.Fifty-six point nine percent （41/72 cases） were immediately PTS,and 31.9% （23/72 cases） were early PTS,and 11.1% （8/72 cases） were late PTS.Among the seizures types,generalized seizures accounted for 51.4% （37/72 cases）,and tonic-clonic seizures were in common;focal seizures accounted for 36.1% （26/72 cases）;focal combined generalized seizures accounted for 2.8% （2/72 cases）,and the remaining 9.7% （7/72 cases） were ominous.Electroencephalogram showed the slow wave and spike wave most common.There were significant differences in factors statistically,included age,Glasgow Coma Scale （GCS） score,the severity of traumatic brain injury,cerebral contusion,subdural hematoma,therapy method between the patients with seizures group and the patients without seizures group （Z =4.717,χ^2 =13.079,17.852,5.664,17.457,5.496,all P 〈 0.05）.In single factor analysis and multi-factor regression analysis,age,GCS score,the severity of traumatic brain injury,subdural hematoma,therapy method were associated with the incidence of PTS （all P 〈 0.05）.Conclusions PTS is a severe complication of brain trauma in children.Small age,GCS ≤8 scores,severe brain injury,subdural hematoma,surgery are the risk factors of PTS.