缺血性脑卒中后迟发型癫痫发作相关危险因素分析

Analysis of related risk factors of delayed onset epileptic seizures after ischemic stroke

目的探讨急性缺血性脑卒中后迟发型癫痫发作相关影响危险因素,为患者预后评估及是否可启动预防癫痫药物治疗提供研究基础。方法 2015年1～12月,选取在本院神经内科急性缺血性脑卒中发病2周后至2年内出现癫痫发作患者32例作为研究组,另选择急性缺血性脑卒中发病2周后至2年内无癫痫发作患者435例作为对照组。采用病例-对照研究。回顾性分析的项目包括:性别、年龄、卒中后发病时间、发病2周内出现并发症,梗死部位,梗死灶,合并其他疾病,发病2周内脑电图,家族癫痫病史,NIHSS评分。结果研究组中的发病年龄、发病2周内出现并发症、梗死部位(皮质、皮质下)、发病2周内脑电图、有癫痫家族病史,与对照组相比差异有统计学意义(P <0.05)。研究组中的梗死灶(单发、多发),合并其他疾病(糖尿病、高血压病、冠心病、高脂血症等),NIHSS评分(> 15分,<15分),与对照组相比差异无统计学意义(P>0.05)。以上因素纳入Logistic回归模型,进行多因素Logistic回归分析,发现发病2周内出现并发症(肺炎、应激性溃疡、电解质紊乱)独立危险因素。结论急性缺血性脑卒中发病年龄较轻的患者若发病2周内出现肺炎、应激性溃疡、电解质紊乱等并发症是迟发型癫痫发作风险较高的因素。

Objective To probe into the the related risk factors of delayed onset epileptic seizures after ischemic stroke,and to provide research basis for patient prognosis assessment and whether it can initiate drug therapy for epilepsy prevention.Methods32patients with epileptic seizures within2weeks to2years after the onset of acute ischemic stroke in neurology department of our hospital from January2015to December2015were selected as the study group,and435patients with non epileptic seizures within2weeks to2years after onset of acute ischemic stroke were selected as the control group.The patients were given case-control study.The projects for retrospective analysis included:gender,age,time of onset after stroke,complications within2weeks of onset,infarct sites,infarct focuses,combined with other diseases,electroencephalogram within2weeks of onset,family history of epilepsy,and NIHSS score.Results The age of onset,complications within2weeks of onset,infarct sites(cortex,subcortex),electroencephalogram within2weeks of onset,and family history of epilepsy in the study group were compared with the control group,the differences were statistically significant(P<0.05).The infarct focuses(single,multiple),combined with other diseases(diabetes,hypertension,coronary heart disease,hyperlipidemia,etc.),NIHSS score(greater than15,less than15)in the study group were compared with the control group,the differences were not statistically significant(P>0.05).The above factors were included in the Logistic regression model,and multiple Logistic regression analysis were conducted,the independent risk factors for complications(pneumonia,stress ulcer,electrolyte disturbance)within2weeks after onset were found.Conclusion Complications such as pneumonia,stress ulcer and electrolyte disturbance within2weeks after onset in younger patients with acute ischemic stroke are higher risk factors for delayed onset epilepsy.