脑外伤后早期癫痫发作的危险因素及对预后的影响

Risk factors of early epileptic seizures after brain trauma and their influence on prognosis

目的探讨脑外伤后早期癫痫发作的危险因素及对预后的影响。方法选择颅脑损伤患者368例作为研究对象,观察早期癫痫发作情况,根据患者是否有癫痫发作分为癫痫发作组和无癫痫发作组,采用单因素及多因素logistic回归分析脑外伤后早期癫痫发作的危险因素。所有患者随访6个月,采用格拉斯哥预后评分(GOS)评价患者临床预后,将患者分为预后良好(GOS 4~5分)和预后不良(GOS 1~3分),分析早期癫痫发作对预后的影响。结果368例颅脑外伤患者发生早期癫痫58例,发生率为15.76%。多因素logistic回归显示,年龄、外伤类型、颅骨骨折类型、受伤部位、硬膜外血肿、脑内血肿、入院时美国国立卫生院神经功能缺损评分(NIHSS)评分、脑出血量、颅脑损伤严重程度、预防使用抗癫痫药物是导致脑外伤后早期癫痫的危险因素(OR分别=2.66、3.90、3.98、1.53、2.31、6.14、2.90、1.89、2.46、6.42,P均<0.05)。早期癫痫患者预后不良的比例为42.55%(20/47),无早期癫痫患者预后不良的比例为12.67%(37/292),差异有统计学意义(χ2=25.85,P<0.05)。结论脑外伤后早期癫痫发作的影响因素较为复杂,应对高危因素进行综合评估,并采取针对性的处理措施,做到早发现、早预防、准确预测,从而预防早期癫痫发作及改善患者预后。

Objective To explore the risk factors of early epileptic seizures after brain trauma and their influence on the prognosis.Methods Totally 368 patients with craniocerebral injury were selected as the research objects to observe early epileptic seizures.All the patients were divided into epileptic seizure group and seizure-free group.The risk factors of early epileptic seizures after traumatic brain injury were analyzed.All patients had been followed up for 6 months,and the Glasgow outcome score(GOS)was used to evaluate the clinical prognosis of the patients.The patients were divided into good prognosis group(GOS 4 to 5 points)and poor prognosis group(GOS 1 to 3 points),and the effects of early seizures on prognosis were analyzed.Results There were 58 cases of early epilepsy occurred in 368 patients with traumatic brain injury,the incidence rate was 15.76%.Multivariate logistic regression showed that the age,type of trauma,type of skull fracture,location of injury,epidural hematoma,intracerebral hematoma,NIHSS score at the time of admission,cerebral hemorrhage,severity of craniocerebral injury and preventive using of antiepileptic drugs were risk factors for early epilepsy after brain trauma(OR=2.66,3.90,3.98,1.53,2.31,6.14,2.90,1.89,2.46,6.42,P<0.05).The proportion of poor prognosis in patients with early epilepsy was 42.55%(20/47)and the proportion of poor prognosis in patients without early epilepsy was 12.67%(37/292),the difference was statistically significant(χ2=25.85,P<0.05).Conclusion The influencing factors of early epileptic seizures after traumatic brain injury are complex.High-risk factors should be comprehensively evaluated,and suitable treatment measures should be taken to achieve early detection,early prevention,and accurate prediction,so as to prevent early seizures and improve the prognosis of patients.