儿童癫痫持续状态近期预后不良的影响因素分析

Analysis of influencing factors of poor prognosis in children with status epilepticus

目的分析儿童癫痫持续状态(status epilepticus,SE)近期预后不良的影响因素。方法回顾性分析2018年2月至2020年5月四川省妇幼保健院·四川省妇女儿童医院收治的196例SE患儿的临床资料,根据格拉斯哥预后评分量表(Glasgow outcome scale,GOS)评分分析患儿预后,GOS=5分为预后良好,GOS<5分为预后不良。分析影响SE患儿近期(出院时)预后的因素。结果196例患儿中未出现死亡病例,29例(14.80%)患儿预后不良。Logistic多因素回归分析显示,既往抽搐(OR=1.508,95%CI 1.122~2.028)、头颅影像学检查异常(OR=1.422,95%CI 1.049~1.927)、抽搐持续时间≥1h(OR=1.533,95%CI 1.094~2.147)、入住PICU(OR=1.542,95%CI 1.140~2.085)、C反应蛋白水平升高(OR=1.487,95%CI 1.081~2.047)、血糖水平升高(OR=1.534,95%CI 1.143~2.059)为SE患儿近期预后不良的危险因素。结论SE患儿近期预后不良发生率较高,既往抽搐史、头颅影像学检查异常、抽搐持续时间、C反应蛋白水平、血糖水平为其主要影响因素,临床上应及早对出现上述因素的患儿进行针对性干预以改善预后。

Objective To analyze the factors affecting the recent poor prognosis of children with status epileptics(SE).Method 196 children with SE were admitted to the hospital from February 2018 to May 2020 for retrospective analysis.Collected the factors that may affect the short-term prognosis of children with SE(at the time of discharge)and analyzed according to the Glasgow outcome scale(GOS)score.For the prognosis of children,GOS=5 is classified as good prognosis,GOS<5 is classified as poor prognosis.Compare the above factors in children with different prognosis,and use multivariate logistic regression analysis to judge the comprehensive effect of each factor.Result There were no deaths among the 196 children in this study,and 29(14.80%)children had a poor prognosis.The results of multivariate analysis on a single factor basis showed that previous convulsions(OR=1.508,95%CI 1.122-2.028),abnormal brain imaging examinations(OR=1.422,95%CI 1.049-1.927),convulsions duration≥1h(OR=1.533,95%CI 1.094-2.147),PICU(OR=1.542,95%CI 1.140-2.085),C-reactive protein level increased(OR=1.487,95%CI 1.081-2.047),blood glucose level increased(OR=1.534,95%CI 1.143-2.059)were risk factors for the poor prognosis of children with SE.Conclusion The incidence of adverse prognosis in children with SE is high.Previous convulsion history,abnormal head imaging examination,convulsion duration,C-reactive protein level and blood glucose level are the main influencing factors.