慢性硬膜下血肿术后早发性癫痫的影响因素

Influencing factors for early epilepsy after operation for chronic subdural hematoma

目的探讨钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的影响因素。方法分析2011年1月—2020年1月在龙岩市第二医院和嘉兴市第一医院采用钻孔引流治疗的230例慢性硬膜下血肿患者的临床资料,分析性别、血肿量、血肿厚度、单双侧出血、术前MGS-GCS评分、电解质异常、术后24 h血肿清除率、术后是否颅内积气和是否使用预防性抗癫痫药物与术后早发性癫痫的相关性。结果230例患者中术后13例发生早发性癫痫,术后早发性癫痫的发生率为5.7%。多因素Logistic回归分析显示术后24 h血肿清除率≥60%(95%CI:1.009~1.092)、未使用预防性抗癫痫药物(95%CI:0.033~0.575)和颅内积气(95%CI:2.113~26.744)与早发性癫痫相关(P<0.05)。结论钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的发生与术后24 h血肿清除率和颅内积气相关,预防性使用抗癫痫药物能预防早发性癫痫。

Objective To study the influencing factors for early epilepsy after burr hole drainage for chronic subdural hematoma.Methods We collected the clinical data of 230 patients with chronic subdural hematoma who underwent burr hole drainage at The Second Hospital of Longyan and The First Hospital of Jiaxing from January 2011 to January 2020 to analyze the association of sex,the volume and thickness of hematoma,unilateral/bilateral hematoma,preoperative Markwalder Grading Scale-Glasgow Coma Scale score,electrolyte abnormalities,the hematoma clearance rate at 24 h after operation,postoperative pneumocephalus,and prophylactic use of antiepileptic drugs with early epilepsy after operation.Results Among the 230 patients,13 developed early epilepsy after operation,with an incidence rate of 5.7%.Multivariable logistic regression analysis showed that the hematoma clearance rate at 24 h after operation being≥60%(95%confidence interval[CI]:1.009-1.092),not having prophylactic use of antiepileptic drugs(95%CI:0.033-0.575),and the occurrence of pneumocephalus(95%CI:2.113-26.744)were significantly associated with early epilepsy after operation(all P<0.05).Conclusion The hematoma clearance rate at 24 h after operation and pneumocephalus are associated with the occurrence of early epilepsy after burr hole drainage for chronic subdural hematoma.Prophylactic use of antiepileptic drugs can prevent early epilepsy.