ICU自发性脑出血后癫痫发作及预防性抗癫痫发作药物应用价值的临床研究

Clinical study on seizure after spontaneous intracerebral hemorrhage in ICU and the application value of prophylactic antiseizure medications

目的 在自发性脑出血(ICH)患者中,癫痫发作的危险因素和预防性抗癫痫发作药物的作用尚不清楚。本研究旨在确定自发性脑出血后癫痫发作的危险因素以及预防性抗癫痫发作药物的作用。方法 选取2013年10月至2021年3月我院重症医学科诊断自发性脑出血的患者并回顾性评估患者临床资料,208例患者入选,男126例(60.58%),女82例(39.42%);年龄32~89岁(54.56±17.88)。按照是否预防性使用抗癫痫发作药物分为预防抗癫组和非预防抗癫组,统计各相关临床指标,采用单因素和二项Logistic回归分析脑出血后癫痫发作的危险因素,并探讨预防性抗癫痫发作药物的临床价值。同时,采用重症超声测量视神经鞘宽度(ONSD)评估颅内压水平。结果 在所有患者中癫痫发作的发生率为15.38%(32/208),其中早发性癫痫发作为8.17%(17/208),迟发性癫痫发作为7.21%(15/208)。二项Logistic回归分析表明年龄(60岁以下)(P=0.006)、皮质受累(P=0.002)、脑叶出血(P=0.000)和交通性脑积水(P=0.036)是脑出血癫痫发作的独立危险因素。亚组分析表明,年龄和脑叶出血是早发性癫痫发作的独立危险因素。而年龄(60岁以下)(P=0.021)、饮酒史(P=0.000),交通HCP(P=0.032),阻塞性HCP(P=0.003),开颅手术(P=0.003)及脑叶出血(P=0.007)是迟发性癫痫发作的独立危险因素。糖尿病病史和ONSD≥5 mm是患者死亡的独立危险因素,而死亡率与癫痫发作无统计学差异(P=0.617)。另外,预防性抗癫痫发作药物的使用可以减少患者的癫痫发作(P=0.016)。结论 年龄、皮质受累、脑叶出血和交通性脑积水是癫痫发作的独立危险因素。癫痫发作并不增加患者的死亡率。预防性抗癫痫发作药物治疗可以减少患者的癫痫发作。

Objective Limited evidence is available concerning the risk factors for seizures and the effect of prophylactic antiseizure medications in patients with spontaneous intracerebral hemorrhage(ICH).This study aimed to investigate the risk factors associated with seizures after ICH and the role of preventive antiepileptic drugs.Methods Between October 2010 and June 2020,208 patients with spontaneous intracerebral hemorrhage diagnosed in the department of intensive care unit of our hospital were enrolled in this retrospective study.There were 126 males(60.58%) and 82 females(39.42%),the age ranged from 32 to 89 years(54.56±17.88).All patients were divided into prophylactic and non-prophylactic antiseizure groups according to whether use of prophylactic antiseizure medications.Univariate and binary logistic regression was used to evaluate risk factors of epilepsy after intracerebral hemorrhage, and explored the clinical value prophylactic antiseizure treatment.In addition, Ultrasound optic nerve sheath diameter(ONSD) determination was performed for qualitative assessment of intracranial pressure(ICP).Results Out of 208 patients, thirty-two patients(15.38%);17(8.17%) patients with early seizures and 15(7.21%) patients with late seizures) developed seizures after spontaneous ICH.Binary logistic regression analysis showed that age﹤60 years old(P=0.006),cortical involvement(P=0.002),intra-lobar hemorrhage(P=0.000),and communicating hydrocephalus(P=0.036) were independent risk factors for seizures.Subgroup analysis showed that age and intra-lobar hemorrhage were independent risk factors for patients with early-stage seizures, while the factors associated with late-stage seizures were age﹤60 years old(P=0.021),drinking history(P=0.000),communicating hydrocephalus(P=0.032),obstructive hydrocephalus(P=0.003),craniotomy(P=0.003) and intra-lobar hemorrhage(P=0.007).Patients with history of diabetes mellitus and ONSD > 5 mm were independent risk factors for death, but there was no significant difference between seizures and mortality(P=0.617).Meanwhile, prophylactic antiseizure medications treatment can reduce patients’ seizures(P=0.016).Conclusion Age, cortical involvement, lobar hemorrhage, and communicating hydrocephalus may be independent factors for provoked seizures.Seizures do not increase mortality.The incidence of seizures decreased after administration of prophylactic antiseizure medications.