熱性驚厥住院患兒病例回顧分析

A retrospective case study of hospitalized children with febrile seizure

目的了解鏡湖醫院熱性驚厥(febrile seizure,FS)患兒的診療及隨訪現狀。方法對2017年1月~2019年12月在本院確診熱性驚厥的住院患兒進行回顧性分析。結果510例患兒首次起病年齡為5月~9歲2月,平均起病年齡(23月±2.4月),男311例(61%),女199例(39%);25例(4.9%)有熱性驚厥家族史,2例致病基因檢測陽性。單純型474例(93%),複雜型36例(7%),複雜型中5例(0.9%)為FS持續狀態。11例(2.2%)患兒行頭顱電腦斷層(Computerized Tomography,CT)檢查結果均為陰性;15例(2.9%)患兒行腰椎穿刺檢查,腦脊液結果均為陰性。163例(32%)患兒進行腦電圖檢查(Electroencephalography,EEG),其中單純性127例,6例異常,陽性率為4.7%;複雜性36例,8例異常,陽性率為22.2%;EEG異常14例中4例可見癇樣放電。383例(75%)急性發作期注射地西泮止驚,67例(13%)病初體溫驟升時口服地西泮間歇短程預防性治療。結論本院熱性驚厥患兒的診療及隨訪規範與指南共識基本接軌。單純性FS腦電圖檢查率偏高,但檢出異常陽性率較低,應抓緊檢查指徵。

Objective To understand the status of diagnosis,treatment and follow-up strategy of children with febrile seizures(FS)in Kiang Wu Hospital.Methods Clinical profiles of hospitalized children with a confirmed diagnosis of febrile seizure were reviewed from January 2017 to December 2019.Results Five hundred and ten patients were enrolled.The average age of the first episode was 23month-old±2.4months.Three hundred and eleven patients were male(61%)and female patients accounted for 199(39%).Twenty-five patients(4.9%)had FS family history.Two patients had positive gene analysis results.Four hundred and seventy-four cases(93%)were diagnosed with simple febrile seizures and 36 cases(0.9%)were complex febrile seizures.Within 36 cases of complex FS,five cases(0.9%)presented as febrile status epilepticus and 4 cases were diagnosed with epilepsy at last.Computerized tomography(CT)scan was performed in 11 cases(2.2%),and all results were negative.Lumbar puncture and cerebrospinal fluid routine studies were performed in 15 cases and the results were negative.Electroencephalography(EEG)was performed in 163 cases(32%).Within these 163 cases,simple FS was found in 127 cases and complex FS was found in 36 cases.Six cases in the simple FS group found abnormal EEG results(4.7%)and 8 abnormal EEG results were noted in the complex FS group(22.2%).For the 14 abnormal EEG cases,epileptic form discharges were found in 4 cases.Diazepam intravenous treatment in the acute phase was given to 383 patients(75%).Oral diazepam for prophylactic treatment was provided for 67 patients(13%)with fever.Conclusion The diagnosis,treatment and follow-up strategy of children with febrile seizures in our hospital had followed the guideline.EEG study rate of simple FS was high,but the positive result rate was low.The indication of EEG was suggested to be considered.