急性一氧化碳中毒后迟发性脑病继发癫痫患者临床特征及预后研究

摘要

背景既往研究对急性一氧化碳中毒后迟发性脑病( DEACMP）患者出现智能障碍、锥体外系神经功能障碍等症状关注较多，而对DEACMP继发癫痫的相关研究较少，因此探究DEACMP继发癫痫的发病率及其临床特点对临床中解决此类问题有很大帮助。目的分析DEACMP继发癫痫患者的临床特点，比较DEACMP继发癫痫与未继发癫痫患者的一般情况、治疗效果和预后的差别，为判断DEACMP继发癫痫患者的预后提供依据。方法2001年1月—2014年1月新乡医学院第二附属医院、新乡医学院第一附属医院、新乡医学院第三附属医院、新乡市中心医院、新乡市第一人民医院、新乡市第二人民医院、中国人民解放军第371中心医院、河南宏力医院8家医院收治的450例DEACMP患者中，共272例患者符合入组与排除标准，通过门诊随访和电话随访，记录患者的病情变化、治疗效果、预后等。结果272例患者中继发癫痫20例(7.4％）， DEACMP发病后6个月内出现癫痫发作者17例(85.0％）。DEACMP继发癫痫与未继发癫痫患者性别、年龄、昏迷持续时间、假愈期比较，差异均无统计学意义( P＞0.05）；DEACMP继发癫痫与未继发癫痫患者病情严重程度比较，差异有统计学意义( P＜0.05）。 DEACMP继发癫痫与未继发癫痫患者疗效比较，差异有统计学意义( Z＝5.098， P＜0.01）。 DEACMP继发癫痫患者随访期间死亡12例，病死率为60.0％； DEACMP未继发癫痫患者死亡52例，病死率为20.6％； DEACMP继发癫痫与未继发癫痫患者病死率比较，差异有统计学意义(χ2＝15.95， P＜0.01）。结论 DEACMP继发癫痫患者具有病情严重程度重、治疗效果差、病死率高的特点，预防继发癫痫尤其是癫痫持续状态的发生对提高DEACMP患者的治疗效果和改善预后至关重要。%Background Previous studies of patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) mainly focused on the symptoms, such as mental retardation, extrapyramidal dysfunction, rather than secondary epilepsy.The investigation of the incidence and clinical features of secondary epilepsy after DEACMP would be beneficial to the aforesaid issues.Objective To analyze the clinical features of DEACMP patients with secondary epilepsy.To compare the clinical manifestations, the therapeutic effects and prognosis between DEACMP patients with and without secondary epilepsy, in order to provide a basis for predicting the prognosis of DEACMP patients with secondary epilepsy.Methods 450 DEACMP patients admitted to eight hospitals of the Second Affiliated Hospital of Xinxiang Medical University, the First Affiliated Hospital of Xinxiang Medical University, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang Center Hospital, the First People′s Hospital of Xinxiang, the Second People′s Hospital of Xinxiang, the 371st Center Hospital of PLA and Henan Honliv Hospital from January 2001 to January 2014 were recruited, and 272 of these patients were eligible for inclusion and exclusion criteria and included in our study. The patients′clinical condition changes, treatment effect and prognosis were recorded through outpatient follow -up and telephone follow -up.Results In the 272 patients, 20 cases ( 7.4%) got secondary epilepsy, and 17 ( 85.0%) of them epileptic seizures occurred within 6 months after DEACMP.There were no statistically significant differences in gender, age, coma duration, latent phase between DEACMP patients with and without secondary epilepsy (P>0.05), but there was statistically significant difference in severity of illness (P<0.05).There was statistically significant difference in treatment effect ( Z =5.098, P <0.01 ) .12 cases of DEACMP patients with secondary epilepsy died during the follow up and the mortality was 60.0%, while 52 cases of DEACMP patients without secondary epilepsy died and the mortality was 20.6%. There was statistically significant difference in mortality between the two groups (χ2=15.95, P<0.01) .Conclusion The DEACMP patients with secondary epilepsy are characteristic of severe condition, poor treatment effect and high mortality.It is important for improving the treatment effect and prognosis of DEACMP patients to prevent the secondary epilepsy, especially epileptic seizure duration.