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目的探讨外伤性癫痫的高危因素、临床特征、预防及治疗方法等。方法回顾分析颅脑外伤患者1612例资料,保守治疗颅脑外伤患者965例,手术治疗颅脑外伤患者647例,共有136例并发外伤性癫痫。药物治疗癫痫82例,手术治疗癫痫15例。结果年龄、病情、脑皮层挫裂伤、功能区脑损伤、脑出血、颅骨骨折、开放伤等因素均与颅脑外伤后癫痫发生密切相关,清除脑内血肿有利于降低癫痫发生率,皮质瘢痕性癫痫灶手术切除治疗效果好,非皮质瘢痕性癫痫灶药物治疗效果好。结论早期癫痫的发生主要是由于脑挫裂伤、脑出血等因素导致神经细胞兴奋性增强所引起,晚期癫痫主要是由于脑软化灶、瘢痕形成致痫灶引起,对于具有癫痫高危因素的颅脑外伤患者可使用抗癫痫药物预防早期癫痫发作,积极处理原发伤,合理治疗,可降低发病率,选择恰当的方法治疗晚期癫痫,可提高疗效。
Objective To investigate the risk factors, clinical features, prevention and treatment of traumatic epilepsy. Methods A retrospective analysis of 1612 patients with traumatic brain injury data, conservative treatment of 965 patients with craniocerebral trauma, surgical treatment of 647 patients with craniocerebral trauma, a total of 136 cases of traumatic epilepsy. 82 cases of drug treatment of epilepsy, surgical treatment of epilepsy in 15 cases. Results Age, condition, cortical laceration, functional brain injury, intracerebral hemorrhage, skull fracture, open injury and other factors were closely related to epilepsy after traumatic brain injury. Clear intracerebral hematoma is helpful to reduce the incidence of epilepsy, cortical scar Surgical treatment of epileptic foci is effective, and cortical cicatricial epileptic foci have good therapeutic effects. Conclusions The occurrence of early epilepsy is mainly caused by the increase of excitability of nerve cells caused by brain contusion and cerebral hemorrhage. Late epilepsy is mainly caused by epileptogenic foci of cerebral softening and scar formation. For the patients with epilepsy, Traumatic patients can use antiepileptic drugs to prevent early seizures, active treatment of primary injury, reasonable treatment, can reduce the incidence, the appropriate choice of treatment of advanced epilepsy, can improve the curative effect.