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目的探讨开放性颅脑创伤后早期癫癎发作危险因素,并提出初步预防措施。方法对2006年9月-2009年9月诊断与治疗的91例开放性颅脑创伤患者的临床资料进行单因素及多因素Logistic逐步回归分析,筛选颅脑创伤后早期癫癎发作之危险因素。结果单因素分析显示,年龄(χ~2=5.131,P=0.023)、颅脑创伤分型(χ~2=6.302,P=0.043)、损伤部位(χ~2=12.800,P=0.046),以及伴发脑挫裂伤(χ~2=7.187,P=0.007)、外伤性蛛网膜下隙出血(χ~2=11.092,P=0.001)、颅内血肿(χ~2=6.555,P=0.010)和凹陷性骨折(χ~2=8.463,P=0.043)等项因素与开放性颅脑创伤后早期癫癎发作显著相关。进一步Logistic逐步回归分析,仅年龄(OR=7.719,95%CI=1.129～52.777;P=0.037)、脑挫裂伤(OR=28.590,95%CI=2.241～364.734;P=0.010)、外伤性蛛网膜下隙出血(OR=8.244,95%CI=1.259～53.706;P=0.028)和颅内血肿(OR=24.344,95%CI=2.415～345.395;P=0.007)为危险因素,且以脑挫裂伤危险度相对较高;而与颅脑创伤分型、损伤部位及凹陷性骨折无关。结论开放性颅脑创伤后早期癫癎发作应及时治疗,对合并危险因素的患者应早期给予预防性抗癫癎药物治疗。
Objective To explore the risk factors of early epileptic seizures after open brain injury and to propose preliminary preventive measures. Methods The clinical data of 91 patients with open traumatic brain injury diagnosed and treated from September 2006 to September 2009 were analyzed by single factor and multivariate Logistic stepwise regression to screen the risk factors of early epileptic seizures after traumatic brain injury. Results Univariate analysis showed that age (χ ~ 2 = 5.131, P = 0.023), traumatic brain injury classification (χ ~ 2 = 6.302, P = 0.043) (Χ ~ 2 = 7.187, P = 0.007), traumatic subarachnoid hemorrhage (χ ~ 2 = 11.092, P = 0.001) and intracranial hematoma (χ ~ 2 = 6.555, P = 0.010) and depression fractures (χ ~ 2 = 8.463, P = 0.043) and other factors were significantly associated with early epileptic seizures after open brain injury. Further Logistic stepwise regression analysis showed that age (OR = 7.719, 95% CI = 1.129-52.777; P = 0.037), cerebral contusion (OR = 28.590, 95% CI = 2.241-364.734, P = 0.010) Subarachnoid hemorrhage (OR = 8.244, 95% CI = 1.259-53.706; P = 0.028) and intracranial hematoma (OR = 24.344, 95% CI 2.415-3445.395; P = 0.007) were risk factors. The risk of contusion was relatively high, but not related to the type of traumatic brain injury, the site of injury and the depression fracture. Conclusions Early episodes of epileptic seizures after open head trauma should be treated promptly. Patients with combined risk factors should be treated with prophylactic antiepileptic drugs early.