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目的评价幕上自发性脑出血患者伴发痫性症状的发生率以及其相关危险因素。方法本研究为前瞻性队列研究,纳入2007年9月~2008年8月中国国家卒中登记数据库的2862例既往无癫痫病史的发病14 d内住院的幕上自发性脑出血患者。住院时记录患者发病时或住院期间是否合并痫性发作症状,根据是否合并痫性发作分为合并痫性发作组和未合并痫性发作组,比较两组患者的基本特征。采用多因素回归模型评价患者的人口学特征、既往史、入院时格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、幕上脑出血累及部位和体积、住院合并症与痫性发作的相关性。结果 2862例幕上自发性脑出血患者,年龄中位数62.0岁(四分位间距53.0~72.0),1115例(39.0%)为女性,1921例(67.1%)既往有高血压病史。133例(4.6%)患者合并痫性发作。与未合并痫性发作患者相比,合并痫性发作患者GCS平均评分低(9.5 vs 12.5,P=0.006),合并脑积水(5.3%vs 1.5%,P=0.050)和肺炎(30.1%vs 17.0%,P<0.001)的比例高。在多因素回归分析中,下列因素与幕上自发性脑出血患者伴发痫性发作独立相关:入院时GCS评分每降低2分[比值比(odds ratio,OR)1.32,95%可信区间(confidence interval,CI)1.21~1.45]、血肿累及皮层(OR 5.82,95%CI 3.88~8.72)、合并脑积水(OR 2.73,95%CI 1.14~6.56)和合并肺炎(OR 1.65,95%CI 1.09~2.52)。结论痫性发作是幕上自发性脑出血患者较为常见的神经系统并发症。昏迷程度、血肿累及皮层,以及合并脑积水和肺炎是并发痫性发作症状的危险因素。
Objective To evaluate the incidence of epileptic symptoms in patients with supratentorial cerebral hemorrhage and its related risk factors. Methods This prospective cohort study included 2862 patients with supratentorial spontaneous intracerebral hemorrhage who were hospitalized within 14 days of the previous absence of epilepsy from September 2007 to August 2008 in the National Register of Stroke Database of China. During hospitalization, patients were recorded with or without symptoms of seizures during hospitalization. The patients were divided into two groups according to whether the patients had combined seizures or not, and the patients without epileptic seizures were divided into two groups. Multivariate regression models were used to evaluate demographic characteristics, past history, Glasgow Coma Scale (GCS) score at admission, involvement of supratentorial intracerebral hemorrhage and volume, hospitalization complications, and seizures. Results Among 2862 patients with supratentorial spontaneous cerebral hemorrhage, the median age was 62.0 years (interquartile range 53.0-72.0), 1115 (39.0%) were female, and 1921 (67.1%) had a history of hypertension. 133 (4.6%) patients with seizures. Patients with concurrent seizures had lower mean GCS scores (9.5 vs 12.5, P = 0.006), hydrocephalus (5.3% vs 1.5%, P = 0.050), and pneumonia (30.1% vs 17.0%, P <0.001). In multivariate regression analysis, the following factors were independently associated with epileptic seizures in patients with supratentorial intracerebral hemorrhage: a 2-point decrease in GCS scores at admission [odds ratio (OR) 1.32, 95% confidence interval (OR 2.82, 95% CI 3.88-8.72), hydrocephalus (OR 2.73, 95% CI 1.14-6.56) and pneumonia (OR 1.65, 95% CI 1.09 ~ 2.52). Conclusion Epileptic seizures are more common neurological complications in patients with supratentorial ICH. Coma, hematoma involvement of the cortex, and hydrocephalus and pneumonia combined are risk factors for concurrent seizures.