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目的通过对儿科重症监护室(PICU)癫非惊厥性发作(NCS)患儿的临床分析,探讨儿科重症患儿NCS的EEG特征与病因。方法回顾性分析深圳市儿童医院PICU2007年6月-2009年12月收治的226例因意识水平改变而行连续EEG监护(24～76h)的患儿,根据发作期EEG特征诊断出NCS的病例;通过收集本组NCS患儿的病史,对年龄分布、既往史及病因进行总结分析;比较1岁前和1岁后2个年龄组的NCS患儿既往惊厥史有无统计学差异;并对发作期EEG行定位分析。结果在226例因意识水平改变而行连续EEG监护的患儿中,48例符合NCS的诊断标准(21.2%);1岁前的NCS患儿多数(16/22例)既往无惊厥病史;此次发病病因依次为颅内感染、癫相关性疾病、HIE、遗传代谢病及创伤。根据发作期EEG定位癫灶,定位于右侧者19例(39.6%),左侧者16例(33.3%),双侧或中央区或无法定位者13例(27.1%);从开始记录至监测到第1次NCS发作的时间平均为287min(13～907min)。结论在有意识改变的儿科重症患儿中,行连续EEG检测可及早明确NCS的诊断,并及早处理。
Objective To investigate the eEG features and causes of NCS in children with pediatric intensive care through clinical analysis of children with epileptic non-convulsive seizures (NCS) in pediatric intensive care unit (PICU). Methods A retrospective analysis of 226 cases of children with consecutive EEG monitoring (24-76 hours) admitted to Shenzhen Children ’s Hospital from June 2007 to December 2009 was performed. The cases of NCS were diagnosed according to the features of EEG during the attack period. By collecting the history of children with NCS in this group, the age distribution, past history and etiology were analyzed. The history of previous convulsions in children with NCS before the age of 1 and 2 years after the age of 1 was compared. Period EEG positioning analysis. Results Among the 226 children with continuous EEG monitoring due to the change of consciousness level, 48 cases (21.2%) met the NCS criteria; the majority of children with NCS before the age of 1 (16/22 cases) had no previous history of seizures; The secondary causes were intracranial infection, epilepsy-related diseases, HIE, genetic metabolic diseases and trauma. Epileptic foci were located according to the onset of EEG. Twenty-nine patients (39.6%) were located on the right, 16 (33.3%) were left, and 13 (27.1%) were unilateral or bilateral. The average time to first NCS onset was 287 min (13 to 907 min). Conclusions In pediatric critically ill children, continuous EEG examination can confirm the diagnosis of NCS as soon as possible and treat it as early as possible.