【摘要】 目的 探讨成人癫持续状态的病因及诱发因素。 方法 对48例成人癫持续状态患者的临床资料进行回顾性分析。结果 大多数癫持续状态(38例)由继发性癫所致,常见病因包括脑血管病(14例)、脑外伤(10例)和病毒性脑炎(8例)等。既往有癫史的32例患者中，常见的诱因有停药或换药(14例)、感染(8例)、过度劳累(3例)等。经积极治疗后45例患者得到有效控制,3例患者死亡，均为继发性癫,病死率为6.25%。 结论 脑血管病是成人癫持续状态最常见的病因，有癫史的患者停药或换药是最常见的诱因。尽早明确病因，及时治疗可以提高抢救成功率。坚持服药，减少各种不良诱因是预防本病的关键。
【关键词】 癫持续状态;成人;病因;预后
【Abstract】 Objective To investigate the etiology and inducing factors of status epileptics (SE) in adults.Methods Clinical data of 48 adult patients with status epileptics were analyzed retrospectively. Results The majority of SE in adults (38 cases) was caused by secondary epilepsy, the major causes of SE in adults were cerebrovascular disease (14 cases), head trauma(10 cases)and viral encephalitis(8 cases). The three leading inducing factors in those with preexisting seizure were anticonvulsant drug withdrawal (14 cases), infection (8 cases) and over fatigue (3 cases). Of all the 48 cases of SE, 45 patients were under complete control after active treatment, 3 patients died and the fatality was 6.25%.Conclusion Cerebrovascular disease is the most common cause of SE in adults and anticonvulsant drug withdrawal is the major cause in adult patients with preexisting epilepsy. Early diagnosis and timely cure may improve the rate of success of salvage. The key to prevention of SE is taking medicine as directed and avoiding all kinds of the inducing factors.
【Key words】 Status epileptics; Adult; Etiology; Prognosis
研究[1]发现癫持续状态的预后与病因密切相关，因此积极寻找癫持续状态的病因及诱发因素, 对于预防癫持续状态发生,改善病人预后具有重要意义。现将我院近年来收治的48例成人SE患者的临床资料进行总结和分析，以进一步了解成人癫持续状态的病因，从而提高我们对癫持续状态的认识和处理。
1 对象与方法
1.1 一般资料 本组男26例,女22例,年龄18～86岁,平均(48±21)岁。既往有癫病史32例,无癫病史16例。
1.2 发病原因及诱因 原发性癫10例(20.83%)，继发性癫38例(79.17%)，其中脑血管病14例(36.84%)，脑外伤10例(26.32%)，病毒性脑炎8例(21.05%)，脑肿瘤2例(5.26%)，糖尿病1例(2.63%)，多发性硬化1例(2.63%)，先天发育不全1例(2.63%)，心肺复苏后1例(2.63%)。既往有癫史32例,其中诱发因素分别为因故停药或换药者14例(43.75%),感染8例(25.00%),过度劳累3例(9.38%)，大量饮酒2例(5.26%),抗癫药物中毒1例(3.13%),精神创伤1例(3.13%)及原因不明3例(9.38%)。既往无癫病史16例病因分别为脑血管病9例(56.25%), 病毒性脑炎2例(12.50%)，脑外伤后遗症1例(6.25%)，糖尿病高血糖1例(6.25%)，脑肿瘤1例(6.25%)，心肺复苏后1例(6.25%)及原发性癫1例(6.25%)。
1.3 发作类型 全面强直阵挛发作41例,部分性发作6例，复杂部分发作1例。
1.4 辅助检查 42例病人行头颅CT或MRI检查，异常34例,病灶大多位于大脑半球各脑叶;正常者8例。25例行脑电图(EEG)检查，均有不同程度异常,其中重度异常6例,中重度异常3例,中度异常7例,轻中度异常5例,轻度异常4例。大多数病人呈广泛性阵发性慢波活动,并伴有尖慢或棘慢综合波发放,少数病人脑电图呈局灶性改变。
