儿童惊厥性癫痫持续状态61例临床分析

目的探讨导致儿童惊厥性癫痫持续状态（convulsivestatusepilepticus，CSE）的病因、临床特点和治疗措施。方法回顾性分析1998年1月至2008年10月61例儿童惊厥性癫痫持续状态的临床资料（年龄为1个月至14岁，平均为5．31岁）。其中，男性患儿为37例，女性为24例，男、女患儿比为1．54：1．00。结果61例惊厥性癫痫持续状态儿童中，以急性症状性惊厥性癫痫持续状态最多。导致该病的多种病因中，中毒为24．59％（15／61），脑外伤、脑出血为19．67％（12／61），中枢系统感染为16．39％（10／61），列前3位，抗癫痫药物减量或停药所致惊厥性癫痫持续状态占9．84％（6／61）。61例患儿中，全面性惊厥性癫痫持续状态为54例（88．52％），部分性惊厥性癫痫持续状态为7例（11．48％）。61例患儿采取地西泮（安定）和／或苯巴比妥治疗，1h内有效为49例（49／61，80．32％）；另12例患儿，采取地西泮治疗的4例患儿中，2例（2／4）有效，1例采取氯硝基安定治疗，无效。结论儿童惊厥性癫痫持续状态以急性症状性最多。意外伤害致该病比例较高。地西泮静脉注射＋苯巴比妥肌内注射可作为儿童惊厥性癫痫持续状态首选治疗，地西泮治疗无效时，应尽早使用二线药物。

Clinical Analysis of61 Children With Convulsive Status Epilepticus

Objective To explore the causes, clinical features and treatment measures of convulsive status epilepticus（CSE） in children. Methods A total of 61 children with convulsive status epilepticus, aged between 1 month and 14 years old, from January 1998 to October 2008 were analyzed retrospectively. The mean age was 5.31 years old. Among them, 37 patients were male and 24 patients were female, the ratio of male to female was 1.54 ： 1.00. Results Among 61 patients, the acute symptoms seizure were the majority. The top three causes were poisoning （15/61,24.59%）, cerebral hemorrhage cerebral trauma （12/ 61,19.67%）, and central nervous system infection（10/61,16.39%）. And antiepileptie drug reduction or discontinuation of treatment accounted for 9. 840/00 （6/61）. In this study, there were 54 patients （54/61, 88.52%） with generalized convulsive status epilepticus and 7 patients （7/61, 11. 48%） with partial convulsive status epilepticus. All the patients were treated with diazepam and /or sodium phenobarbital. A total of 49 patients were effective in an hour, and the effective rate was 80. 32%. Among the rest 12 patients, 1 was treated with clonazepam without any efficacy, 4 were treated with diazepam, 2 of them were effective. Conclusion Most children with convulsive status epilepticus were acute symptomatic seizure, and the proportion of accident injury was high. Diazepam intravenous injection plus phenobarbita intramuscular injection could be the first choice for children with convulsive status epilepticus. For the patients using diazepam ineffectively, the second-line treatment should be administered in time.