癫痫持续状态的救治体会

癫痫持续状态又称癫痫状态,指一次癫痫发作至少持续30min以上,或者两次发作间歇期意识不恢复者.处理不当或不及时可导致死亡或严重的永久性脑损害.一直以来,地西泮被认为是治疗癫痫持续状态的首选药物,但各家医院使用的方法及剂量差异较大.我科近年来收治了32例癫痫持续状态患者,探索出一套行之有效的用药方法,现报告如下.     

癫痫持续状态临床分析

癫痫持续状态（statas epilepticas,SE）是指一次癫痫发作时间较长（10—30min以上）,或频繁发作,发作间歇期意识不完全恢复。癫痫持续状态是神经内科的危重症之一,致残率、致死率极高。本文总结了我科2003至2010年共收治SE患者25例,报道如下。     

癫痫持续状态患者临床治疗分析

目的：探讨癫痫持续状态的临床用药方法及疗效。方法：回顾性分析本科77例癫痫持续状态患者的临床资料,并对患者的治疗及疗效进行总结。结果：本组77例患者经治疗,完全控制47例,显效18例,有效7例,效差3例,无效1例,有效率为93.5%。结论：癫痫持续状态重在寻找病因、控制发作和有针对性的治疗,及时有效地控制痉挛发作是抢救癫痫持续状态的关键。     

癫痫持续状态诊治分析

癫痫是常见病。根据国内初步调查,癫痫患者约占人群的0．78％～1．75％。国外约为5％～7%。癫痫持续状态或癫痫状态是指频繁而持续的癫痫大发作,形成一种固定的持续状态,包括一次癫痫发作30min以上或连续多次发作,发作间歇期意识不恢复者,是内科急诊常见危重病,需作紧急处理。1998年6月-2003年6月,我们共急诊处理癫痫持续状态患者22例,现分析报告如下：     

癫痫持续状态患者的临床治疗分析

目的探讨对癫痫持续状态的临床用药方法及疗效。方法回顾性分析2008年1月至2009年12月住院的癫痫持续状态50例患者的临床资料。结果本组50例患者经治疗,完全控制21例,显效15例,有效10例,效差3例,无效1例,有效率为92%;儿童患者治疗效果优于成人患者,两组有效率比较,差异有统计学意义(P<0.05)。结论癫痫持续状态重在寻找病因、控制发作和有针对性的治疗,及时有效地控制痉挛发作是抢救癫痫持续状态的关键。     

癫痫持续状态的死亡分析

癫痫持续状态(SE)是临床神经科和急症科抢救重危病之一。虽经目前医疗技术和治疗方法的改进，很多得以较好控制和成功抢救，但仍有较高的病死率。现将我院1990～2003年共收治癫痫持续状态82例中18例死亡进行分析如下：     

癫痫持续状态的临床分型及治疗药物选择

癫痫持续状态是一种神经科急症,按临床表现、病理生理基础及预后分型,每种类型都有其独特的临床表现及相应的治疗方法。本文综述癫痫持续状态分型以及其临床表现和治疗药物选择,有助于为患者提供最佳的治疗方案。     

癫痫持续状态及其治疗体会

目的 探讨抗癫痫药物治疗癫痫持续状态的疗效.方法 回顾分析60例癫痫持续状态病例,对抗癫痫药物疗效进行分析.结果 有效控制56例,治愈出院52例,家属放弃自动出院5例,死亡3例.结论 及时处理癫痫持续状态,减少脑损害程度.     

癫痫持续状态的临床护理体会及分析

目的：分析癫痫持续状态的急救护理措施。方法：回顾性分析37例癫痫持续状态患者的临床资料。结果：经过及时合理的临床护理,37例癫痫持续状态患者病情得到明显控制,无一例死亡。结论：精心及时有效的护理,有助于控制疾病的发展。     

Pharmacologic treatment of status epilepticus

Introduction: Status epilepticus (SE) requires rapid identification of its cause and urgent pharmacological treatment. Despite an estimated incidence of up to 61 per 100,000 per year, evidence from high-class clinical trials is only available for the early stages of SE.

Areas covered: Following a four-stage approach of SE (early, established, refractory and super-refractory), we present pharmacological treatment options and their clinical utility.

Expert opinion: Intravenous lorazepam and intramuscular midazolam appear as most effective treatments for early SE. In children, buccal midazolam has emerged as first-line non-intravenous drug with similar efficacy and safety to other intravenous or rectal benzodiazepines. In established SE intravenous antiepileptic drugs are in use. There are no double-blind, but six randomized open studies with valproate and two with levetiracetam. A meta-analysis found higher rates of seizure cessation with valproate 75.7% (95% CI 63.7–84.8) and phenobarbital 73.6%, (95% CI 58.3–84.8) than with levetiracetam (68.5%, 95% CI 56.2–78.7) or phenytoin (50.2%, 95% CI 34.2–66.1). Based on the favourable tolerability profile of levetiracetam and valproate, the authors prefer these drugs in established SE over phenytoin. Treatment options in refractory SE are intravenous anaesthetics. In super-refractory SE ketamine, magnesium, steroids and other drugs have been used with variable outcomes. At this stage therapeutic decisions are based on doctors’ preferences, patient factors such as age and comorbidity, and cause of SE, if identified.     

癫痫持续状态的临床研究

目的:探讨癫痫持续状态的病因、临床特点、诊断和治疗方法.方法:对51例癫痫持续状态患者的临床资料进行回顾性分析.结果:经积极治疗后48例患者得到有效控制,3例自动出院后死亡,病死率为5.9%.结论:脑血管病是癫痫持续状态最常见的病因,在有癞痫史的患者中停药或换药是最常见的诱因.尽早诊断,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.     

癫痫持续状态的诊疗进展

<正> 癫痫持续状态是神经内科常见的急症之一,作为一个神经内科医生应掌握癫痫持续状态的处理原则。大多数癫痫持续状态的发作不超过2～3min。发作超过5min就有很高的机会进展到癫痫状态,因此早期治疗至关重要。1 癫痫持续状态的定义及发展历史 1903年Clark and Prout首先提出癫痫持续状态的定义:癫痫持续状态是指癫痫的严重程度,一次发作后短时间内另一次发作,两次发作间持续昏迷     

丙戊酸钠静脉注射治疗癫痫持续状态

目的 :探讨丙戊酸钠注射液治疗癫痫持续状态的疗效和安全性。方法 :丙戊酸钠组 (n =19)和地西泮组 (n =2 2 ) ,均在负荷量丙戊酸钠 10～ 15mg·kg- 1或地西泮 10～ 2 0mg推注后 ,继续 2 4h维持治疗 (分别为 1mg·kg- 1·h- 1和 0 .1～ 0 .2mg·kg- 1·h- 1) ,观察其抗癫痫状态的疗效和不良反应。结果 :丙戊酸钠组和地西泮组起效时间为 (2 3±s18)min和 (7± 5 )min(P <0 .0 1) ,有效率分别为4 7%和 73% (P >0 .0 5 )。丙戊酸钠对不同的癫痫状态类型的疗效无显著差异 (P >0 .0 5 )。丙戊酸钠组治疗前后的生命体征无明显变化 ,血、尿常规 ,肝、肾功能及心电图也无明显改变 ,癫痫状态控制后 ,意识恢复较地西泮组快。结论 :丙戊酸钠注射液治疗癫痫状态有效 ,尤其适用于危重病伴发癫痫持续状态者     

Generalized convulsive status epilepticus: Pathophysiology and treatment

The treatment of generalized convulsive status epilepticus according to a protocol, including a time schedule, prevents unnecessary delay and improves outcome. Based on a literature study and our own clinical experiences a treatment protocol is discussed with special emphasis on medical complications, choice of antiepileptic drugs, route of administration and a proper time schedule.     

Generalized convulsive status epilepticus: Pathophysiology and treatment

The treatment of generalized convulsive status epilepticus according to a protocol, including a time schedule, prevents unnecessary delay and improves outcome. Based on a literature study and our own clinical experiences a treatment protocol is discussed with special emphasis on medical complications, choice of antiepileptic drugs, route of administration and a proper time schedule.     

Mechanisms underlying status epilepticus

Status epilepticus is a state of prolonged or recurrent seizure activity that is associated with significant mortality and morbidity. At a cellular level, status epilepticus results from a failure of normal inhibitory pathways, primarily mediated by gamma-n-aminobutyric acid (GABA) acting via GABA(A) receptors. This loss of inhibitory drive allows the activation of excitatory feedback loops, leading to repetitive, synchronous firing of large groups of neurons. As seizure activity continues, there is further decline in GABAergic function. Continued excitatory input mediated primarily by glutamate leads to neuronal cell death. These alterations in inhibitory and excitatory pathways have important implications for the pharmacologic management of status epilepticus. Currently recommended agents act primarily through the GABA(A) receptor and have been shown to become less effective in status epilepticus of longer duration. Agents designed to inhibit glutamate activity show promise both in the treatment of status epilepticus and in the prevention of associated neuronal injury.