儿童热性惊厥的研究进展

热性惊厥是儿科常见的神经系统疾病之一,好发于6个月 ~ 5岁儿童。热性惊厥发病机制复杂,大部分患儿预后较好,但也有部分患儿病情反复发作,甚至进展为继发性癫痫,引起神经系统后遗症。热性惊厥的治疗分为院外急救、院内治疗和预防性治疗等部分,包括一般支持性治疗、终止发作的对症治疗和预防复发治疗等。远程医疗技术的开发和应用丰富了热性惊厥的治疗手段,该文对近年相关基础和临床研究文献进行综述,探讨国内外在儿童热性惊厥治疗方面的进展。     

护理干预对小儿高热惊厥的影响

[目的]探讨护理干预对小儿高热惊厥预后的影响.[方法]将36例高热惊厥患儿随机分为对照组和干预组各18例,对照组仅给予常规护理,干预组在接受常规护理基础上给予个体化的护理干预.对两组患儿在干预前后,高热惊厥终止发作的时间、并发症和复发率的情况进行比较.[结果]护理干预后,干预组患儿终止发作的时间短于对照组(P<0.05),并发症发生率和复发率低于对照组(P<0.05).[结论]护理干预对小儿高热惊厥有着积极的影响,可以改善患儿的预后.     

护理干预对小儿高热惊厥的影响

[目的]探讨护理干预对小儿高热惊厥预后的影响。[方法]将36例高热惊厥患儿随机分为对照组和干预组各18例,对照组仅给予常规护理,干预组在接受常规护理基础上给予个体化的护理干预。对两组患儿在干预前后,高热惊厥终止发作的时间、并发症和复发率的情况进行比较。[结果]护理干预后,干预组患儿终止发作的时间短于对照组（P〈0.05）,并发症发生率和复发率低于对照组（P〈0.05）。[结论]护理干预对小儿高热惊厥有着积极的影响,可以改善患儿的预后。     

小儿热性惊厥的急救护理措施分析

目的：探讨小儿热性惊厥的急救护理措施。方法选择我院2011年11月至2013年11月接诊的热性惊厥患儿110例,其中观察组55例患儿采用急救护理措施,而对照组55例患儿采用常规护理措施,比较两组患儿的护理效果。结果护理后,观察组患儿的抽搐至停止时间、抽搐至意识清醒时间、住院时间分别为（2．2±0．5） min、（5．2±0．7） min、（5．4±0．4） d,均明显短于对照组患儿,组间比较差异有统计学意义（ P＜0．05）;观察组患儿的复发率为5．45％,明显低于对照组患儿,组间比较差异有统计学意义（ P＜0．05）;观察组患儿并发症的发生率仅为3．64％,明显低于对照组患儿,组间比较差异有统计学意义（ P＜0．05）。结论采用急救护理措施有利于缩短患儿惊厥抽搐时间和住院时间,促进患儿意识快速清醒,并在一定程度上降低患儿复发率和并发症等的发生率,有利于患儿的预后,值得临床应用。     

院前急救指导应用于小儿高热晾厥治疗的效果评价

目的探讨院前急救指导应用于小儿高热惊厥的效果,以降低高热惊厥对患儿的损伤,取得最佳的急救效果。方法2009年4月至2011年2月我院儿科共收治小儿高热惊厥急救患儿112例,对其中75例患儿家长采取院前急救护理指导,此75例患儿作为院前急救护理指导组。其余37例患儿作为非院前急救护理指导组,待医护人员赶到发病现场后对其进行常规急救护理。随后分别记录2组患儿的误吸、舌咬伤、高热惊厥再度发作以及脑损伤发生情况。结果院前急救护理指导组由于家长操作不当导致误吸的仅有1例,高热惊厥3例,无脑损伤、舌咬伤情况发生,院前急救护理指导组不良后果发生率为5．3％,低于非院前急救护理指导组的51．4％。结论在医疗急救人员还未到达患儿的发病现场之前便利用移动电话对患儿家长进行院前急救护理指导,能够显著减少患儿意外损伤,稳定患儿家长情绪,降低惊厥对患儿的影响,这对改善患儿症状及其后续治疗具有积极作用。     

The child with febrile seizures

Febrile seizures are common in children. They are associated with disease outside of the central nervous system and are usually generalized, brief and self-limited. History and physical examination are usually sufficient to rule out central nervous system disease, and an extensive laboratory work-up is seldom indicated. Prophylaxis with antiseizure medications is only indicated in certain circumstances. The major risk in one febrile seizure is the increased likelihood of another.     

左乙拉西坦预防小儿热性惊厥复发疗效的Meta分析

目的系统评价左乙拉西坦预防小儿热性惊厥复发的有效性与安全性。方法计算机检索PubMed、The Cochrane Library、Embsae、CBM、Wan fang Data、VIP和CNKI数据库,查找关于以左乙拉西坦为干预措施预防小儿热性惊厥复发的随机对照试验,并追查纳入排除文献的参考文献。检索时限均从建库至2016年3月20日。由2名研究者按照纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入5个研究,共计475例患者。Meta分析结果显示：与常规退热治疗相比,左乙拉西坦可以明显降低热性惊厥的复发率［RR=0.30,95%CI(0.21,0.43),P<0.01］;不能降低癫痫发生率［RR=1.11,95%CI（0.26,4.79),P=0.89］;同时会增加不良反应发生率［RR=4.36,95%CI(1.01,18.76),P=0.05］。结论左乙拉西坦在预防小儿热性惊厥复发方面具有较好的疗效,不能降低癫痫发生率,会增加不良反应发生,由于纳入研究存在偏倚可能,尚需更多高质量、多中心、大规模RCT进一步验证。     

院前急救指导应用于小儿高热惊厥治疗的效果评价

目的 探讨院前急救指导应用于小儿高热惊厥的效果,以降低高热惊厥对患儿的损伤,取得最佳的急救效果.方法 2009年4月至2011年2月我院儿科共收治小儿高热惊厥急救患儿112例,对其中75例患儿家长采取院前急救护理指导,此75例患儿作为院前急救护理指导组.其余37例患儿作为非院前急救护理指导组,待医护人员赶到发病现场后对其进行常规急救护理.随后分别记录2组患儿的误吸、舌咬伤、高热惊厥再度发作以及脑损伤发生情况.结果 院前急救护理指导组由于家长操作不当导致误吸的仅有1例,高热惊厥3例,无脑损伤、舌咬伤情况发生,院前急救护理指导组不良后果发生率为5.3％,低于非院前急救护理指导组的51.4％.结论 在医疗急救人员还未到达患儿的发病现场之前便利用移动电话对患儿家长进行院前急救护理指导,能够显著减少患儿意外损伤,稳定患儿家长情绪,降低惊厥对患儿的影响,这对改善患儿症状及其后续治疗具有积极作用.     

PRECEDE-PROCEED模式健康教育在高热惊厥患儿家属中的应用

目的探讨PRECEDE-PROCEED模式健康教育在高热惊厥患儿家属中的应用效果.方法将86例高热惊厥患儿及86名家属按照患儿入院顺序分为观察组与对照组,每组患儿43例,家属43名.对照组家属实施常规健康教育,在此基础上观察组家属施以PRECEDE-PROCEED模式健康教育,出院后随访1个月.采用疾病知识评价问卷评定患儿家属健康知识掌握情况,焦虑自评量表、抑郁自评量表评定患儿家属焦虑、抑郁情绪,由责任护士对患儿治疗期间家属配合情况进行评估,随时记录患儿退热时间、止惊时间及随访期间惊厥复发次数,采用满意度评价问卷评定患儿家属护理满意度.结果干预后观察组患儿家属疼病知识评价问卷各维度评分均显著高于对照组(P<0.01);焦虑自评量表、抑郁自评量表评分均显著低于对照组(P<0.05或0.01);患儿家属配合度(93.0%)、护理满意度(95.3%)显著高于对照组(76.7%、74.4%)(P<0.05或0.01);两组患儿退热、止惊时间比较差异无统计学意义(P>0.05),但观察组患儿复发次数显著少于对照组(P<0.01).结论对高热惊厥患儿家属进行PRECEDE-PROCEED模式健康教育,能有效缓解其焦虑抑郁情绪,提高对相关健康知识的掌握程度、临床工作配合度、护理满意度,有利于降低患儿惊厥复发率.     

Preventive treatment for recurrent febrile seizures

Febrile seizures are the most common convulsive events in childhood occurring in 2-5 % of children. 20-30% of these children will have a recurrence during a subsequent febrile infection. Even though the outcome of febrile seizures is benign, the possibility of recurrences keeps most families in fear for years after the first seizure event. Each febrile infection the child experiences increases the risk of recurrence, and there is a positive correlation between the height of the temperature during an infectious disease and the occurrence of febrile seizures. However, prophylactic use of antipyretics does not decrease the recurrence rate. Intermittent use of diazepam during febrile episodes prevents febrile seizures only in selected child populations. The continuous use of antiepileptic drugs is no longer warranted because their side-effects outweigh their benefits. The number of febrile episodes is the only risk factor that can be influenced by preventive measures. The time being, we can reassure parents on the benign nature of febrile seizures.     

Complex partial seizures

Complex partial seizures, the most common of the adult seizure types, originate in the temporal lobe or limbic system. They include spells with emotional content, cognitive defects, hallucinations and automatisms. Video recordings, EEG telemetry and positron emission tomography have provided a better understanding of the electrophysiology of these seizures. Computed tomography reveals lesions in 50 to 70 percent of the patients. Seizures that are intractable to medical therapy can be treated by temporal lobe resection, with benefits in at least 70 percent of patients.     

Pediatric febrile seizures and childhood headaches in primary care

Febrile seizures and migraine headaches in children are two of the most common neurological diagnoses seen by primary care practitioners. It is essential that a knowledge base be developed to better care for this population. This article reviews pediatric febrile seizures, including management and treatment recommendations and childhood headaches, with an emphasis on migraine headaches. Diagnosis, management, and referral criteria are also reviewed.     

高热惊厥患儿家属应对方式现状及其相关影响因素分析

目的 探究高热惊厥患儿家属应对方式现状及其相关影响因素。方法 选取2022年4月至2023年5月我院收治的100例高热惊厥患儿家属,采用简易应对方式问卷（SCSQ）评估患儿家属的应对方式,并收集相关资料,分析该类患儿家属应对方式的影响因素。结果 100例患儿家属中消极应对者32例,占32.00%。家属与患儿的关系、受教育程度、家庭关怀度、心理弹性与高热惊厥患儿家属的消极应对有关（P＜0.05）;经Logistic回归分析显示,患儿母亲、高中及以下是高热惊厥患儿家属消极应对的危险因素（OR＞1,P＜0.05）;家庭关怀度及心理弹性评分较高是高热惊厥患儿家属消极应对的保护因素（OR＜1,P＜0.05）。结论 高热惊厥患儿家属消极应对主要受其为患儿母亲、受教育程度较低、家庭关怀度较低、心理弹性较低等因素影响,临床可据此采取措施来改善其应对方式。     

Retrospective study of febrile seizures: subsequent electroencephalogram findings,unprovoked seizures and epilepsy in adolescents

A retrospective questionnaire to determine the prevalence of febrile seizures was given to adolescents (16- and 17-year-olds) in the final 2 years of secondary school at the five schools in Alexandroupolis, Greece. Parents were interviewed, and clinical and electroencephalographic examinations were performed in all adolescents with a history of febrile seizures. Of 1708 adolescents, 56 (3.3%) had experienced at least one febrile seizure. Of these, 44 (78.6%) were simple and 12 (21.4%) were complex febrile seizures. Recurrent seizures occurred in 22 cases (39.3%), and the mean age at onset was 25.1 months. There was a positive first-degree family history in eight cases (14.3%) and this increased to 27.3% in cases with recurrent seizures. Two of the adolescents (3.6%) had had one unprovoked seizure before the age of 3 years, and another two children developed epilepsy. Epileptiform electroencephalogram discharges were observed in only one case (1.8%) with generalized tonic-clonic epilepsy.     

Evaluation and management of pediatric febrile seizures in the emergency department

Febrile seizures are common in children, who are often brought to the nearest emergency department (ED). Patients who meet the case definition of simple febrile seizure are not at higher risk for serious bacterial illness than clinically similar febrile children who have not experienced a convulsion. Children who have had complex febrile seizures must be evaluated on a case-by-case basis, and treated with diagnostic and therapeutic measures based on the differential diagnosis. Round-the-clock prophylactic administration of antipyretics has not been demonstrated to affect recurrence of simple febrile seizure. Parents should be informed that recurrence is common, and that these convulsions are benign with an excellent prognosis. Care-givers should be informed that the risk of developing epilepsy after a simple febrile seizure is low, but that complex febrile seizures carry a significantly higher risk.