脑出血后癫痫的发病机制及临床意义

目的探讨脑出血(CH)后癫痫(EP)发病机制及临床意义。方法回顾性分析735例CH发生EP资料的临床。结果735例中发生EP85例,发生率为11.56%;以EP大发作为主;7d以内EP发作者明显高于其他发作时间段(P<0.01),且缓解率较高(P<0.05);以出血灶位于大脑皮质者EP发生率最高(P<0.01);血肿体积越大,EP发生率越高(P<0.05);有电解质紊乱者EP发生率高于无电解质紊乱者(P<0.05);应激性血糖升高者发生EP较高(P<0.05);发生EP者病死率明显高于非发生EP者(P<0.01);CH后14d内发生EP者病死率与14d后发生EP者比较差异无显著性(P>0.05)。结论颅内大量出血、颅内高压、脑组织缺血、应激性血糖升高、电解质紊乱及神经递质代谢紊乱是引起CH后发生EP的主要原因。EP是CH主要病死因素之一。

The clinical significance and pathogenesis of epilepsy after cerebral hemorrhage

Objective To discuss the clinical significance and pathogenesis of epilepsy(EP) after cerebral hemorrhage(CH). Methods Clinical data of 85 epileps y cases suffered from CH in 735 cases was retrospectively analyzed. Results The 85 epilepsy cases were suffered from CH. The occurred rate was 11.56%(85/735). The mainly expression was severe seizures. Seizures within 7d was markedly highe r than in other period(P<0.01); relief rate of former was higher(P<0.05). The hi ghest occurred rate of EP was in the patients whose bleeding focus being in cere bra cortex (P<0.01). The bigger haematoma in brain was, the higher EP occurred r ate was (P<0.05). Incidence of EP with electrolyte disbalance was higher than th at without electrolyte disbalance (P<0.05). Stress blood glucose elevating in CH has higher EP occurred rate (P<0.05). Mortality with EP was markedly higher tha n without EP in CH (P<0.01). The mortality between the EP occurred in 14d and af ter 14d had not significant difference (P>0.05). Conclusion The main causes res ulting in EP in CH are the encephalic mass bleeding and intracerebral high press ure, brain tissue ischemia, stress blood glucose elevation, electrolyte disbalan ce and neurotransmitters metabolism disbalance. EP is one of the main factors wh ich bring about death of patient with CH.