癫痫持续状态患者发生多器官功能障碍的危险因素分析

目的分析成年人癫痫持续状态患者中发生多器官功能障碍（MODS）的危险因素.方法1988-2004年连续住院的317例全身惊厥性癫痫持续状态（GCSE）患者,其中资料完整的共137例.疾病组为41例癫痫持续状态继发MODS的患者,对照组96例为同期住院未发生MODS的癫痫持续状态患者.病例和对照采用统一的调查表,用Microsoft Access 2003建立数据库,共53个主项内容,部分主项设有下属分项.对研究资料先进行单因素分析,然后进行多因素非条件logistic回归模型分析.结果经分析筛选出癫痫状态持续时间（OR=14.965）、GCSE持续抽搐发作类型（OR=3.836）、GCSE治疗时机（OR=2.404）、持续发热（OR=1.539）、年龄（OR=1.324）等5个因素为癫痫持续状态继发MODS的独立危险因素.结论癫痫状态继发MODS与抽搐持续时间、GCSE持续抽搐发作类型、治疗时机关系最为密切,持续发热、患者高龄也可促发MODS.

Analysis on the risk factors regarding multiple organ dysfunction syndrome in patients with status epilepticus

Objective The purpose of this study was to evaluate the risk factors responsible for multiple organ dysfunction syndrome (MODS) in adult patients with status epilepticus. Methods The authors retrospectively reviewed the medical records of 317 patients admitted to Department of Neurology at hospitals from April 1988 to December 2004 with the diagnosis of generalized convulsive status epilepticus (GCSE). Of these patients, 137 had detailed and complete documents of case history. Forty-one patients with MODS following GCSE were compared with 96 controls without MODS after GCSE. All of them were inpatients in the same period. Based on a standardized questionnaire,a database was set using the Microsoft Access 2003 with data including 53 indexes and some subindexes. Nonconditional multivariate stepwise logistic regression was made after univariate analysis.Odds ratio(OR) and 95% confidence interval after adjustment for possible confounding variables were calculated. Results Five parameters emerged as significant independent predictors of MODS induced by GCSE in adults in multiple logistic regression which including duration of seizures during GCSE (OR=14.965), GCSE with continuous seizure activity (OR=3.836), time interval between the onset of GCSE and starting therapy (delay in SE treatment) (OR =2. 404), persistent fever (OR =1.539) and older age (OR= 1. 324). Conclusion Duration of seizures during GCSE, GCSE type of continuous seizure activity and delay in treatment for GCSE were indicators, which independently associated with a higher likelihood of MODS following GCSE in adults. Persistent fever and older age seemed to be independent predictors of a higher risk of MODS after GCSE.