急性病毒性脑炎并发癫癎持续状态的临床研究

目的探讨急性病毒性脑炎并发癫癎持续状态和难治性癫癎持续状态的临床特征及预后影响因素。方法回顾分析26例急性病毒性脑炎并发癫癎持续状态患者癫癎持续状态出现的时间，以及脑脊液、影像学、脑电图变化特点和预后相关影响因素。结果26例患者中15例（57．69％）进展为难治性癫癎持续状态，与非难治性癫癎持续状态患者相比，12例（12／15）于急性病毒性脑炎发病后10d内出现癫癎持续状态；14例（14／15）脑脊液压力升高；7例（7／15）急性期呈弥漫性脑水肿；14例（14／15）脑电图检查显示普遍重度异常；7例（7／15）同时应用≥5种抗癫癎药物；15例患者均伴有并发症，其中14例（14／15）需呼吸机辅助呼吸；住院时间明显延长f（446±336）d]；5例死亡。6例难治性癫痈持续状态患者随访2～10年，2例呈植物状态生存；3例为难治性癫癎伴智力减退；1例发作终止，遗留轻度记忆力减退。结论急性病毒性脑炎是导致癫癎持续状态的常见原因，其中近半数患者可进展为难治性癫癎持续状态。危险因素包括疾病早期即出现癫癎持续状态、脑脊液压力升高、急性期脑水肿、脑电图异常等。难治性癫癎持续状态患者病死率高，预后不良。

A clinical study of status epilepticus related acute virus encephalitis

Objective To explore the clinical features and influencing factors for the prognosis of status epilepticus （SE） and refractory status epilepticus （RSE） complicated by acute virus encephalitis （AVE）. Methods The onset time of SE, characteristic changes of cerebral spinal fluid （CSF）, imaging study and electroencephalography （EEG）, and related influencing factors for the prognosis of 26 AVE patients with SE were retrospectively analysed. Results Among 26 AVE patients, 15 patients （57.69%） developed RSE, and were compared with non-RSE patients. In these 15 patients, 12 eases （12/15） appeared SE 10 d after AVE, 14 cases （14/15） occurred high CSF pressure, 7 cases （7/15） presented diffuse cerebral edema at acute stage, 14 eases （14/15） had severe generalized abnormalities on EEG, 7 cases （7/15） used 5 or more than 5 antiepileptic drugs （AEDs） simultaneously. The 15 patients were all associated with complications, and 14 （14/15） of them used respirator to assist respiratory, the hospitalization duration was prolonged （446±336） d], and 5 patients died. Six RSE patients were followed for 2-10 years, 2 of them became vegetable, 3 were associated with mental deficiency, and one did not occur epileptic attack ever but remained hypomnesis. Conclusion AVE is the common cause of SE, and nearly half of the patients may develope RSE. The risk factors are early onset of SE, high CSF pressure, acute cerebral edema and EEG abnormalities. In RSE patients, the mortality is high, and the prognosis is relatively poor.