616例小儿热性惊厥首次发作的临床特点及危险因素分析

目的了解热性惊厥患儿首次发作的临床特点及危险因素,指导临床医师对有危险因素的患儿采取相应干预措施,降低热性惊厥的发生。方法选取我院2016年8月至2018年8月收治的616例首次热性惊厥患儿为研究对象,回顾性分析患儿的临床特征及首次发作危险因素,并随机抽取同期发热但无惊厥发作(既往也无惊厥病史)的601例患儿为对照组。结果616例热性惊厥患儿,男344例,女272例,汉族584例,蒙古族32例。1岁以下126例(20.5%),~3岁405例(65.8%),3岁以上85例(13.7%)。发作病因中以急性上呼吸道感染53.6%(330/616)]、疱疹性咽峡炎25.9%(160/616)]及幼儿急疹10.5%(65/616)]居前3位。惊厥发作时体温在38.0℃及以上者570例(92.5%),16例(2.6%)患儿惊厥发作后出现发热。534例(86.7%)患儿在发热24 h内出现惊厥发作。608例(98.7%)患儿表现为全面强直阵挛性发作。惊厥持续时间<5 min 548例(89.0%)、~14 min 48例(7.8%)、~29 min 16例(2.6%)及≥30 min 4例(0.4%)。572例(92.9%)患儿在单次热程中仅1次惊厥发作。临床类型中单纯性热性惊厥占88.3%(544/616),复杂性热性惊厥占11.0%(68/616),惊厥持续状态占0.7%(4/616)。危险因素分析显示首次惊厥时年龄、低钠、低铁、低锌、剖宫产、异常出生史、抽搐前1周疫苗接种史及热性惊厥家族史在热性惊厥组和对照组中差异有统计学意义(P<0.05)。Logistic回归分析发现首次发热惊厥年龄、低铁、剖宫产、低钠及热性惊厥家族史是热性惊厥首次发作的独立危险因素(P<0.05)。结论热性惊厥首次发作多见于3岁以内婴幼儿,以单纯性热性惊厥为主,惊厥发作时体温高,易发生于发热后24 h内,病毒感染是最常见病因。引起热性惊厥首次发作的危险因素依次为首次发作年龄、低铁、剖宫产、低钠及热性惊厥家族史,针对危险因素采取相应的干预措施可降低热性惊厥的发生。

Clinical characteristics and risk factors analysis of 616 children with febrile seizures

Objective To understand the clinical features and risk factors of the first seizures in children with febrile seizures,to guide clinicians to take appropriate intervention measures for children with risk factors,and to reduce the incidence of febrile seizures.Methods A total of 616 children with first-onset febrile seizures admitted in our hospital from August 2016 to August 2018 were enrolled in this study.The clinical characteristics and risk factors of first-onset seizures were retrospectively analyzed.And 601 children with fever but no seizures were randomly selected as the control group.Results There were 616 children with febrile seizures,including 344 males and 272 females,584 Hans and 32 Mongolian.A total of 126 cases(20.5%)were under 1 year old,405 cases(65.8%)were 1-3 years old,and 85 cases(13.7%)were over 3 years old.The upper third of the episodes were acute upper respiratory tract infections53.6%(330/616)],herpetic angina25.9%(160/616)],and infant acute rash10.5%(65/616)].There were 570 cases(92.5%)with seizures at 38.0℃and above,16 cases(2.6%)had fever after seizures.A total of 534 cases(86.7%)had seizures within 24 hours of fever,and 608 cases(98.7%)presented with a generalized seizures.The duration of seizures was less than 5 min in 548 cases(89.0%),5-14 min in 48 cases(7.8%),15-29 min in 16 cases(2.6%)and more than 30 min in 4 cases(0.4%).Of the 572 patients(92.9%),only one seizure occurred in a single heat stroke.In the clinical type,simple febrile seizures accounted for 88.3%(544/616),complex febrile seizures accounted for 11.0%(68/616),and seizures persisted in 0.7%(4/616).Risk factors analysis showed that age,low sodium,low iron and low zinc,cesarean section,abnormal birth history,vaccine exposure history one week before convulsion,and family history of febrile seizures were statistically different between the febrile seizure group and the control group(P<0.05).Logistic regression analysis found that the age of first febrile seizures,low iron,cesarean section,low sodium and family history of febrile seizures were the independent risk factors for the first episode of febrile seizures(P<0.05).Conclusion The first episode of febrile seizures are more common in infants and young children under 3 years old.It is mainly caused by simple febrile seizures.The temperature of seizures is high and it is easy to occur within 24 hours after fever.Viral infection is the most common cause.The risk factors for the first episode of febrile seizures are episode age,low iron,cesarean section,low sodium and family history of febrile seizures.Taking appropriate interventions for risk factors can reduce the incidence of febrile seizures.