开放性颅脑创伤早期癫痫发作危险因素分析

目的探讨开放性颅脑创伤后早期癫痫发作危险因素，并提出初步预防措施。方法对2006年9月-2009年9月诊断与治疗的91例开放性颅脑创伤患者的临床资料进行单因素及多因素Logistic逐步回归分析，筛选颅脑创伤后早期癫痫发作之危险因素。结果单因素分析显示，年龄（X^2=5．131，P=0．023）、颅脑创伤分型（X^2=6．302，P=0．043）、损伤部位（X^2=12．800，P=0．046），以及伴发脑挫裂伤（X^2=7．187，P=0．007）、外伤性蛛网膜下隙出血（X^2=11．092，P=0．001）、颅内血肿（X^2=6．555，P=0．010）和凹陷性骨折（X^2=8．463，P=0．043）等项因素与开放性颅脑创伤后早期癫痼发作显著相关。进一步Logistie逐步回归分析，仅年龄（OR=7．719，95％CI=1．129。52．777；P=0．037）、脑挫裂伤（OR=28．590，95％CI=2．241．364．734；P=0．010）、外伤性蛛网膜下隙出血（OR=8．244，95％CI=1．259。53．706；P=O．028）和颅内血肿（OR=24．344，95％CI=2．415．345．395；P=0．007）为危险因素，且以脑挫裂伤危险度相对较高；而与颅脑创伤分型、损伤部位及凹陷性骨折无关。结论开放性颅脑创伤后早期癫痼发作应及时治疗，对合并危险因素的患者应早期给予预防性抗癫痫药物治疗。

Analysis of risk factors related to early post-traumatic seizure in opening traumatic brain injury

Objective To explore the risk factors for early post-traumatic seizure （EPTS） in opening traumatic brain injury （TBI）, and to propose prophylaxis of the seizures. Methods Ninety-one patients were identified in Shanghai Institute of Neurosurgery from September 2006 to September 2009. Information were obtained on opening TBI and early post-traumatic seizure from these patients. The clinical data were analysed retrospectively. Results Chi-square test showed that age （X^2= 5.131, P = 0.023）, severity of injury （X2= 6.302, P= 0.043）, site of lesion （X2= 12.800, P= 0.046）, contusion （X^2= 7.187, P = 0.007）, traumatic subarachnoid hemorrhage （X2= 11.092, P = 0.001）, intracerebral hematoma （X^2= 6.555, P = 0.010） and depressed fracture （X2= 8.463, P = 0.043） were all significantly correlated with early posttraumatic seizure in opening TBI. Logistic regression analysis revealed that risk factors for early posttraumatic seizure were age （OR = 7.719, 95%CI = 1.129-52.777; P = 0.037）, contusion （OR = 28.590, 95% CI = 2.241-364.734; P = 0.010）, traumatic subaraehnoid hemorrhage （OR = 8.244, 95%CI = 1.129-53.706; P = 0.028） and intracerebral hematoma （OR = 24.344, 95%CI = 2.415-345.395; P = 0.007）. Conclusion Early post-traumatic seizure should be controlled promptly in patients with opening TBI, and anti-epileptic drugs should be used prophylactically on the patients with high risk factors.