颅脑损伤合并外伤性癫痫患者的病情特点分析

Analysis of the Condition Characteristics of Traumatic Brain Injury Complicated with Post–traumatic epilepsy

摘要:

〔摘 要〕 目的：研究康复医院颅脑损伤（TBI）合并外伤性癫痫（PTE）住院患者的病情特点，为临床治疗外伤性癫痫 提供参考依据。方法：收集 2014 年 1 月至 2020 年 12 月期间在广东省工伤康复医院住院的 91 例 TBI 合并 PTE 患者的病历 资料，回顾性分析其流行病学、危险因素、发作类型、药物治疗、认知、吞咽及生活自理能力等特点。结果：91 例患者中， 男性多于女性，交通事故（53.85 %）为最常见的受伤机制，重型（97.80 %）患者为主。影像学提示脑损伤前三位为脑挫 裂伤（82.42 %），蛛网膜下腔出血（75.82 %），硬膜外血肿（74.72 %）。痫性发作类型以部分性发作继发全面性发作为 主（79.12 %），多为晚发型（81.32 %）。大部分患者伤后实施外科治疗（80.22 %），并进行 2 次或 2 次以上的手术治疗 （79.12 %）。大部分患者服用 1 种或 2 种抗癫痫药物（84.62 %），常用的前三位药物为丙戊酸钠（73.63 %）、左乙拉西坦 （37.36 %）和奥卡西平（14.29 %）。多数患者存在认知、吞咽及生活自理能力功能障碍，部分伴有多个并发症。结论： 在规范治疗 PTE 同时，应重视并发症的治疗，同时加强认知、吞咽及生活自理能力等功能障碍的综合康复训练。

Abstract:

〔Abstract〕 Objective To study and analyze the condition characteristics of inpatients with traumatic brain injury (TBI) complicated with traumatic epilepsy (PTE) in rehabilitation hospital, and to provide reference for clinical treatment of traumatic epilepsy.Methods Medical records of 91 patients with TBI complicated with PTE hospitalized in Guangdong Provincial Industrial Injury Rehabilitation Hospital from January 2014 to December 2020 were collected, and the characteristics of epidemiology, risk factors, type of attack, medication, cognition, swallowing and self-care ability were analyzed retrospectively. Results Among the 91 patients, male patients were more than female patients. Traffic accidents (53.85%) were the most common injury mechanism, and severe injuries (97.80%) were the most common. The imaging results indicated that the first 3 cases of brain injury were brain contusion (82.42%), subarachnoid hemorrhage (75.82%) and epidural hematoma (74.72%). The type of epileptic seizures was mainly partial seizures followed by comprehensive seizures (79.12%), and most of them were late seizures (81.32%). Most of the patients received surgical treatment after injury (80.22%), and 2 or more times of surgical treatment (79.12%). Most patients took one or two antiepileptic drugs (84.62%), and the top three commonly used drugs were sodium valproate (73.63%), levetiracetam (37.36%) and oxacaxipine (14.29%). Most patients have cognitive, swallowing and self-care ability dysfunction, and some patients have multiple complications. Conclusion In the standardized treatment of PTE, attention should be paid to the treatment of complications, and comprehensive rehabilitation training for cognitive impairment, swallowing and self-care ability should be strengthened.