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目的分析672例脑卒中后癫痫患者的临床病征与预防继发病征的方法。方法回顾性研究我院2012年10月~2015年10月期间收治的脑卒中住院治疗患者672例作为研究对象,经临床诊断可确诊为脑卒中患者有38例,分析其临床病征特点与临床危险因素。结果重度神经功能缺损11例(28.9%)、中度神经功能缺损21例(55.3%)、轻度神经功能缺损6例(15.8%);运动性大发作23例(60.5%),运动性小发作1例(2.6%),局限性运动发作12例(31.6%),精神运动性发作2例(5.3%);迟发性发作10例(26.3%);患者病灶部位(皮层上24例占比63.2%,皮层下14例占比36.8%);早发性癫痫28例(73.7%)。672例脑卒中后癫痫研究对象中,高血压患者单次发作10例(37.0%),反复发作4例(36.4%);高血脂患者单次发作18例(66.7%),反复发作6例(54.5%);糖尿病患者单次发作3例(11.1%),反复发作1例(9.1%);脑梗死致脑卒中患者单次发作8例(29.6%),多次发作4例(36.4%)。结论继发癫痫的脑卒中患者的临床发病率约为5%~15%,而癫痫发作后的患者致残率高达31%,病死率为17%。迟发性癫痫与早发性癫痫以及多脑叶病灶都可作为脑卒中后癫痫的独立危险因素,这可能与脑卒中患者脑部严重缺血、缺氧以及病情继续恶化导致的出血性脑循环障碍、脑水肿相关,由于脑卒中患者多数神经功能障碍较为严重,颅内压升高明显,肾功能系统失衡,可继发癫痫颅内酸中毒,加剧脑水肿的恶化。
Objective To analyze the clinical symptoms and prevention of secondary symptoms of 672 post-stroke epilepsy patients. Methods A retrospective study of 672 hospitalized patients with stroke in our hospital from October 2012 to October 2015 were retrospectively studied. Among them, 38 cases were diagnosed as clinically diagnosed as stroke, and their clinical characteristics and clinical risk were analyzed factor. Results There were 11 cases (28.9%) with severe neurological deficits, 21 cases (55.3%) with moderate neurological deficits, 6 cases with mild neurological deficits (15.8%), 23 cases with motor major episodes (60.5%), 1 episode (2.6%), 12 locomotion episodes (31.6%), 2 psychomotor episodes (5.3%), late onset episodes in 10 (26.3%) cases, and 24 cases More than 63.2%, 14 cases under the cortex accounted for 36.8%); early onset epilepsy in 28 cases (73.7%). Of the 672 stroke patients with epilepsy, 10 (37.0%) had a single episode of hypertension and 4 (36.4%) had recurrent episodes of hypertension; 18 (66.7%) had a single episode of hyperlipidemia and 6 had recurrent episodes 54.5%). There were 3 patients (11.1%) with single episode and 1 patient (9.1%) with recurrent episode of diabetes mellitus. There were 8 patients (29.6%) with single episode of stroke and 4 patients (36.4% . Conclusion The clinical incidence of stroke in patients with secondary epilepsy is about 5% -15%, while the rate of disability in patients after epileptic seizure is as high as 31% and the case fatality rate is 17%. Delayed epilepsy and premature epilepsy and multiple brain lesions can be used as independent risk factors for post-stroke epilepsy, which may be associated with severe ischemic brain injury, hypoxia and continued deterioration of the hemorrhagic cerebral circulation Obstacles, cerebral edema related, due to stroke in patients with most of the more serious neurological dysfunction, intracranial pressure increased significantly, imbalance of renal function system, epilepsy can be intracranial acidosis, exacerbated cerebral edema.