中国实用儿科杂志

中国实用儿科杂志

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小儿难治性癫疒间持续状态的临床特征与治疗分析

周渝冬，蒋莉   

  1. 重庆医科大学附属儿童医院神经内科，重庆 400014
  • 收稿日期:2006-01-18 修回日期:2006-03-29 出版日期:2006-08-06 发布日期:2006-08-06
  • 通讯作者: 蒋莉

Analysis of clinical characteristics and treatment of refractory status epilepticus in children.

Zhou Yudong.   

  1. Chindren's Hospital,Affiliated to Chongqing Medical University,Chongqing 400014,China
  • Received:2006-01-18 Revised:2006-03-29 Online:2006-08-06 Published:2006-08-06

摘要： 目的探讨难治性癫疒间持续状态(RSE)的临床特征，提出可能早期预测RSE的因素。 方法回顾性对比分析200101—200403重庆医科大学附属儿童医院52例癫疒间持续状态(SE)住院患儿的临床资料。 结果(1)52例SE中，29例呈RSE。(2)23例SE中22例为强直-阵挛(GTCS)发作，1例为混合发作；29例RES中14例为GTCS发作，2例强直性发作，4例部分运动性发作，1例复杂部分性发作，8例混合性发作。(3)52例中，23例非RSE病例对安定和(或)苯巴比妥治疗有效。RSE组中，药物治疗有效19例，其中对安定和(或)苯巴比妥治疗有效15例(78.9%)；安定+硫喷妥钠1例(5.3%)；氯硝安定1例(5.3%)；利多卡因2例(10.5%)。 结论(1)在儿童SE中，RSE发生率高。(2)局限性发作、强直发作、混合性发作多提示SE可能呈RES。(3)安定静脉注射联合苯巴比妥肌注是治疗SE的首选用药。对首次使用安定不敏感的RSE，重复使用的有效率低，可尽早考虑换用二线抗癫疒间药物，利多卡因不失为治疗RSE的有效方法。

关键词: 癫疒间持续状态, 难治性癫疒间持续状态, 儿童, 临床特征, 治疗

Abstract: AbstractObjectiveTo explore the clinical characteristics of status epilepticus (SE) and refractory status epilepticus (RSE) in children,present the possible factors to forecast RSE,and summarize the effective methods for seizure control. MethodsFifty-two children with SE were evaluated retrospectively,and were divided into groups of SE and RSE to make a compared analysis. Results(1) There were 56% children with RSE in all 52 children with SE.(2) Two patients with tonic seizures,4 with partial motional seizures,1 with partial complex seizures and 8 with mingle seizures belonged to the group of RSE.(3) In 52 children,diazepam and/or sodium pentothal were effective in 23 children.In RSE,there were 19 times of effective action of medicines,in which diazepam plus/or Phenobarbital 15 times(79%),diazepam plus sodium pentothal 1 time(5%),clonazepam 1 time(5%),lidocaine 2 times(11%). Conclusion(1) The mobility of RSE is high in children with SE; (2) Partial seizures,tonic seizures and mixture seizures hint that SE will develop into RSE; (3) Diazepam plus Phenobarbital is the first choice of medicines for seizure control.The patients in RSE group not sensitive to first use of diazepam will have lower response to the repetition of using diazepam.The second line AEDs can be administered in time.Lidocaine can be an effective drug to treat RSE.

Key words: Clinical characteristics, Treatment , Refractory status epilepticus, Children