CAJ | 학술논문

目的评价幕上自发性脑出血患者伴发痫性症状的发生率以及其相关危险因素。 　　方法本研究为前瞻性队列研究，纳入2007年9月～2008年8月中国国家卒中登记数据库的2862例既往无癫痫病史的发病14d内住院的幕上自发性脑出血患者。住院时记录患者发病时或住院期间是否合并痫性发作症状，根据是否合并痫性发作分为合并痫性发作组和未合并痫性发作组，比较两组患者的基本特征。采用多因素回归模型评价患者的人口学特征、既往史、入院时格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分、幕上脑出血累及部位和体积、住院合并症与痫性发作的相关性。 　　结果2862例幕上自发性脑出血患者，年龄中位数62.0岁（四分位间距53.0～72.0），1115例（39.0%）为女性，1921例（67.1%）既往有高血压病史。133例（4.6%）患者合并痫性发作。与未合并痫性发作患者相比，合并痫性发作患者GCS平均评分低（9.5 vs 12.5，P=0.006），合并脑积水（5.3%vs 1.5%，P=0.050）和肺炎（30.1% vs 17.0%，P＜0.001）的比例高。在多因素回归分析中，下列因素与幕上自发性脑出血患者伴发痫性发作独立相关：入院时GCS评分每降低2分[比值比（odds ratio，OR）1.32，95%可信区间（confidence interval，CI）1.21～1.45]、血肿累及皮层（OR 5.82，95%CI 3.88～8.72）、合并脑积水（OR 2.73，95%CI 1.14～6.56）和合并肺炎（OR 1.65，95%CI 1.09～2.52）。 　　结论痫性发作是幕上自发性脑出血患者较为常见的神经系统并发症。昏迷程度、血肿累及皮层，以及合并脑积水和肺炎是并发痫性发作症状的危险因素。
목적평개막상자발성뇌출혈환자반발간성증상적발생솔이급기상관위험인소。 　　방법본연구위전첨성대렬연구，납입2007년9월～2008년8월중국국가졸중등기수거고적2862례기왕무전간병사적발병14d내주원적막상자발성뇌출혈환자。주원시기록환자발병시혹주원기간시부합병간성발작증상，근거시부합병간성발작분위합병간성발작조화미합병간성발작조，비교량조환자적기본특정。채용다인소회귀모형평개환자적인구학특정、기왕사、입원시격랍사가혼미량표（Glasgow Coma Scale，GCS）평분、막상뇌출혈루급부위화체적、주원합병증여간성발작적상관성。 　　결과2862례막상자발성뇌출혈환자，년령중위수62.0세（사분위간거53.0～72.0），1115례（39.0%）위녀성，1921례（67.1%）기왕유고혈압병사。133례（4.6%）환자합병간성발작。여미합병간성발작환자상비，합병간성발작환자GCS평균평분저（9.5 vs 12.5，P=0.006），합병뇌적수（5.3%vs 1.5%，P=0.050）화폐염（30.1% vs 17.0%，P＜0.001）적비례고。재다인소회귀분석중，하렬인소여막상자발성뇌출혈환자반발간성발작독립상관：입원시GCS평분매강저2분[비치비（odds ratio，OR）1.32，95%가신구간（confidence interval，CI）1.21～1.45]、혈종루급피층（OR 5.82，95%CI 3.88～8.72）、합병뇌적수（OR 2.73，95%CI 1.14～6.56）화합병폐염（OR 1.65，95%CI 1.09～2.52）。 　　결론간성발작시막상자발성뇌출혈환자교위상견적신경계통병발증。혼미정도、혈종루급피층，이급합병뇌적수화폐염시병발간성발작증상적위험인소。
Objective To investigate the incidence of the symptomatic seizure after spontaneous supratentorial intracerebral hemorrhage and its relative risk factors. Methods This prospective cohort from the China National Stroke Registry included consecutive patients between September 2007 and August 2008. This study included patients with spontaneous supratentorial intracerebral hemorrhage within 14 days after symptom onset and without history of epilepsy. The symptomatic seizure that occurred at intracerebral hemorrhage symptom onset and during hospitalization was recorded. The baseline clinical characteristics were compared between patients with or without seizures. The multivariable Logistic model was used to identify the relationship between patients’ demographic characteristics, medical histories, Glasgow Coma Scale (GCS) scores on admission, hemorrhagic locations and hematoma volume, in-hospital complications, and the occurrence of the symptomatic seizure. Results This study included 2862 patients with spontaneous supratentorial intracerebral hemorrhage. In this cohort, their median age was 62.0 (interquartile range 53.0~72.0), 1115 (39.0%) of them were female, 1921 (67.1%) had the history of hypertension disease. Compared with those without seizures,patients with seizures more likely have low GCS score (9.5 vs 12.5, P=0.006), high rate of in-hospital complications including hydrocephalus (5.3%vs 1.5%, P=0.050) and pneumonia (30.1%vs 17.0%, P<0.001). In the multiple logistic analysis, the following factors were independently associated with the occurrence of the symptomatic seizure:GCS on admission (per decreasing 2 scores, odds ratio [OR] 1.32, 95%confidence interval [CI] 1.21~1.45), hematoma involving cortical locations (OR 5.82, 95%CI 3.88~8.72), and the in-hospital complications including hydrocephalus (OR 2.73, 95%CI 1.14~6.56) and pneumonia (OR 1.65, 95%CI 1.09~2.52). Conclusion The symptomatic seizure after spontaneous supratentorial intracerebral hemorrhage is common. Level of consciousness, hematoma involving the cortex, and complications of hydrocephalus and pneumonia are independent relative factors.