医学论文：颅脑外伤术后癫痫的预防

颅脑外伤术后癫痫的预防

[摘要] 目的为颅脑外伤术后癫痫的早期预防和治疗提供依据。方法回顾性分析166例颅脑损伤行开颅手术患者的临床资料，重点分析显微开颅手术、人工硬脑膜的应用以及预防性应用抗癫痫药物等因素与外伤性癫痫的关系。将所选择病例随机分为3组作为研究（每组又分为治疗组和对照组），治疗组分别采用显微镜下开颅手术、人工硬脑膜减张修补硬脑膜缺损、手术后预防性应用抗癫痫药物。对照组采用非显微开颅手术，无硬脑膜修补，术后无系统预防癫痫治疗。结果显微手术组患者癫痫发生率为6.66%，其对照组癫痫发生率为22.50%；硬脑膜修补组癫痫发生率为0，其对照组癫痫发生率为11.36%；药物预防癫痫组癫痫发生率为8.88%，对照组癫痫发生率为25.64%。各组之间对比差异有统计学意义（0.01 < p < 0.05）。结论显微手术、硬脑膜减张修补以及开颅术后预防性应用抗癫痫药物对减少术后癫痫发作有重要作用。

[关键词] 颅脑外伤；继发性癫痫；显微手术；预防

precautions for epilepsy followed by brain injury operation chen weichao li shaopeng han weiying neurosurgery department, dongguan people′s hospital of guangdong province, dongguan 523808, china

[abstract] 0bjective to provide the basis for clinical prevent and treatment of post-traunmtie epilepsy (pte). methods the clinical data of 166 patients with craniocerebral

injury and operation were retrospectively analyzed. focuses on the analyzed of microscopic surgical operation, artificial dural application and antiepileptic drugs to prevent traumatic epilepsy happen effect. the patients selected were randomly divided into 3 groups as a case study (each group divided into the treatment group and control group), the treatment group were used respectively to microscope surgical operation, artificial dural repaired, used drugs to prevent seizures. the control group, adopts the microscopic surgical operation, no dural repaired, no drugs to prevent seizures. results the microscopic operative patients epilepsy rate of 6.66%, and the control group epilepsy rate of 22.50%. the artificial dural repaired patients epilepsy rate was 0, and the control group epilepsy rate of 11.36%. the application of anti-epilepsy drugs of epilepsy patients was 8.88%, and the control group epilepsy rate of 25.64%. contrast between groups with a statistical significance (0.01 < p < 0.05). conclusion the incidence of pte is significantly reduced by the microsurgery, artificial dural repairs and antiepileptic drug application.

[key words] craniocerebral injury; secondary epilepsy; microsurgery; prevention

脑外伤性癫痫发生率为1.9%～30.0%[1]，是颅脑损伤后的严重并发症之一。外伤性癫痫一旦发生，将对患者的生理以及心理造成严重的影响，甚至威胁生命。为了有效地降低脑外伤性癫痫的发病率，笔者对2007～2010年166例颅脑外伤并且行开颅手术的病例资料进行了统计对比，分析了相关因素，现报道如下：

1 资料与方法

1.1 一般资料

本院2007～2010年因为头部外伤而行开颅手术患者166例，其中，男96例，女70例，年龄15～78岁，平均43.76岁；硬膜外及硬模下血肿75例，硬膜下血肿合并脑挫伤脑内血肿85例，凹陷性颅骨骨折6例。根据开颅手术方式以及术后预防癫痫措施的实行方法的不同，将手术患者按治疗方案的差异分别分为3个对照组，而每个对照组均为随机配对：组1将85例脑挫伤脑内血肿的患者随机分为显微手术组与非显微手术组；组2将75例单纯硬膜外及硬膜下血肿患者以及6例凹陷性颅骨骨折患者随机分为硬脑膜修补组与非修补组；组3将非显微手术以及无硬脑膜修补共84例患者随机分为药物预防癫痫组与非预防癫痫组。以上患者手术医师均为同一治疗组医师。

1.2 治疗方法

（1）显微手术、硬脑膜修补以及药物预防癫痫组患者分别采用显微镜下彻底清除颅内血肿；应用人工硬脑膜减张修补硬脑膜缺损；术后药物预防癫痫发作方面，术后第1天开始应用氯丙嗪针剂