摘要
目的探讨小儿急诊惊厥的病因,为急诊儿科提供诊断思路。方法采用回顾性分析法,收集210例惊厥患儿的临床资料,并根据病史、性别、初发年龄、脑脊液、脑电图、体温、影像学检查等进行分析。结果 210例患儿中,不伴发热48例(22.86%),伴发热162例(77.14%);伴咳嗽、流涕137例(65.24%),伴腹泻、呕吐26例(12.38%),意识障碍或昏迷12例(5.71%),反复惊厥发作并智力发育迟缓7例(3.33%),惊厥持续状态4例(1.90%),既往已确诊癫痫3例(1.43%)。体格检查神经系统阳性体征51例(24.29%)。对27例伴有意识障碍疑似颅内感染的患儿进行脑脊液检查,发现其中有8例出现异常;对55例白细胞明显增加的患儿进行血培养检查,发现其中有9例出现细菌生长;对113例患儿进行脑电图检查,发现有61例患儿出现异常。64例患儿行头颅CT检查,9例异常,分别为颅内出血6例、脑干多发低密度灶1例、脑室增宽1例、颅内占位病变1例。210例患儿中最常见症状为热性惊厥、癫痫和颅内感染。其中,1~28 d新生儿惊厥多为颅内出血所致;28 d^3岁婴幼儿期惊厥病因主要为热性惊厥,其次为癫痫和颅内感染;3~6岁学龄前儿童的惊厥仍以热性惊厥为主;>6岁后,病因则以癫痫为主。结论因儿童发生惊厥的病因呈多样化、复杂化,在对患儿的惊厥病因进行确诊时,不仅需根据患儿的过往病史、年龄段等进行辅助分析,更需要应用诸如头颅CT、脑电图等辅助检查工具,以达到快速确诊、及早治疗、预防复发和减轻患儿脑损伤、杜绝患儿后遗症发生的效果。
Objective To investigate pathogeny of pediatric convulsions in emergency treatment, and to provide diagnosis basis for pediatric emergency treatment. Methods A retrospective analysis was made on clinical data of 210 children with convulsions, along with their medical history, gender, onset age, cerebrospinal fluid, electroencephalogram, body temperature, and imageological examination. Results Among the 210 children, there were 48 cases without fever（22.86%） and 162 cases with fever（77.14%）. There were 137 cases with cough and snot（65.24%）, 26 cases with diarrhea and emesis（12.38%）, 12 cases with disturbance of consciousness or coma（5.71%）, 7 cases with recurrent onset and mental retardation（3.33%）, 4 cases with status convulsion（1.90%）, and 3 cases with diagnosed epilepsy（1.43%）. Physical examination showed 51 cases with positive nervous system signs（24.29%）. Cerebrospinal fluid examination for 27 cases with disturbance of consciousness and suspected intracranial infection showed 8 abnormal cases. Blood culture examination for 55 cases with increased leukocyte showed 9 cases with bacterial growth. Electroencephalogram for 113 cases showed 61 abnormal cases. Head CT for 64 cases showed 9 abnormal cases, as 6 cases with intracranial hemorrhage, 1 case with brain stem multiple low density lesions, 1 case with ventriculomegaly, and 1 case with intracranial space-occupied lesion. Common symptoms in 210 children included febrile convulsions, epilepsy, and intracranial infection. Neonatal convulsions in 1~28 d was mainly caused by intracranial hemorrhage, while infantile convulsions in 28 d^3 years old was mainly showed as febrile convulsions, followed by epilepsy, and intracranial infection. Preschool child aging 3~6 years old had febrile convulsions as main sign. Children aging 6 years old had epilepsy as the main sign. Conclusion Due to diversification and complication of pediatric convulsions, diagnosis of their pathogeny should be made on the basis of medical history, age, head C
出处
《中国现代药物应用》
2016年第2期7-9,共3页
Chinese Journal of Modern Drug Application
关键词
急诊
惊厥
病因分析
癫痫
颅内感染
Emergency treatment
Convulsions
Pathogeny analysis
Epilepsy
Intracranial infection
