TY - JOUR T1 -比较重症监护室孤立性癫痫发作和癫痫持续状态的患者:一项观察性队列研究JF - Neurology JO - Neurology DO - 10.1212/WNL.0000000000206838半岛投注体育官网Sp - 10.1212/ wnl.0000000000206838AU - Wagner, Anna S AU - Baumann, Sira M AU - Semmlack, Saskia AU - Frei, Anja I AU - Rüegg, Stephan AU - Hunziker, Sabina AU - Marsch, Stephan AU - Sutter, Raoul Y1 - 2023/03/06 UR - http://n.半岛投注体育官网neurology.org/content/early/2023/03/06/WNL.0000000000206838.abstract N2 -目标:目的:评估癫痫持续状态(SE)在重症监护病房(ICU)危重成人患者中的发生频率，并确定孤立性癫痫发作患者与SE患者之间的临床差异。方法:从2015年到2020年，通过筛查所有数字医疗、ICU和脑电图记录，确定了瑞士三级护理中心所有重症监护医师和/或咨询神经科医生报告的孤立性癫痫或SE的连续成年ICU患者。排除18岁以下的患者和因缺氧缺血性脑病引起的肌阵挛，但脑电图无癫痫发作的患者。孤立性癫痫发作和SE的频率以及与SE相关的癫痫发作时的临床特征是主要结局。进行单变量和多变量逻辑回归以确定与SE出现的关联。结果:404例癫痫发作患者中，51%为SE。与孤立性癫痫患者相比，SE患者Charlson共病指数(CCI)中位数更低(3比5,p<0.001)，致死性病因更少(43.6%比80.5%，p<0.001)，格拉斯哥昏迷评分中位数更高(7比5,p<0.001)，发烧频率更高(27.5%比7.5%，p<0.001)，中位数ICU和住院时间更短(ICU: 4比5天，p=0.039;住院时间:13天对15天，p=0.045)，且更常恢复到发病前功能(36.8%对17%，p<0.001)。 Multivariable analyses revealed decreased odds ratios(OR) for SE with increasing CCI (OR=0.91, 95%confidence interval[CI] 0.83-0.99), fatal etiology (OR=0.15, 95%CI 0.08-0.29), and epilepsy (OR=0.32, 95%CI 0.16-0.63). Systemic inflammation was an additional association with SE after excluding patients with seizures as the reason for ICU admission (ORfor CRP=1.01, 95%CI 1.00-1.01; ORfor fever=7.35, 95%CI). While fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy.Conclusions: Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention. ER -