癫痫持续状态及治疗

癫痫持续状态特别是全身（面）性强直一阵挛癫痫持续状态，是神经系统疾病中少有的几个常见的、需要紧急处置的急诊之一。若治疗不及时将导致死亡，而正确的处理不仅可挽救患生命，还可为患保留良好的生活质量。因此，基层医师应该全面认识和掌握癫痫持续状态的诊断与治疗知识。     

癫痫持续状态45例分析

对我院1996-01～2004-01收治的癫痫持续状态45例分析如下. 　　1 临床资料 　　1.1 一般资料本组男26例,女19例,年龄16～78（平均47）岁.既往有原发性癫痫病史14例.多为停药或不规范应用抗癫痫药物（SEDs）治疗而诱发.急性脑卒中8例,脑卒中后遗症5例,低血糖状态2例,有机氟中毒1例,毒鼠强中毒5例,非酮症高血糖（NKH）4例,脑外伤后遗症2例,病毒性脑炎2例,脑转移瘤1例,脑胶质瘤1例.     

癫痫持续状态及治疗

癫痫持续状态又称癫痫状态(Status edileptius).一般指频繁或持续的癫痫发作所导致的固定而持久的癫痫状态,或一次癫痫发作至少持续30分钟以上,或两次发作间歇期意识不恢复者.癫痫持续状态的发生率占癫痫患者的2.6%～6%.癫痫持续状态不是癫痫的一型,各型癫痫都可以出现持续状态.小儿持续状态的发生率较其他各年龄组高,是神经科常见危急重症.如能及时诊断处理,可降低病死率.     

癫痫持续状态35例分析

目的：探讨癫痫持续状态（SE）的病因、机制、表现、治疗和预后。方法：对35例SE患者的资料进行回顾性分析。结果：SE主要病因有脑外伤、感染、中毒、肿瘤、脑血管病等;机制复杂;临床表现大多是全面性发作,少数为局灶性发作,脑电图80％异常。结论：SE病因很多,诊断主要靠病史和临床表现,需采用综合治疗,预后取决于病因、发作类型、抢救是否及时。     

癫痫持续状态的诊断和治疗

癫痫持续状态(Status epilepticus,SE)是一种以反复或持续的癫痫发作为特征的病理状况,它是一个医学急症,现在常用的定义是:出现两次以上的癫痫发作而在发作期间没有神经功能的完全恢复;或者痫性抽搐持续30分钟以上.     

儿童癫痫持续状态56例临床研究

目的:探讨儿童癫痫持续状态(SE)的临床特点,分析影响SE近期疗效的相关因素.方法:对北京大学第一医院近3年来收治的56例SE患儿的病因、发病年龄、发作类型、惊厥持续时间及控制时间、相关辅助检查、治疗方案进行回顾性分析,寻找影响SE近期预后的相关因素.结果:发病年龄以3岁以内多见,以症状性病因最常见,往往由治疗不规则及感染等诱发,发作类型大部分为惊厥性癫痫持续状态(CSE).出院时发作终止49例,发作减少5例,持续发作2例,其中发作持续时间≤60 min、使用咪唑安定持续静滴治疗者,近期疗效较好(P ＜ 0.05).结论:SE患儿发病年龄以3岁以内多见,症状性病因最常见,往往由不规则服用抗癫痫药物及感染诱发,发作类型大部分为CSE.发作持续时间、治疗方案与SE近期疗效密切相关(P ＜ 0.05).     

安定治疗癫痫持续状态140例报告

癫痫持续状态又称癫痫状态,指癫痫连续发作超过半小时或者在二次癫痫大发作间期没有意识清醒期,属于危重症,死亡率较高,治疗颇为棘手。尤其发作持续时间较长者死亡率甚高。现将癫痫持续状态140例用安定治疗的情况做一个简要的讨论。     

癫痫持续状态130例临床分析

癫痫持续状态是临床较常见的危急重症,如不及早控制,则患者常因高热、脱水、电解质紊乱及脑水肿、心肺功能衰竭等并发症死亡。因而正确处理癫痫持续状态以降低其病死率具有重要的临床意义。本文作者在重庆医科大学神经内科进修学习期间,总结了1959年至1996年12月期间,重庆医科大学神经内科治疗的130例癫痫持续状态病例,现报道如下。1　临床资料1.1　一般资料　130例中男80例,女50例,年龄最小1岁,年龄最大67岁,以11～20岁最多见。1.2　临床表现　大多数表现为反复的强直阵挛发作,发作间歇期患者神志不能恢复,少数表现为惊厥发作持续30分钟以…     

癫痫持续状态的护理

目的对癫痫持续状态的护理进行总结。方法本文分别对癫痫发作前期、癫痫持续状态、并发症的观察和护理做了详细的总结，并阐述了相应的处理措施。结果癫痫发作前期需要注意发作先兆，护理需防止摔伤、防止咬伤舌。癫痫持续状态需积极给以药物控制，治疗的目的是阻止脑损害，首要任务是迅速控制癫痫发作或心电图异常；护理需注意密切观察病情，保证足够的营养，应尽早地用鼻食给以高蛋白、高热量、高维生素的流质，定时翻身、吸痰、保暖、预防感染，癫痫持续状态并发症需恰当处理，否则持续状态不能缓解；持续癫痫发作后常伴发脑水肿和颅内压升高，表现为：意识障碍不断加深或抽搐停止后意识无好转、生命体征恶化、抽搐幅度变小变频，护理中需注意：使用脱水剂，纠正水电解质平衡；高热者降温；加强皮肤护理，防止褥疮发生。结论及时恰当的护理措施有助于癫痫持续状态的缓解，减少并发症。     

癫痫持续状态病因分析

癫痫持续状态(SE)是神经科的常见急症,若不及时处理,可造成不可逆脑损害.因此,为进一步了解SE的病因以准确的进行治疗,现将我院75例SE患者的病因分析如下. 1 临床资料 1.1 一般资料本组男43例,女32例,年龄10～75岁,平均(52±8)岁.一次SE63例,两次以上12例,既往有癫痫病史28例,无癫痫病史47例,发作后20分钟至10小时就诊,平均1.5小时.     

Rectal diazepam in pediatric status epilepticus

Status epilepticus is a neurologic emergency with an 8% to 12% mortality. Rapid ablation of seizure activity is imperative. Although intravenous administration of diazepam is the preferred immediate treatment, vascular access is often difficult to achieve. Rectal administration of diazepam is easily accomplished during status epilepticus. Five cases in which diazepam administered in the rectal lumen stopped seizure activity are reported. Rectal diazepam appears to be safe and efficacious. It should be considered as an alternate to intravenous therapy when immediate vascular access is delayed. Rectal diazepam may have great benefit in the prehospital setting.     

经直肠前列腺穿刺活检术并发症的防治及护理

目的 探讨经直肠前列腺穿刺活检并发症的防治及护理.方法 采用经直肠指引前列腺穿刺活检与经直肠超声引导前列腺穿刺活检165例,给予术前充分的肠道准备,术中密切观察病情、严格无菌操作、利多卡因加舒泰局部麻醉,术后止血、抗炎治疗,观察有无排尿困难、血尿、发热等情况.结果 穿刺后25例患者出现血尿,尿路刺激症伴有/不伴有发热20例,疼痛80例,排尿困难15例,经相关处理后恢复.结论 前列腺穿刺活检术可能发生各种并发症,做好并发症的防治及护理,才能确保前列腺穿刺的安全.     

地西泮与丙戊酸钠治疗癫痫持续状态的疗效比较

目的:回顾性比较丙戊酸钠注射液与地西泮治疗癫痫持续状态的疗效。方法:选择我院神经内科近两年来收治的成人癫痫持续状态患者35例。地西泮组16例入院后立即予地西泮10mg以2mg·min-1静脉缓慢注射,注射完毕后给予地西泮50mg加0.9%氯化钠注射液500ml静脉缓慢滴注维持,24h总量不超过120mg;丙戊酸钠组19例入院后立即予丙戊酸钠注射液400mg静脉注射,注射完毕后给予丙戊酸钠400mg加0.9%氯化钠注射液50ml静脉微泵缓慢注射维持,24h总量不超过20～30mg·kg-1。结果:两组抽搐控制率、抽搐控制时间、48h内复发率比较均差异无统计学意义。结论:丙戊酸钠注射液与地西泮在治疗癫痫持续状态疗效方面无明显差别。     

Advances in the management of seizures and status epilepticus in critically ill patients

Seizures and status epilepticus are common in critically ill patients. They can be difficult to recognize because most are non-convulsive and require electroencephalogram monitoring to detect; hence, they are currently underdiagnosed. Early recognition and treatment are essential to obtain maximal response to first-line treatment and to prevent neurologic and systemic sequelae. Anti-seizure medication should be combined with management of the underlying cause and reversal of factors that can lower the seizure threshold, including many medications, fever, hypoxia, and metabolic imbalances. This article discusses specific treatments and specific situations, such as hepatic and renal failure patients and organ transplant patients.     

Prehospital diagnosis and management of patients with acute stroke

Significant advances in the early management of ischemic stroke have been made since the 1995 National Institute of Neurologic Disorders and Stroke data demonstrated the benefit of early intravenous administration of tissue plasminogen activator to select patients with acute ischemic stroke within a 3-hour onset window of suspected stroke symptoms. One concept in stroke care that has become better understood is the importance of time management and the ability to deliver patients with acute stroke to appropriate care as soon as possible. Minimizing delay to definitive therapy remains the current focus in the prehospital phase of stroke care.     

Prehospital stability of diazepam and lorazepam.

Injectable benzodiazepines are commonly stocked on ambulances for use by paramedics. We evaluated the stability of lorazepam and diazepam as a function of storage temperature. Diazepam (5 mg/mL) and lorazepam (2 mg/mL) injectable solutions were stored for up to 210 days in clear glass syringes at three conditions: 4 degrees C to 10 degrees C (refrigerated); 15 degrees C to 30 degrees C (on-ambulance ambient temperature); and 37 degrees C (oven-heated). High-performance liquid chromatography (HPLC) analyses of syringe contents were performed at 30-day intervals. After 210 days, the reduction in diazepam concentration was 7% refrigerated, 15% at ambient temperature, and 25% at 37 degrees C. The reduction in lorazepam concentration was 0% refrigerated, 10% at ambient temperature, and 75% at 37 degrees C. Whereas diazepam retained 90% of its original concentration for 30 days of on-ambulance storage, lorazepam retained 90% of its original concentration for 150 days. The decrease in lorazepam concentration correlated with an increase in the maximum ambient temperature in San Francisco. These results suggest that diazepam and lorazepam can be stored on ambulances. When ambient storage temperatures are 30 degrees C or less, ambulances carrying lorazepam and diazepam should be restocked every 30 to 60 days. When drug storage temperatures exceed 30 degrees C, more frequent stocking or refrigeration is required.