唐忠 陈启富 廖广生

[摘要]目的 探討高血压脑出血神经外科手术后癫痫发作的影响因素。方法 回顾性分析2016年5月～2017年10月在深圳市第三人民医院神经外科行手术治疗的58例高血压脑出血患者的诊疗情况。按照术后是否癫痫发作分为两组，其中17例术后癫痫发作患者作为观察组，41例术后无癫痫发作患者作为对照组。观察两组患者术后的神经元特异性烯醇化酶（NSE）、炎症因子水平，并对患者的临床特点进行比较分析。结果 两组患者的年龄和性别比较，差异无统计学意义（P>0.05）；两组患者的血肿体积、血肿位置、术后再出血及手术方式比较，差异有统计学意义（P<0.05）；术后，观察组的肿瘤坏死因子-α（TNF-α）、血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）、NES水平明显高于对照组，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，血肿位置、血肿体积、术后再出血情况及机体内血清炎症因子TNF-α、IL-6、CRP、NSE等都是作为高出血脑出血后癫痫发作的独立危险因素（P<0.05）。结论 血肿位置、血肿体积、手术方式等都是脑出血后早发性癫痫发生的独立危险性因素，在临床中应进行密切关注。

[关键词]高血压脑出血；癫痫发作；神经元特异性烯醇化酶；炎症因子

[中图分类号] R743.34 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0081-04

[Abstract] Objective To explore the influencing factors of postoperative seizures after Department of Neurosurgery operation for hypertensive intracerebral hemorrhage. Methods A total of 58 cases of patients with hypertensive intracerebral hemorrhage of diagnosis treated in Department of Neurosurgery， the Third People′s Hospital of Shenzhen City from May 2016 to October 2017 were retrospective analyzed. They were divided into two groups according to whether they were epileptic seizures after operation. Among them， 17 patients with postoperative seizures were selected as the observation group， and 41 patients without seizures were used as control group. The levels of NSE and inflammatory factors in the two groups were observed， and their clinical characteristics were statistically analyzed. Results There were no significant difference in age and sex between the two groups （P>0.05）. The hematoma volume， hematoma location， postoperative rebleeding and operative mode between the two groups were significant differences （P<0.05）. After operation， the levels of TNF-α， IL-6， CPR and NES in the observation group were significantly higher than those in the control group， and the differences were statistically significant （P<0.05）. The results of multiple factor Logistic regression analysis showed that the position of hematoma， hematoma volume， and postoperative rebleeding， including serum inflammatory factor TNF-α， IL-6， CPR， NSE were independent risk factors for epileptic seizures after high hemorrhage of cerebral hemorrhage （P<0.05）. Conclusion The location of hematoma， hematoma volume and operation mode are independent risk factors for early onset epilepsy after intracerebral hemorrhage， and should be paid close attention in clinical practice.

[Key words] Hypertensive intracerebral hemorrhage； Seizure； Neuron specific enolase； Inflammatory factor

高血压脑出血是一种脑血管疾病，目前，临床中治疗高血压脑出血的方法主要是手术治疗和保守药物治疗。颅内血肿微创清除术是近年来使用的比较多且疗效较为显著的手术方法，治疗效果优于保守治疗和开颅手术[1-2]。临床研究显示，高血压脑出血术后癫痫发作具有较高的发病率和病死率，是中老年的常见病和多发病。癫痫的发生会加重患者的病情，甚至会进一步损伤脑神经组织[3-4]。临床上对于术后癫痫发作的机制尚未明确，认为影响癫痫发作的因素非常多。本文通过对17例术后癫痫发作患者和41例术后无癫痫发作患者进行对比，旨在探讨高血压脑出血术后癫痫发作的影响因素，研究不同手术、出血位置、血肿位置、神经元损伤程度对于术后癫痫发作的影响以及临床特点，现报道如下。