Intensive Care Department, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay, France.
Crit Care Med. 2010 Dec;38(12):2295-303. doi: 10.1097/CCM.0b013e3181f859a6.
Few outcome data are available about convulsive status epilepticus managed in the intensive care unit. We studied 90-day functional outcomes and their determinants in patients with convulsive status epilepticus.
Two hundred forty-eight convulsive status epilepticus patients admitted to 18 intensive care units in 2005-2007 were included in a prospective observational cohort study. The main outcome measure was a Glasgow Outcome Scale score of 5 (good recovery) on day 90.
Convulsive status epilepticus occurred out of hospital in 177 (67%) patients, and all but 15 patients were still seizing at medical team arrival. The median time from convulsive status epilepticus onset to anticonvulsant drug initiation was 40 mins (interquartile range, 5-80). Total seizure duration was 85 mins (interquartile range, 46.5-180). Convulsive status epilepticus was refractory in 49 (20%) patients. The most common causes of convulsive status epilepticus were anticonvulsive agent withdrawal (36.4%) in patients with previous epilepsy and stroke (27.7%) in inaugural convulsive status epilepticus. Mechanical ventilation was needed in 210 (85%) patients. On day 90, 42 (18.8%) patients were dead, 87 (38.8%) had marked functional impairments (Glasgow Outcome Scale score, 2-4), and 95 (42.4%) had a good recovery (Glasgow Outcome Scale score, 5). Factors showing independent positive associations with poor outcome (Glasgow Outcome Scale score, <5) were older age (odds ratio, 1.04/year; 95% confidence interval, 1.02-1.05; p=.0005), cerebral insult (odds ratio, 2.70; 95% confidence interval, 1.37-5.26; p=.007), longer seizure duration (odds ratio, 1.72/120 min; 95% confidence interval, 1.05-2.86; p=.03), on-scene focal neurologic signs (odds ratio, 2.08; 95% confidence interval, 1.03-4.16; p=.04), and refractory convulsive status epilepticus (odds ratio, 2.70; 95% confidence interval, 1.02-7.14; p=.045).
Ninety days after intensive care unit admission for convulsive status epilepticus, half the survivors had severe functional impairments. Longer seizure duration, cerebral insult, and refractory convulsive status epilepticus were strongly associated with poor outcomes, suggesting a role for early neuroprotective strategies.
关于在重症监护病房中治疗的惊厥性癫痫持续状态的预后数据很少。我们研究了惊厥性癫痫持续状态患者 90 天的功能预后及其决定因素。
2005-2007 年间，我们纳入了 18 个重症监护病房中 248 例惊厥性癫痫持续状态患者，进行前瞻性观察队列研究。主要转归为第 90 天时格拉斯哥预后评分（GOS）为 5 分（良好恢复）。
177 例（67%）患者的惊厥性癫痫持续状态发生于院外，且所有患者除 15 例外，在医疗团队到达时仍有癫痫发作。从惊厥性癫痫持续状态发作到开始使用抗癫痫药物的中位时间为 40 分钟（四分位距，5-80）。总癫痫发作持续时间为 85 分钟（四分位距，46.5-180）。49 例（20%）患者的惊厥性癫痫持续状态为难治性。惊厥性癫痫持续状态最常见的原因是抗癫痫药物撤药（36.4%）和首发惊厥性癫痫持续状态的卒中（27.7%）。210 例（85%）患者需要机械通气。第 90 天时，42 例（18.8%）患者死亡，87 例（38.8%）有明显的功能障碍（GOS 评分 2-4 分），95 例（42.4%）恢复良好（GOS 评分 5 分）。与不良预后（GOS 评分<5 分）有独立正相关的因素是年龄较大（优势比，1.04/年；95%置信区间，1.02-1.05；p=.0005）、脑损伤（优势比，2.70；95%置信区间，1.37-5.26；p=.007）、更长的癫痫发作持续时间（优势比，1.72/120 分钟；95%置信区间，1.05-2.86；p=.03）、现场局灶性神经体征（优势比，2.08；95%置信区间，1.03-4.16；p=.04）和难治性惊厥性癫痫持续状态（优势比，2.70；95%置信区间，1.02-7.14；p=.045）。
惊厥性癫痫持续状态患者在重症监护病房治疗 90 天后，一半幸存者有严重的功能障碍。更长的癫痫发作持续时间、脑损伤和难治性惊厥性癫痫持续状态与不良预后密切相关，提示早期神经保护策略的作用。
