全身二次脑损伤与癫痫持续状态患者结局的相关性：一项随机对照试验的事后研究。

Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus: A post hoc study of a randomized controlled trial.

机构信息

From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.

出版信息

Neurology. 2020 Nov 3;95(18):e2529-e2541. doi: 10.1212/WNL.0000000000010726. Epub 2020 Sep 10.

DOI:10.1212/WNL.0000000000010726

PMID:32913029

Abstract

OBJECTIVE

To evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus.

METHODS

This was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C-34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus.

RESULTS

The 172 men and 93 women had a median age of 57 years (45-68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35-120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20-3.85; = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04-3.85; = 0.04), primary brain insult (OR 2.00, 95% CI 1.02-4.00; = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05-5.59; = 0.04).

CONCLUSIONS

In our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus.

CLINICALTRIALSGOV IDENTIFIER

NCT01359332.

摘要

目的

评估全身性因素（平均动脉压、动脉二氧化碳和氧分压、体温、血钠和血糖）在癫痫持续状态后第 1 天与 90 天神经结局之间的关系。

方法

这是 Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care（HYBERNATUS）多中心开放标签对照试验的事后分析，该试验于 2011 年 3 月至 2015 年 1 月期间随机纳入 270 例需要机械通气的癫痫持续状态的危重症患者，将其分为治疗性低温（32°C-34°C 24 小时）+标准治疗组和标准治疗组，主要终点为癫痫持续状态后 90 天的格拉斯哥结局量表评分 5 分，定义为预后良好。

结果

172 名男性和 93 名女性的中位年龄为 57 岁（45-68 岁）。其中 130 名（49%）有癫痫病史，59 名（29%）有原发性脑损伤。86 名（32%）患者癫痫持续状态难治，总癫痫发作持续时间为 67 分钟（35-120 分钟）。90 天预后不良的患者有 126 名（48%）。多变量分析显示，无全身性脑二次损伤与预后相关；预后不良与年龄>65 岁（比值比[OR]2.17，95%置信区间[CI]1.20-3.85； = 0.01）、难治性癫痫持续状态（OR 2.00，95%CI 1.04-3.85； = 0.04）、原发性脑损伤（OR 2.00，95%CI 1.02-4.00； = 0.047）和无旁观者目击的癫痫发作起始（OR 2.49，95%CI 1.05-5.59； = 0.04）有关。