【作者】 郭欣；

【导师】 林卫红；

【作者基本信息】 吉林大学 ， 临床医学硕士（神经病学）（专业学位）， 2022， 硕士

【摘要】 目的:脑出血(intracerebral hemorrhage,ICH)后癫痫发作是ICH常见和重要的并发症,且严重影响患者的生活质量及预后,本文章旨在使用系统评价和荟萃分析的方法明确ICH后癫痫发作的发生率及相关因素,早期识别ICH后癫痫发作的危险人群,并给是否对高危人群进行早期干预提供科学证据,以提高ICH患者的预后及生活质量。方法:根据系统评价和荟萃分析的首选报告项目声明(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA),系统检索Pub Med、EMBASE、cochrane图书馆,收集截止到2021年8月14日发表的研究ICH后癫痫发作的发生率及相关因素的相关文献。根据纳入和排除标准对文献进行筛选,提取有用信息。所有被纳入的研究采用stata12.0版软件进行荟萃分析,使用Microsoft Word软件、stata12.0版软件及Adobe Photoshop CS6软件绘制图表。结果:纳入20个队列研究,总样本量为31025例,其中ICH后癫痫发作1767例,ICH后未发生癫痫发作患者29258例。荟萃分析结果显示ICH后癫痫发作的发生率为8.8%。其中,有六个相关因素与ICH后癫痫发作高发生率有关,包括饮酒(RR(95%CI)=1.26(1.07,1.48),I~2=44.40%,P=0.05),皮层受累(RR(95%CI)=3.77(2.86,4.97),I~2=57.00%,P=0.02),脑叶出血(RR(95%CI)=3.31(2.36,4.65),I~2=66.40%,P<0.01),较大的出血体积(SMD(95%CI)=0.65(0.22,1.08),I~2=95.50%,P<0.01),血肿清除手术(RR(95%CI)=2.38(1.08,5.25),I~2=86.60%,P<0.01),抗癫痫药物的使用(anti-seizure medication,ASM)(RR(95%CI)=2.77(1.91,4.03),I~2=0.00%,P=0.42)。相反,较大年龄(SMD(95%CI)=-0.27(-0.37,-0.16),I~2=66.80%,P<0.01),入院时高格拉斯哥昏迷(Glasgow Coma Scale,GCS)评分(SMD(95%CI)=-1.62(-2.91,-0.34),I~2=99.70%,P<0.01),和高血压(RR(95%CI)=0.83(0.74,0.94),I~2=28.80%,P=0.16)的ICH患者发生癫痫发作的概率较低。结论:1.ICH患者癫痫发作的发生率为8.8%;2.饮酒、皮层受累、脑叶出血、出血体积较大、血肿清除术和预防性使用ASM治疗与较高的ICH后癫痫发作发生率有关;3.老年、入院时有较高的GCS分数和高血压的ICH患者癫痫发作的发生率较低。更多还原

【Abstract】 Objective:Seizure after intracerebral hemorrhage(ICH)is a common and important complication of ICH,which seriously affects the life quality and prognosis of patients.This article aims to identify the incidence and relevant factors for seizures after ICH by performing a systematic review and meta-analysis.Early identify the risk groups of epilepsy after ICH,and provide scientific evidence for early intervention in high-risk groups,so as to improve the prognosis and quality of life of ICH patients.Methods:We systematically searched Pub Med,EMBASE,and the Cochrane Library from inception to 14 August 2021 for studies investigating the incidence and relevant factors associated with seizures after ICH,which followed the current standards in PRISMA2009 guidelines.According to the inclusion and exclusion criteria,the literature was screened and useful information was extracted.Meta-analysis of all included studies was performed by using Stata version 12.0 software.And we drew charts using Microsoft Word software,stata12 0 software and Adobe Photoshop CS6 software.Results:The 20 included cohort studies comprised 31,025 individuals,including 1767participants with seizures and 29258 participants without seizures after ICH.The meta-analysis showed 8.8%incidences of seizures after ICH.Six factors were found to increase the risk of seizures after ICH,including alcohol consumption(RR(95%CI)=1.26(1.07,1.48),I~2=44.40%,P=0.05),cortical involvement(RR(95%CI)=3.77(2.86,4.97),I~2=57.00%,P=0.02),lobar location(RR(95%CI)=3.31(2.36,4.65),I~2=66.40%,P<0.01),large hematoma volume(SMD(95%CI)=0.65(0.22,1.08),I~2=95.50%,P<0.01),hematoma evacuation(RR(95%CI)=2.38(1.08,5.25),I~2=86.60%,P<0.01),and treatment with anti-seizure medication(ASM)(RR(95%CI)=2.77(1.91,4.03),I~2=0.00%,P=0.42).Instead,old age(SMD(95%CI)=-0.27(-0.37,-0.16),I~2=66.80%,P<0.01),high Glasgow Coma Scale(GCS)score at admission(SMD(95%CI)=-1.62(-2.91,-0.34),I~2=99.70%,P<0.01),and hypertension(RR(95%CI)=0.83(0.74,0.94),I~2=28.80%,P=0.16)were associated with a significantly low probability of seizures occurrence in ICH patients.Conclusion:1、The incidence of seizures after ICH was 8.8%;2、Alcohol consumption,cortical involvement,lobar location,large hematoma volume,hematoma evacuation,and treatment with ASM were closely related to the high incidence of seizures after ICH;3、Age,GCS score at admission,and hypertension were were associated with a significantly low rate of seizures occurrence in ICH patients.更多还原