顱骨修補術后癲癇持續狀態發作藥物干預和優質護理

馬菲韓　杜曉亮　厲春林

【摘要】 目的：探討顱骨修補術后患者癲癇持續狀態（Status Epilepticus，SE）的藥物和優質護理干預。方法：回顧性分析2015年9月-2017年3月本院單側顱骨缺損患者110例顱骨修補術后SE發作患者7例的發病特點，給予有效藥物控制和優質護理干預，并分析癲癇發作可能原因。結果：7例患者經抗癲癇藥物及優質護理治療后均康復出院，無因癲癇致死及致殘患者。術后SE發作的原因中，術中分離顳肌導致假硬膜破裂損傷腦組織4例，術后發生感染2例，術后硬膜外血腫再次手術清除血腫1例。結論：術中操作影響癲癇發作，術后藥物有效干預SE，積極開展優質護理觀察病情，對于控制顱骨修補術后SE至關重要。

【關鍵詞】 顱骨修補術； 抗癲癇治療； 護理

Drug Intervention and Quality Care for the Status Epilepticus following Cranioplasty/MA Feihan，DU Xiaoliang，LI Chunlin.//Medical Innovation of China，2017，14（32）：137-140

【Abstract】 Objective：To explore the drug intervention and quality care for the status epilepeticus following cranioplasty.Method：The clinical features of 7 cases of SE seizures after cranioplasty in 110 patients with unilateral skull defect in our hospital from September 2015 to March 2017 were retrospectively analyzed，the effective drug control and high quality nursing intervention were given，and the possible causes of epileptic seizure were analyzed.Result：7 patients were discharged after treatment with antiepileptic drugs and high quality nursing care，and no death or disability due to epilepsy.The reason of SE attack after operation，4 cases of temporal muscle separation during operation resulted in rupture of the brain tissue by false dura mater rupture，2 cases of postoperative infection，1 case of epidural hematoma after operation were removed again.Conclusion：Intraoperative operation has an effect on epileptic seizure，postoperative effective drug intervention in SE，and actively carry out high-quality care to observe the condition，for the control of skull repair after SE is very important.

【Key words】 Cranioplasty； Antiepileptic therapy； Nursing

First-authors address：Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430030，China

doi：10.3969/j.issn.1674-4985.2017.32.035

顱骨修補術是治療因各種原因行去骨瓣減壓術后所引起的顱骨缺失的常見手術，可以部分改善患者心理狀況、社會表現、認知功能和外在美觀[1]。但顱骨修補術后的常見并發癥之一的癲癇發生率達3.4%～14.8%[2]。而癲癇持續狀態（Status Epilepticus，SE）是癲癇發作時間持續30 min以上，或經過一系列癲癇發作，而發作間期意識狀態仍無法恢復正常狀態[3]。SE不僅增加患者家庭及社會醫療負擔，而且給患者神經功能恢復造成嚴重影響。因此積極分析癲癇原因，術后積極給予藥物治療和優質護理干預，對顱骨修補術后SE的控制至關重要。本文回顧性分析2015年9月-2017年3月本院110例顱骨修補術后SE發作7例患者的發病特點及綜合干預措施，以期待對SE的有效治療提供新的思路，現報道如下。……