摘要： 目的 探讨开放性颅脑创伤后早期癫发作危险因素，并提出初步预防措施。方法 对2006 年9 月-2009 年9 月诊断与治疗的91 例开放性颅脑创伤患者的临床资料进行单因素及多因素Logistic 逐步回归分析，筛选颅脑创伤后早期癫痫发作之危险因素。结果 单因素分析显示，年龄（χ2 =5.131，P = 0.023）、颅脑创伤分型（χ2 = 6.302，P = 0.043）、损伤部位（χ2 = 12.800，P = 0.046），以及伴发脑挫裂伤（χ2 = 7.187，P = 0.007）、外伤性蛛网膜下隙出血（χ2 = 11.092，P = 0.001）、颅内血肿（χ2 = 6.555，P =0.010）和凹陷性骨折（χ2 = 8.463，P = 0.043）等项因素与开放性颅脑创伤后早期癫痫发作显著相关。进一步Logistic 逐步回归分析，仅年龄（OR = 7.719，95%CI = 1.129 ~ 52.777；P = 0.037）、脑挫裂伤（OR = 28.590，95%CI = 2.241 ~ 364.734；P = 0.010）、外伤性蛛网膜下隙出血（OR = 8.244，95%CI = 1.259 ~ 53.706；P =0.028）和颅内血肿（OR = 24.344，95%CI = 2.415 ~ 345.395；P = 0.007）为危险因素，且以脑挫裂伤危险度相对较高；而与颅脑创伤分型、损伤部位及凹陷性骨折无关。结论 开放性颅脑创伤后早期癫痫发作应及时治疗，对合并危险因素的患者应早期给予预防性抗癫痫药物治疗。

关键词: 脑损伤, 癫痫, 创伤后, 危险因素, 回归分析

Abstract: Objective To explore the risk factors for early post-traumatic seizure (EPTS) in opening traumatic brain injury (TBI), and to propose prophylaxis of the seizures. Methods Ninety-one patients were identified in Shanghai Institute of Neurosurgery from September 2006 to September 2009. Information were obtained on opening TBI and early post-traumatic seizure from these patients. The clinical data were analysed retrospectively. Results Chi?square test showed that age (χ2 = 5.131, P = 0.023), severity of injury (χ2 = 6.302, P = 0.043), site of lesion (χ2 = 12.800, P = 0.046), contusion (χ2 = 7.187, P = 0.007), traumatic subarachnoid hemorrhage (χ2 = 11.092, P = 0.001), intracerebral hematoma (χ2 = 6.555, P = 0.010) and depressed fracture (χ2 = 8.463, P = 0.043) were all significantly correlated with early post-traumatic seizure in opening TBI. Logistic regression analysis revealed that risk factors for early post-traumatic seizure were age (OR = 7.719, 95%CI = 1.129-52.777; P = 0.037), contusion (OR = 28.590, 95%CI = 2.241-364.734; P = 0.010), traumatic subarachnoid hemorrhage (OR = 8.244, 95%CI = 1.129-53.706; P = 0.028) and intracerebral hematoma (OR = 24.344, 95% CI = 2.415-345.395; P = 0.007). Conclusion Early post-traumatic seizure should be controlled promptly in patients with opening TBI, and anti-epileptic drugs should be used prophylactically on the patients with high risk factors.

Key words: Brain injuries, Epilepsy, post-traumatic, Risk factors, Regression analysis