小儿热性惊厥的中西医研究进展（附156例病历分析）

【作者】 周青雯；

【导师】 周忠蜀；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 热性惊厥是儿科惊厥中常见的一种,其确切的发病机制尚不清楚,其遗传倾向已得到证实,临床上急性上呼吸道感染为主要促发因素。热性惊厥患儿多数预后良好,随着研究进展亦发现惊厥反复发作或持续时间长可导致小儿智力降低,甚则继发癫痫。而且,热性惊厥对患儿及其家长的生活、心理均造成不良影响。故临床对热性惊厥治疗得当,普及热性惊厥预防措施及加强家庭健康教育有重要意义热性惊厥,俗称抽风,属祖国医学之“急惊风”范畴,由多种原因及多种疾病引起,现将其概括为“痰、热、惊、风”四证。治疗以清热、豁痰、镇惊、熄风为基本法则。中医常以针灸、推拿及中医三宝等中成药口服以治疗及预防急惊风的发作及复发。现代临床上针对中成药治疗急惊风研究众多,报道中取得与西药相当的疗效。并且中成药物在对于急惊风的预防方面有突出疗效,副作用小。但临床上患儿家长于急惊风急性发作期间应用中药治疗者明显少于西医治疗者本文针对热性惊厥的病因详细阐述,尤其是分子遗传方面,目前发现的与热性惊厥相关的染色体及基因有8q13-q21、19p13.3、2q23-q24、5q14-q15、6q22-q24、18p11.2及15q21.4-q23。部分热性惊厥的发病与离子通道基因突变(电压控制钠离子、钾离子通道基因突变)、神经递质(源于氨基酸类的介质、肽类介质等)、免疫机制异常(体液免疫及细胞免疫低下等)、病毒感染等有关。部分热性惊厥患儿发病前已存在围产期及脑发育异常。临床上热性惊厥患儿表现多样,多数呈全身强直-阵挛发作,少数可见惊厥持续状态、肢体活动障碍等不典型表现。热性惊厥患儿复发率较高,但多数患儿6-7岁后不再发作。多数热性惊厥患儿预后良好,临床资料显示热性惊厥与癫痫及部分癫痫综合征(全面性癫痫伴热性惊厥附加症、Dravet综合征)密切相关,并发现共同的基因突变位点,本文中详细列出其复发及发展为癫痫的危险因素。有动物实验及临床资料显示：多次发作热性惊厥、长程热性惊厥可导致脑损伤,致远期智力水平下降。故于惊厥发作时及时抢救,积极寻找诱发热性惊厥的危险因素并探讨其可能的发病机制,可以合理地处理和预防热性惊厥的再发。临床上,针对热性惊厥病因及发病机制仍需要进一步的探讨和研究,目前发现的基因突变位点仅在部分家族中发现,仍然需要大样本的资料研究。中医治疗及预防急惊风的临床资料逐年增加,但普遍研究样本量小,且关于中药应用过程的毒副作用待进一步深入研究。针对惊厥发作止痉治疗首选安定,对于有高危因素、频繁发作的患儿提倡长程连续用药治疗,但临床西药治疗副作用明显。而临床上西医、中医联合治疗热性惊厥有很好的发展前景,应进一步提倡并发展,尤其是针对高危患儿,这为以后临床研究也提供了新的方向。更多还原

【Abstract】 Febrile seizures(FS) is common in convulsions of children. Its exact pathogenesis is still not clear and its genetic tendency has confirmed. In clinical FS often causes by acute upper respiratory tract infection. Most prognosis of FS is good. As research progress, we also find that FS can lead to young child intelligence, multi-episode can cause epilepsy. Moreover, FS has a bad influence to the life and psychology of children and their parents. So appropriate treatment of FS in clinical, popularizing the preventive measures and strengthening the family health education is important.Febrile seizures commonly known as convulsions, belongs to "JiJing-Feng" in Traditional Chinese medicine. It is caused by a variety of reasons and various illnesses. It is summarized as four cards and eight syndromes. The treatment of fundamental law is clearing heat and phlegm、revieling convulsion. Clinical seizure often treats with acupuncture and moxibustion, manipulation and TCM the triple gem. Modern, there is much research for Chinese patent drug curing JiJingFeng.And Chinese patent drug obtains the appropriate curative effect with western medicine. Especially in the prevention of FS, Chinese medicine treatment has outstanding curative effect with small side effect. But JiJingFeng children in clinical during acute onset of parents who used herbal treatment obviously less than western medicine healers.This paper expounds in detail on the pathogenesis of FS, especially on molecular genetics. Now chromosomes related with FS are 8ql3-q21、19p13.3、2q23-q24.5q14-q15、6q22-q24、18p11.2 and 15q21.4-q23. Part of FS is related with ion channels gene mutations (voltage control sodium, potassium ion channel gene mutation), neurotransmitters, immune mechanism, the virus infection and so on. Also some FS children have perinatal abnormal and brain abnormalities. Clinically febrile seizures are varied, most children appeared to typical display, a few with not typical performance, for example sustaining state, limb activity obstacles and so on. The recurrence rate of FS is higher, but most children aged 6-7 children no longer attack. Most prognosis of FS children is good. Clinical data shows that FS、epilepsy and partial epilepsy syndrome (generalized epilepsy with febrile seizures plus and Dravet syndrome) have closely relation. It has found common gene mutations sites with them. This paper has a detailed list on the risk factors of the recurrence and development. Some animal experiments and clinical datas show multi-episode convulsions, long-range seizures can cause brain damage and intellectual damage. So when in seizure, actively treatment induced undoing the risk factors of the FS and discuss the possible pathogenesis, can be reasonably treat and prevent convulsions.Clinically, the pathogenesis of FS still needs further discussion and research. The found genetic mutations sites do not apply to all people. This still needs a large number of material research. The clinical data of TCM treatment and prevention of JiJingFeng increased year by year, but the universal was a small study, and the side effects of TCM application process for further research. Treatment for seizures preferres diazepam. The children with high-risk factors and frequent attacks are advocated long-term clinical western medicine therapy,but western medicine has side-effect apparent. In clinical, comprehensive therapy with Chinese and western medicine has very good development. We should further promote and develop, especially for high-risk patients. This provides a new direction for clinical research.更多还原