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热性惊厥的治疗及预后

Authors
John J Millichap, MD, FAAP
J. Gordon Millichap, MD, FRCP
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
王娜, 副主任医师

引言

热性惊厥是婴幼儿最常见的神经系统疾病，在5岁以下的儿童中发生率为2%-4%。这是一种年龄依赖性现象，并有很强的遗传倾向。虽然热性惊厥常令家长及目击者感到恐慌，但其大多呈良性发作，将来发展为癫痫的风险比较低。约1/3的患儿在儿童期早期会反复发生热性惊厥，具有某些临床特征时风险增加，包括年幼、低热、热性惊厥家族史，以及首次癫痫发作时发育异常。

热性惊厥被描述为单纯性和复杂性两种类型。单纯性热性惊厥是最常见的类型，特征表现为单次的全面性癫痫发作，持续时间短于10-15分钟。复杂性热性惊厥是指局灶性、持续时间长或者在24小时内反复发作的热性惊厥。 (参见“热性惊厥的临床特征及评估”)

通常到对患儿进行评估的时候，单纯性热性惊厥就已自行停止，因此不需要治疗，而对于持续时间长的惊厥，可能需在救护车内或急诊科使用苯二氮卓类药物终止发作(abortive treatment)。预防性应用抗癫痫药(antiepileptic drug, AED)可降低热性惊厥反复发作的风险，但考虑到大多数发作为良性，发生药物副作用的风险往往超过所得的益处。

本专题将总结热性惊厥的治疗及预后，包括热性惊厥持续状态(febrile status epilepticus, FSE)。婴幼儿非热性癫痫发作及癫痫的治疗将单独讨论。 (参见“儿童癫痫发作和癫痫：初始治疗和监测”)

初步评估

对于在发热情况下出现癫痫发作的儿童，初始评估必须鉴别热性惊厥和其他更严重的病因(如，中枢神经系统感染)。这可通过详尽的病史及体格检查来完成，在某些情况下需联合神经影像学检查和腰椎穿刺。与单纯性热性惊厥患儿相比，局灶性或持续时间较长的热性惊厥发作患儿可能需要更全面的评估，尤其是在首次发作时。下文将讨论在上述病因已经排除并且已经确诊热性惊厥的前提下进行的治疗。 (参见“热性惊厥的临床特征及评估”)

                   

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Literature review current through: 2017-07 . | This topic last updated: 2017-03-07.
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