小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 持续性或反复性强直阵挛发作伴意识水平改变（全身惊厥性 SE
- 意识改变/意识模糊（非惊厥性 SE
其他诊断因素
- 长期局灶性运动活动或者感觉或自主神经性症状，且意识完全清醒（意识正常型局灶性 SE
- 低血氧饱和度
危险因素
- 对抗惊厥药物不依从
- 慢性酒精中毒
- 难治性癫痫
- 毒性或代谢性病因
- 进程导致直接皮质结构损伤
- 药物使用
诊断性检查
首要检查
- 抗惊厥药物的血浓度水平
- 毒理学筛查
- 综合代谢检查
- 全血细胞计数 (FBC
- 心电图 (ECG)
- 脑电图（EEG
需考虑的检查
- 动脉血气 (ABG)
- 头颅 CT
- 腰椎穿刺
- 头部 MRI
治疗流程
全面惊厥性癫痫持续状态
非惊厥性癫痫持续状态
意识正常型局灶性（单纯部分性）癫痫持续状态
撰稿人
作者
Emily L. Johnson, MD
Assistant Professor of Neurology
Johns Hopkins Medical Institutions
Baltimore
MD
利益声明
ELJ has been reimbursed by New England Journal of Medicine Knowledge+ and Univadis MD for developing educational materials.
鸣谢
Dr Emily L. Johnson would like to gratefully acknowledge Dr Ronald P. Lesser, Dr Mohammad Koubeissi, and Dr Nabil Azar, previous contributors to this topic.
利益声明
RPL or his wife have stock in the following companies, which sell health care products: Abbott Labs, Apple, Avanos, Celgene, Express Scripts, Johnson and Johnson, and Pfizer. NJA declares that he has no competing interests. MZK declares that he has no competing interests.
同行评议者
Yvonne Hart, MBBS
Consultant Neurologist
John Radcliffe Hospital
Oxford
UK
利益声明
YH has been reimbursed by UCB Pharma Ltd, Janssen-Cilag Ltd, Pfizer Ltd, and Eisai Ltd for attending conferences; has taught at meetings sponsored by the above companies and by GlaxoSmithKline Services Unlimited; and has received payment for advisory board work from UCB Pharma Ltd, Janssen-Cilag Ltd, Eisai Ltd, and GlaxoSmithKline Services Unlimited.
鉴别诊断
- 心因性非癫痫性 SE
- 谵妄
- 昏迷
更多 鉴别诊断指南
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- 循证指南：儿童和成人惊厥性癫痫持续状态的治疗
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