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癫痫发作(Seizures)
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慈怀疗护中的紧急情况
癫痫发作(Seizures)
EN
中文
简介
癫痫是由于大脑异常的电传导导致暂时性神经系统症状突然发作的结果。
持续超过30分钟的癫痫发作活动被称为“癫痫持续状态”。
有惊厥性和非惊厥性癫痫发作。
惊厥性癫痫可能会令家人感到非常痛苦。
应对方法
在慈怀疗护的背景下,癫痫发作的常见原因包括:
脑病理学 - 原发性或转移性脑瘤,疤痕性癫痫,中风
代谢异常 - 肝性脑病,低血糖,尿毒症,低钠血症
药物相关 - 酒精戒断症候群
一般措施
旨在终止和预防癫痫发作
纠正可逆转原因(如适用)
停用可降低癫痫阈值的药物(如亚胺培南 Imipenem,先锋霉素族抗菌素 Cephalosporins,氟哌啶醇 Haloperidol)。
保持镇静,安抚病人和家属
可以让家庭成员“在外等待”并加以安抚直到局势得到控制。
让患者采取侧卧位
如有,提供氧气和抽吸器
除非有明显的呼吸窘迫,一般不需要口咽气道插管。
考虑长期使用抗癫痫药(如左乙拉西坦 Levetiracetam(Keppra),苯妥英Phenytoin)
如果根本原因是脑肿瘤,特别是脑水肿,服用地塞米松 Dexamethasone(16-24mg /天)。
如果癫痫发作持续2分钟以上,应开始进行药物措施。
癫痫如果在家中发作,则应进行以下药物措施,并酌情考虑住院或入住慈怀疗护机构。
药物措施
如有,可给地西泮(Diazepam)直肠剂10mg
可每15分钟注射咪达唑仑(Midazolam) 1-2.5mg,直到癫痫停止发作。
如果癫痫持续发作,可以开始持续注射(静脉/ 皮下)咪达唑仑(midazolam)(范围从0.5-3mg /每小时开始),或考虑静脉注射抗癫痫药(例如苯妥英Phenytoin,左乙拉西坦levetiracetam或苯巴比妥Phenobarbitone)
对于持续性癫痫发作,应考虑紧急转诊给神经科医师或专科慈怀疗护团队
参考资料
Droney J, Hall E. Status Epilepticus in a Hospice Inpatient Setting.
J Pain Symptom Manage.
2008;36(1):97–105.
Golf M, Paice JA, Feulner E, O'Leary C, Marcotte S, Mulcahy M; Refractory Status Epilepticus.
Palliat Med.
2004;7(1):85–88.
Twycross R, Wilcock A, Howard P, eds.
Palliative Care Formulary.
5TH ed. Nottingham, UK: palliativedrugs.com Ltd; 2014.
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