경련이 동반된 저산소성 허혈성 뇌병증 소아의 특성
The Chracteristics of Hypoxic Ischemic Encephalopathy with Seizures in Children
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목 적 : 저산소성 허혈성 뇌병증 환아를 경련군과비경련군으로 나누어 특성을 비교, 분석하고자 하였다. 방 법: 1999년 6월 1일부터 2011년 12월 31일기간 동안 인하대학병원 소아청소년과에 입원한 환아 중 저산소성 허혈성 뇌병증을 진단받은 총 55명을 대상으로 의무기록 분석을 통해 후향적으로 조사하였다. 결 과:대상 환아 55명 중 경련군은 34명, 비경련군은 21명이었다. 남녀비는 경련군은 1:1, 비경련군은 2.5:1 이었다. 경련군의 발병 평균 연령은9.7개월(범위 : 0-158개월)이었고, 비경련군은 10개월(범위 : 0-108개월)이었다. 위험인자는 경련군에서는 신생아 가사가 6명(17.7%), 비경련군에서는 미숙아가 5명(23.8%)로 가장 많은 부분을 차지하였다. 임상 증상은 두 군 모두에서 호흡곤란이 주로 나타났다. 영상검사에서 두 군 모두 대뇌 피질 병변이가장 많았다. 사망하거나 신경학적 후유증이 남은경우는 경련군에서 23명(67.7%), 비경련군에서 16 명(76.3%)으로 나타났다. 두 군 모두에서 위험요인들 간의 통계학적으로 유의한 차이는 없었다. 결 론 : 본 연구에서는 저산소성 허혈성 뇌병증 경련군과 비경련군의 특성에서 유의한 차이는 없었지만 저산소성 허혈성 뇌병증은 신생아의 사망 또는영구적 뇌손상을 주로 일으켰다. 그러므로 저산소성허혈성 뇌병증의 조기 진단과 치료가 영구적 뇌손상을 최소화할 수 있을 것이다.
Abstract
Purpose : This study was aimed to evaluate the clinical features of hypoxic ischemic encephalopathy(HIE) in children with and without seizures. Methods : Fifty five children who had been diagnosed as HIE at Inha University Hospital from June 1999 to December 2011 were enrolled in this study. Subjects were divided into two groups by the presence of seizures and their medical records were retrospectively analyzed. Results : Among the 55 cases, 34 patients (61.8%) had seizures, while 17 patients (32.2%) did not have them. Male to female ratio was 1:1 for the ‘seizure’ group and 2.5:1 for the ‘no seizure’ group. The onset age was 9.7 months (range: 0-158 months) for the ‘seizure’ group and 10 months (range : 0-108 months) for the ‘no seizure’ group. The most common risk factor was birth asphyxia (17.7%) for the ‘seizure’ group, and prematurity (23.8%) for the ‘no seizure’ group. The most common symptom other than seizure was respiratory arrest for both groups. On radiologic imaging studies of the brain, main causative lesion was most commonly observed in the cerebral cortex in both groups. The neurologic deficits or death were detected in 67.7% of the ‘seizure’ group, and 76.3% of the ‘no seizure’ group. There were no statistically significant differences in risk factors between the two groups. Conclusion : Although the characteristics between patients with and without seizures from HIE revealed no significant differences, HIE still can result in death or permanent disability in children. Therefore, permanent brain damage may be minimized by early suspicion and treatment in these patients.
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