背景:癫痫持续状态(SE)是一种异质性神经系统急症,预后差异很大,受潜在疾病和病理生理环境的影响。酸碱紊乱常见于危重病人,然而它们在SE患者中的分布和影响仍然知之甚少.
方法:这是一项观察性队列研究,包括非低氧SE患者,在SE的最初24小时内进行了可用的血气分析,在日内瓦大学医院接受治疗,瑞士在2015年至2023年之间。使用Henderson-Hasselbalch方程对酸碱干扰进行分类,通过斯图尔特方法证实了普遍存在的代谢性碱中毒。主要结果是住院死亡率,出院时格拉斯哥结果量表(GOS),回到病前的神经功能。
结果:在540例SE患者中,365包括在内。一半的患者在SE的最初24小时内表现出酸碱紊乱,代谢和呼吸性酸中毒是最普遍的,虽然预测意义不大。在纠正可能的混杂因素后,代谢性碱中毒(6%)与住院死亡率增加相关(P=0.011;OR=4.87,95%CI=1.29-7.84),GOS恶化(P=0.012;OR=3.18,95%CI=1.29-7.84),恢复至病前功能的可能性降低(P=0.017;OR=3.30,CI95%=1.24-8.80)。按照斯图尔特的方法,9%的患者以代谢性碱中毒为主,与较差的GOS相关(P=0.005;OR:3.37,95CI=1.45-7.82),返回基线的机会减少(P=0.012;OR=3.29,CI95%=1.30-8.32)。代谢性碱中毒与低蛋白血症和低血清钾有关。
结论:代谢性碱中毒强烈预测SE患者的死亡率和不良功能结局。前瞻性研究应评估早期发现和纠正代谢性碱中毒和相关电解质失衡是否可以改善SE预后。
BACKGROUND: Status epilepticus (SE) is a heterogeneous neurological emergency with significant variability in prognosis, influenced by underlying disease and pathophysiological context. Acid-base disturbances are common in critically ill patients, yet their distribution and impact in SE patients remain poorly understood.
METHODS: This was an observational cohort study including non-hypoxic SE patients with available blood gas analysis within the first 24 h of SE, treated at the University Hospital of Geneva, Switzerland between 2015 and 2023. Acid-base disturbances were classified using the Henderson-Hasselbalch equation, with prevalent metabolic alkalosis confirmed through the Stewart approach. Primary outcomes were in-hospital mortality, Glasgow Outcome Scale (GOS) at discharge, and return to premorbid neurologic function.
RESULTS: Among 540 SE patients, 365 were included. Half of patients exhibited acid-base disturbances within the initial 24 h of SE, with metabolic and respiratory acidosis being the most prevalent, though not prognostically significant. After correction for possible confounders, metabolic
alkalosis (6%) was associated with increased in-hospital mortality (P = 0.011; OR = 4.87, 95% CI = 1.29-7.84), worse GOS (P = 0.012; OR = 3.18, 95% CI = 1.29-7.84), and reduced likelihood of returning to premorbid function (P = 0.017; OR = 3.30, CI95% = 1.24-8.80). Following the Stewart approach, 9% of patients had predominant metabolic
alkalosis, associated with worse GOS (P = 0.005; OR:3.37, 95%CI = 1.45-7.82), and reduced chance of returning to baseline (P = 0.012; OR = 3.29, CI95% = 1.30-8.32). Metabolic
alkalosis was related to hypoalbuminemia and lower serum potassium.
CONCLUSIONS: Metabolic
alkalosis strongly predicts mortality and adverse functional outcome in SE patients. Prospective studies should assess whether early detection and correction of metabolic
alkalosis and related electrolyte imbalances can improve SE prognosis.