Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: A systematic review
Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: A systematic review
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DOI：
10.1046/j.1528-1157.2002.28501.x
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发表时间：
2002-02-01
期刊：
影响因子：
5.6
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Hirsch, LJ;Mayer, SA
背景：新型持续输注抗癫痫药物(Civ-AEDs)为治疗难治性癫痫持续状态(RSE)提供了戊巴比妥的替代品。然而，还没有前瞻性随机研究对RSE的治疗进行评估。这篇系统性综述比较了咪唑安定(MDL)、异丙酚(PRO)和戊巴比妥(PTB)在终止RSE患者癫痫发作和改善预后方面的疗效。方法：我们利用MEDLINE、OVID和手动检索的文献检索1970年1月至2001年9月发表的关于使用MDL、PRO或PTB治疗RSE的文献。我们纳入了对成年SE患者进行的同行评议研究，这些患者对至少两种标准的AED药物无效。主要观察指标是即刻治疗失败的频率(在开始Civ-AED治疗后1~6h发生临床或心电图癫痫发作)和根据药物选择和滴定目标的死亡率(Civ-AED滴定为“癫痫抑制”与“EEG背景抑制”)。结果：28项研究描述了193例患者，符合我们的选择标准：MDL(n=54)、PRO(n=33)和PTB(n=106)。48%的患者死亡，死亡率与试剂或滴定目标的选择没有显著关系。PTB通常通过间歇性脑电监测被滴定到脑电背景抑制，而MDL和PRO更常通过连续脑电监测被滴定到癫痫抑制。与MDL或PRO治疗相比，肺结核治疗伴随着较低的短期治疗失败(8vs.23%)、突破性发作(12vs.42%p；0.001)和改变为不同的CIVAED(3vs.21%；p<；0.001)，以及较高的低血压(收缩压)发生率。
Background: New continuous infusion antiepileptic drugs (cIV-AEDs) offer alternatives to pentobarbital for the treatment of refractory status epilepticus (RSE). However, no prospective randomized studies have evaluated the treatment of RSE. This systematic review compares the efficacy of mid-azolam (MDL), propofol (PRO), and pentobarbital (PTB) for terminating seizures and improving outcome in RSE patients.Methods: We performed a literature search of studies describing the use of MDL, PRO, or PTB for the treatment of RSE published between January 1970 and September 2001, by using MEDLINE, OVID, and manually searched bibliographies. We included peer-reviewed studies of adult patients with SE refractory to at least two standard AEDs. Main outcome measures were the frequency of immediate treatment failure (clinical or electrographic seizures occurring 1 to 6 h after starting cIV-AED therapy) and mortality according to choice of agent and titration goal (cIV-AED titration to "seizure suppression" versus "EEG background suppression").Results: Twenty-eight studies describing a total of 193 patients fulfilled our selection criteria: MDL (n = 54), PRO (n = 33), and PTB (n = 106). Forty-eight percent of patients died, and mortality was not significantly associated with the choice of agent or titration goal. PTB was usually titrated to EEG background suppression by using intermittent EEG monitoring, whereas MDL and PRO were more often titrated to seizure suppression with continuous EEG monitoring. Compared with treatment with MDL or PRO, PTB treatment was associated with a lower frequency of short-term treatment failure (8 vs. 23% p < 0.01), breakthrough seizures (12 vs. 42% p < 0.001), and changes to a different cIV-AED (3 vs. 21%; p < 0.001), and a higher frequency of hypotension (systolic blood pressure