Midazolam Versus Diazepam for the Treatment of Status Epilepticus in Children and Young Adults: A Meta-analysis
Midazolam Versus Diazepam for the Treatment of Status Epilepticus in Children and Young Adults: A Meta-analysis
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DOI：
10.1111/j.1553-2712.2010.00751.x
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发表时间：
2010-06-01
影响因子：
4.4
通讯作者：
Silbergleit, Robert
中科院分区：
文献类型：
--
作者：
McMullan, Jason;Sasson, Comilla;Silbergleit, Robert
背景：癫痫持续状态(SE)的快速治疗与较好的预后相关。安定和咪达唑仑是常用的药物，但最佳的给药途径和给药途径尚不清楚。目的：通过系统评价，确定非静脉(非静脉)咪达唑仑在终止儿童和成人SE发作方面是否与安定一样有效。方法：应用计算机检索PubMed、Web of Knowledge、Embase、Cochrane系统综述数据库、效果综述摘要数据库、美国医师学会期刊俱乐部、Cochrane对照试验中央注册表、护理与相关健康文献累积索引、国际药学文摘，检索时间为1950年1月1日至2009年7月4日。符合条件的英文准试验性或随机对照试验比较咪达唑仑和安定作为SE的一线治疗，并满足基于CONSORT的综合试验报告标准(CONSORT)。两名评价者独立筛选纳入研究并提取结果数据。给药途径分为非IV(口腔、鼻腔、肌肉、直肠)或IV。固定效应模型产生汇总统计。结果：纳入6项研究，涉及774名受试者。在停止癫痫发作方面，咪达唑仑在任何一种途径上都优于安定(相对危险度[RR]=1.52；95%可信区间[CI]=1.27-1.82)。非静脉注射咪达唑仑与静脉注射地西安定的效果相同(RR=0.79；95%CI=0.19~3.36)，而口腔咪达唑仑在控制癫痫发作方面优于直肠安定(RR=1.54；95%CI=1.29~1.85)。咪达唑仑用药时间比安定快(平均差2.46分钟；95%CI=1.52~3.39分钟)，用药时间与停药时间相近。不同给药途径需要干预的呼吸道并发症相似(RR=1.49；95%CI=0.25~8.72)。结论：非静脉用咪达唑仑治疗SE安全有效。与劳拉西潘比较，需要对成人进行评估，并对安全性和有效性进行前瞻性确认。学术急救医学2010；17：575-582(C)2010，学术急救医学学会
Background: Rapid treatment of status epilepticus (SE) is associated with better outcomes. Diazepam and midazolam are commonly used, but the optimal agent and administration route is unclear.Objectives: The objective was to determine by systematic review if nonintravenous (non-IV) midazolam is as effective as diazepam, by any route, in terminating SE seizures in children and adults. Time to seizure cessation and respiratory complications was examined.Methods: We performed a search of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, American College of Physicians Journal Club, Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, and International Pharmaceutical Abstracts for studies published January 1, 1950, through July 4, 2009. English language quasi-experimental or randomized controlled trials comparing midazolam and diazepam as first-line treatment for SE, and meeting the Consolidated Standards of Reporting Trials (CONSORT)-based quality measures, were eligible. Two reviewers independently screened studies for inclusion and extracted outcomes data. Administration routes were stratified as non-IV (buccal, intranasal, intramuscular, rectal) or IV. Fixed-effects models generated pooled statistics.Results: Six studies with 774 subjects were included. For seizure cessation, midazolam, by any route, was superior to diazepam, by any route (relative risk [RR] = 1.52; 95% confidence interval [CI] = 1.27 to 1.82). Non-IV midazolam is as effective as IV diazepam (RR = 0.79; 95% CI = 0.19 to 3.36), and buccal midazolam is superior to rectal diazepam in achieving seizure control (RR = 1.54; 95% CI = 1.29 to 1.85). Midazolam was administered faster than diazepam (mean difference = 2.46 minutes; 95% CI = 1.52 to 3.39 minutes) and had similar times between drug administration and seizure cessation. Respiratory complications requiring intervention were similar, regardless of administration route (RR = 1.49; 95% CI = 0.25 to 8.72).Conclusions: Non-IV midazolam, compared to non-IV or IV diazepam, is safe and effective in treating SE. Comparison to lorazepam, evaluation in adults, and prospective confirmation of safety and efficacy is needed. ACADEMIC EMERGENCY MEDICINE 2010; 17:575-582 (C) 2010 by the Society for Academic Emergency Medicine