Igartua J, Silver P, Maytal J, Sagy M
Division of Critical Care Medicine, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Crit Care Med. 1999 Sep;27(9):1982-5. doi: 10.1097/00003246-199909000-00043.
To implement and retrospectively evaluate a therapeutic algorithm for the treatment of refractory status epilepticus with midazolam coma.
Eight consecutive patients with refractory status epilepticus were mechanically ventilated. Their arterial and central venous blood pressures were continuously monitored by indwelling vascular catheters. These patients were also continuously monitored by a 16-channel video electroencephalogram (EEG). A midazolam bolus of 0.15 mg/kg was administered, and a continuous infusion of 1-2 microg/kg/min was started. If seizures continued, the infusion was increased every 15 mins by 1-2 microg/kg/min. If seizures stopped and/or burst suppression was achieved, the patients continued to receive that dose for 48 hrs and were then weaned by decrements of 1-2 microg/kg/min every 15 mins.
The patients' ages ranged from 17 days to 16 yrs, and they had various underlying diseases. In five of the eight patients, cessation of seizures occurred before achieving burst suppression on EEG, in two patients, cessation occurred during burst suppression, and in one patient, no response before or during burst suppression was encountered. The maximal midazolam doses required to achieve cessation of seizures and/or burst suppression, whichever came first, ranged from 4-24 microg/kg/min, with a mean of 14 +/- 6 microg/kg/min. The patients maintained stable cardiovascular function while receiving the maximal dose of midazolam and did not require inotropic support.
Midazolam infusion, as per our described algorithm, is effective in terminating refractory status epilepticus. This treatment is not associated with cardiovascular instability, even at doses resulting in burst suppression. In the majority of cases, cessation of seizures occur before burst suppression is achieved on EEG.
实施并回顾性评估一种使用咪达唑仑昏迷治疗难治性癫痫持续状态的治疗方案。
连续8例难治性癫痫持续状态患者接受机械通气。通过留置血管导管持续监测其动脉和中心静脉血压。这些患者还通过16通道视频脑电图（EEG）进行持续监测。给予0.15 mg/kg的咪达唑仑推注，并开始以1 - 2μg/kg/min的速度持续输注。如果癫痫持续发作，每15分钟将输注速度增加1 - 2μg/kg/min。如果癫痫发作停止和/或实现爆发抑制，患者继续接受该剂量48小时，然后每15分钟以1 - 2μg/kg/min的递减速度撤药。
患者年龄从17天至16岁不等，患有各种基础疾病。8例患者中有5例在脑电图上实现爆发抑制之前癫痫发作停止，2例患者在爆发抑制期间发作停止，1例患者在爆发抑制之前或期间无反应。实现癫痫发作停止和/或爆发抑制（以先出现者为准）所需的最大咪达唑仑剂量为4 - 24μg/kg/min，平均为14±6μg/kg/min。患者在接受最大剂量咪达唑仑时维持稳定的心血管功能，无需使用血管活性药物支持。
按照我们描述的方案输注咪达唑仑可有效终止难治性癫痫持续状态。即使在导致爆发抑制的剂量下，这种治疗也不会导致心血管不稳定。在大多数情况下，癫痫发作在脑电图实现爆发抑制之前停止。
