Rainbow J, Browne G J, Lam L T
Department of Emergency Medicine, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
J Paediatr Child Health. 2002 Dec;38(6):582-6. doi: 10.1046/j.1440-1754.2002.00046.x.
To determine which is the most effective and safe treatment for controlling seizures in children out-of-hospital: diazepam or midazolam.
A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW-ED) with seizures requiring treatment in the field by paramedics was carried out over a 4-year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise.
Over the 4-year period, 2566 children presented to CHW-ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05).
Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.
确定在院外控制儿童癫痫发作最有效且安全的治疗方法：地西泮还是咪达唑仑。
对在4年期间（1996年4月至2000年3月）因癫痫发作被护理人员在现场进行治疗而送至韦斯特米德儿童医院急诊科（CHW-ED）的儿童病历进行回顾性研究。在新南威尔士州，1998年3月之前，院外癫痫发作的儿童接受每千克体重0.5毫克直肠给药（p.r.）或0.1毫克/千克静脉注射地西泮，从1997年3月起，他们接受0.15毫克/千克肌肉注射或0.1毫克/千克静脉注射咪达唑仑。主要测量结果是院外癫痫发作停止。次要结果是开始治疗的时间和心肺功能不全的发生率。
在这4年期间，2566名儿童因癫痫发作被送至CHW-ED；107名儿童符合纳入本研究的条件。在这107名患者中，62名接受了地西泮治疗，45名接受了咪达唑仑治疗。地西泮组中有31名（50.0%）、咪达唑仑组中有15名（33.3%）为热性惊厥。两组在人口统计学和癫痫发作类型方面相似。地西泮与咪达唑仑的比较表明，两种药物在给药后5分钟内均能有效停止癫痫发作（37.1%对51.1%）。咪达唑仑组呼吸暂停的患者较少（20.0%对29.0%；P<0.05）。
在院外环境中，咪达唑仑控制癫痫发作的效果与地西泮相同。此外，咪达唑仑可能会减少呼吸抑制和治疗时间。
