Niermeijer Jikke-Mien F, Uiterwaal Cuno S P M, Van Donselaar Cees A
Rudolf Magnus Institute of Neuroscience, Dept. of Neurology, Section Epilepsy, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
J Neurol. 2003 Oct;250(10):1237-40. doi: 10.1007/s00415-003-0180-7.
Several guidelines recommend the use of propofol for the treatment of refractory status epilepticus. An increased mortality rate in high dose, long-term treatment with propofol in adult patients was published recently. This prompted us to assess the literature on the scientific evidence for the efficacy and safety of propofol in the treatment of refractory status epilepticus.
Medline was searched and the three authors independently reviewed all Medline abstracts for selection of papers.
We included 22 articles with original data on the use of propofol in refractory status epilepticus. Randomised clinical trials were lacking. Two non-randomised studies compared propofol with barbiturates and midazolam respectively. Both studies reported a higher risk of mortality for propofol. In addition, case reports and case series on the use of propofol as anaesthetic or sedative in children and adults reported several lethal cases.
Serious doubts may be raised on the safety of propofol in the treatment of refractory status epilepticus. The two non-randomised studies and several case reports show an increased risk of mortality. Guidelines should not recommend the use of propofol as a routine treatment in refractory status epilepticus before a proper randomised trial has been performed.
多项指南推荐使用丙泊酚治疗难治性癫痫持续状态。最近有研究报道，成年患者大剂量、长期使用丙泊酚会导致死亡率增加。这促使我们评估关于丙泊酚治疗难治性癫痫持续状态有效性和安全性的科学证据的文献。
检索了Medline数据库，三位作者独立审阅了所有Medline摘要以筛选论文。
我们纳入了22篇关于丙泊酚用于难治性癫痫持续状态的原始数据文章。缺乏随机临床试验。两项非随机研究分别将丙泊酚与巴比妥类药物和咪达唑仑进行了比较。两项研究均报告丙泊酚的死亡风险更高。此外，关于丙泊酚在儿童和成人中用作麻醉剂或镇静剂的病例报告和病例系列也报告了几例致死病例。
丙泊酚治疗难治性癫痫持续状态的安全性可能会受到严重质疑。两项非随机研究和几例病例报告显示死亡风险增加。在进行适当的随机试验之前，指南不应推荐将丙泊酚作为难治性癫痫持续状态的常规治疗方法。
