Harbord M G, Kyrkou N E, Kyrkou M R, Kay D, Coulthard K P
Department of Paediatrics and Child Health, Flinders Medical Centre, Adelaide, South Australia 5042, Australia.
J Paediatr Child Health. 2004 Sep-Oct;40(9-10):556-8. doi: 10.1111/j.1440-1754.2004.00463.x.
To evaluate the acceptability of intranasal midazolam (INM) in acute seizure management in the community.
Parents and staff in residential and educational settings were trained in first aid and seizure management and the administration of INM. Feedback was obtained from those who had given INM over the 30-month period September 2000-March 2003.
Intranasal midazolam was administered to 22 children for a total of 54 seizures (range 1-6 seizures each). The dose was 0.2-0.3 mg/kg rounded down to 1 or 2 of the 5 mg in 1-mL plastic ampoules, with the anticonvulsant instilled into the child's nose directly from the plastic ampoule. Seizures were effectively stopped on 48 occasions, i.e. 89%, while no respiratory arrests occurred. Thirty carers had given INM to a convulsing child and 27 (90%) reported no difficulty in administering it. Fifteen people had also previously administered rectal diazepam and INM was considered easier to administer than rectal diazepam by 13 while a preference to use INM rather than rectal diazepam was indicated by 14.
This study has shown that INM is an acceptable treatment option as a first aid response for acute seizures. We believe that INM should be considered as the preferred alternative in the community setting, as it is easier to administer and is more dignified for the patient than rectal diazepam.
评估鼻内咪达唑仑（INM）在社区急性癫痫发作管理中的可接受性。
对住宿和教育机构中的家长及工作人员进行急救、癫痫发作管理及INM给药方面的培训。收集了2000年9月至2003年3月这30个月期间使用过INM的人员的反馈。
对22名儿童使用了鼻内咪达唑仑，共发生54次癫痫发作（每人1 - 6次发作）。剂量为0.2 - 0.3mg/kg，向下取整为1或2个1mL塑料安瓿中的5mg，抗惊厥药直接从塑料安瓿滴入儿童鼻腔。48次发作（即89%）的癫痫有效停止，且未发生呼吸骤停。30名护理人员对惊厥儿童使用过INM，27名（90%）报告给药无困难。15人之前也使用过直肠地西泮，13人认为INM比直肠地西泮更容易给药，14人表示更倾向于使用INM而非直肠地西泮。
本研究表明，INM作为急性癫痫发作的急救措施是一种可接受的治疗选择。我们认为，在社区环境中应将INM视为首选替代药物，因为它比直肠地西泮更容易给药，且对患者来说更体面。
