Holsti Maija, Sill Benjamin L, Firth Sean D, Filloux Francis M, Joyce Steven M, Furnival Ronald A
Division of Pediatric Emergency Medicine, Department of Pediatrics, Primary Children's Medical Center/University of Utah, Salt Lake City, UT 84158, USA.
Pediatr Emerg Care. 2007 Mar;23(3):148-53. doi: 10.1097/PEC.0b013e3180328c92.
The local emergency medical services (EMS) council implemented a new pediatric treatment protocol using a Mucosal Atomization Device (MAD) to deliver intranasal (IN) midazolam for seizure activity.
We sought to compare outcomes in seizing pediatric patients treated with IN midazolam using a MAD (IN-MAD midazolam) to those treated with rectal (PR) diazepam, 18 months before and after the implementation of the protocol.
Of 857 seizure patients brought by EMS to our emergency department (ED), 124 patients (14%) had seizure activity in the presence of EMS and were eligible for inclusion in this study. Of the 124 patients eligible for this study, 67 patients (54%) received no medications in the prehospital setting, 39 patients (32%) were treated with IN-MAD midazolam, and 18 patients (15%) were treated with PR diazepam. Median seizure time noted by EMS was 19 minutes longer for PR diazepam (30 minutes) when compared with IN-MAD midazolam (11 minutes, P = 0.003). Patients treated with PR diazepam in the prehospital setting were significantly more likely to have a seizure in the ED (odds ratio [OR], 8.4; confidence interval [CI], 1.6-43.7), ED intubation (OR, 12.2; CI, 2.0-75.4), seizure medications in the ED to treat ongoing seizure activity (OR, 12.1; CI, 2.2-67.8), admission to the hospital (OR, 29.3; CI, 3.0-288.6), and admission to the pediatric intensive care unit (OR, 53.5; CI, 2.7-1046.8).
The IN-MAD midazolam controlled seizures better than PR diazepam in the prehospital setting and resulted in fewer respiratory complications and fewer admissions.
当地紧急医疗服务（EMS）委员会实施了一项新的儿科治疗方案，使用黏膜雾化装置（MAD）经鼻给予咪达唑仑以控制癫痫发作。
我们试图比较在该方案实施前后18个月，使用MAD经鼻给予咪达唑仑（经鼻 - MAD咪达唑仑）治疗的癫痫患儿与直肠给予地西泮（PR地西泮）治疗的患儿的治疗结果。
在857例由EMS送至我们急诊科（ED）的癫痫患者中，124例患者（14%）在EMS在场时出现癫痫发作，符合纳入本研究的条件。在这124例符合本研究条件的患者中，67例患者（54%）在院前未接受任何药物治疗，39例患者（32%）接受了经鼻 - MAD咪达唑仑治疗，18例患者（15%）接受了PR地西泮治疗。与经鼻 - MAD咪达唑仑（11分钟）相比，EMS记录的PR地西泮治疗组癫痫发作的中位时间长19分钟（30分钟，P = 0.003）。在院前接受PR地西泮治疗的患者在ED中癫痫发作的可能性显著更高（优势比[OR]，8.4；置信区间[CI]，1.6 - 43.7），ED插管（OR，12.2；CI，2.0 - 75.4），在ED中使用癫痫药物治疗持续的癫痫发作活动（OR，12.1；CI，2.2 - 67.8），住院（OR，29.3；CI，3.0 - 二十八十八点六），以及入住儿科重症监护病房（OR，53.5；CI，2.7 - 1046.8）。
在院前环境中，经鼻 - MAD咪达唑仑比PR地西泮能更好地控制癫痫发作，且导致的呼吸并发症和住院人数更少。
