Lewena Stuart, Pennington Victoria, Acworth Jason, Thornton Susan, Ngo Peter, McIntyre Shona, Krieser David, Neutze Jocelyn, Speldewinde Deirdre
Royal Children's Hospital, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Pediatr Emerg Care. 2009 Feb;25(2):83-7. doi: 10.1097/PEC.0b013e318196ea6e.
To perform a multicenter study examining the presentations and emergency management of children with convulsive status epilepticus (CSE) to sites within the Paediatric Research in Emergency Departments International Collaborative.
Retrospective review of children presenting to emergency departments (EDs) with convulsive seizures of at least 10 minutes' duration. Eight sites within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand participated. Patients were identified through a search of ED electronic records for the period January 2000 to December 2004.
Data were obtained from 542 eligible episodes of CSE. Demographics and seizure history were similar across all sites. One third of children with CSE presented with their first seizure. A preexisting diagnosis that predisposed to seizures was present in 59%. Median duration of seizures before hospitalization was 45 minutes, and median duration of treatment in ED before termination was 30 minutes. Prehospital duration did not seem to influence the timing of key ED interventions such as the administration of second-line anticonvulsants or progression to rapid sequence induction (RSI) of anesthesia and intubation. Convulsive status epilepticus was terminated after first-line treatment in 42%, second-line treatment in 35%, and RSI in 22%. One third of the patients had persistent seizure activity beyond 40 minutes of ED treatment. Marked variation in the use of RSI for refractory seizures was observed between sites.
Convulsive status epilepticus is an important neurological emergency, with many children experiencing prolonged seizures in both the prehospital and hospital phases. Persistent seizure activity beyond 40 minutes contrasts with current published guidelines. There is a need to adopt a widely accepted approach to the management of children who fail to respond to standard anticonvulsant therapy.
开展一项多中心研究，调查惊厥性癫痫持续状态（CSE）患儿在国际急诊儿科研究协作组各机构的临床表现及急救处理情况。
对在急诊科就诊、惊厥发作持续至少10分钟的患儿进行回顾性研究。澳大利亚和新西兰国际急诊儿科研究协作网络中的8个机构参与了研究。通过检索2000年1月至2004年12月期间急诊科的电子记录来确定患者。
获取了542例符合条件的CSE发作的数据。所有机构的人口统计学特征和癫痫发作史相似。三分之一的CSE患儿为首次发作。59%的患儿存在易引发癫痫发作的既往诊断。住院前癫痫发作的中位持续时间为45分钟，急诊科终止发作前治疗的中位持续时间为30分钟。院前持续时间似乎不影响急诊科关键干预措施的时机，如二线抗惊厥药物的使用或进展到麻醉快速顺序诱导（RSI）及插管。42%的患儿在一线治疗后终止惊厥性癫痫持续状态，35%在二线治疗后终止，22%在RSI后终止。三分之一的患者在急诊科治疗40分钟后仍有持续性癫痫活动。各机构间在难治性癫痫发作使用RSI方面存在显著差异。
惊厥性癫痫持续状态是一种重要的神经急症，许多患儿在院前和住院阶段都经历了长时间的癫痫发作。超过40分钟的持续性癫痫活动与当前发表的指南相悖。对于对标准抗惊厥治疗无反应的患儿，需要采用一种广泛接受的管理方法。
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