Iyer Vivek N, Hoel Rebecca, Rabinstein Alejandro A
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Crit Care Med. 2009 Dec;37(12):3024-30. doi: 10.1097/CCM.0b013e3181b08ac7.
Propofol is a sedative, anesthetic, and antiepileptic agent that is frequently used in patients with refractory status epilepticus. Propofol infusion syndrome is a feared complication of propofol use, especially at high infusion rates for prolonged periods. The present study describes the use of propofol and its associated complications in patients with refractory status epilepticus.
: Retrospective study with outcome assessment.
Intensive care units at Mayo Clinic.
Intensive care unit admissions with refractory status epilepticus.
None.
A computer-assisted search identified 41 consecutive patients from January 1997 to September 2008 admitted to our intensive care unit with refractory status epilepticus, defined by the need for continuous intravenous infusion of anesthetic agents to control seizures. Propofol infusion syndrome was defined per previously published criteria. The study population consisted of 24 males and 17 females with a median age of 51 yrs (range, 0.25- 80). Propofol was used in 31 (76%) of these patients (propofol group), and other agents like midazolam, lorazepam, and pentobarbital were used in the other ten (24%) patients (nonpropofol group). Median hospital (12 days; range, 2-112) and intensive care unit length of stay (9 days; range, 2-95) did not differ among the two groups. Propofol was used for a median of 63 hrs (range, 2-391) with a median cumulative dosage of 12,750 mg (range, 336-57,545). The median peak infusion rate was 67 microg/kg/min (range, 19-200). There were three sudden unexplained cardiorespiratory arrests in the propofol group (3 of 31, 10%), of which two were fatal. These three patients were aged 37, 46, and 55 yrs and had no prior cardiopulmonary disease. Eleven additional patients (11 of 31, 35%) had non-life-threatening features of propofol infusion syndrome. There were no such events noted in the nonpropofol group.
The prolonged use of large doses of propofol to treat refractory status epilepticus was associated with significant mortality and morbidity.
丙泊酚是一种镇静、麻醉和抗癫痫药物，常用于难治性癫痫持续状态患者。丙泊酚输注综合征是丙泊酚使用中令人担忧的并发症，尤其是长时间高输注速率时。本研究描述了丙泊酚在难治性癫痫持续状态患者中的使用及其相关并发症。
带有结果评估的回顾性研究。
梅奥诊所的重症监护病房。
因难治性癫痫持续状态入住重症监护病房的患者。
无。
通过计算机辅助检索，确定了1997年1月至2008年9月期间连续41例因难治性癫痫持续状态入住我们重症监护病房的患者，难治性癫痫持续状态定义为需要持续静脉输注麻醉剂以控制癫痫发作。丙泊酚输注综合征根据先前发表的标准定义。研究人群包括24名男性和17名女性，中位年龄为51岁（范围0.25 - 80岁）。其中31例（76%）患者使用了丙泊酚（丙泊酚组），另外10例（24%）患者使用了咪达唑仑、劳拉西泮和戊巴比妥等其他药物（非丙泊酚组）。两组患者的中位住院时间（12天；范围2 - 112天）和重症监护病房住院时间（9天；范围2 - 95天）无差异。丙泊酚使用的中位时间为63小时（范围2 - 391小时），中位累积剂量为12,750毫克（范围336 - 57,545毫克）。中位峰值输注速率为67微克/千克/分钟（范围19 - 200微克/千克/分钟）。丙泊酚组有3例（31例中的3例，10%）出现不明原因的突然心肺骤停，其中2例死亡。这3例患者年龄分别为37岁、46岁和55岁，既往无心肺疾病。另外11例患者（31例中的11例，35%）出现丙泊酚输注综合征的非危及生命特征。非丙泊酚组未观察到此类事件。
大剂量丙泊酚长时间用于治疗难治性癫痫持续状态与显著的死亡率和发病率相关。
