Chiulli D A, Terndrup T E, Kanter R K
Department of Internal Medicine, State University of New York Health Science Center, Syracuse.
J Emerg Med. 1991 Jan-Apr;9(1-2):13-7. doi: 10.1016/0736-4679(91)90525-k.
Anticonvulsant management of status epilepticus (SE) may result in respiratory depression, often requiring endotracheal intubation (ETI). By examining rates of ETI in childhood SE after intravenous diazepam or lorazepam, when administered alone or in combination with phenytoin, the influence of anticonvulsants on the frequency of ETI during SE was determined. The medical records of 142 consecutive children younger than 16 years of age admitted from a university hospital ED with seizures during a 28-month period were retrospectively reviewed. SE was identified in 38 (27%) of cases. Records of children with SE were reviewed for demographic, seizure severity, and management variables. Twelve patients were excluded, ten of whom received concomitant phenobarbital. Patients receiving lorazepam had ETI rate of 27% (4/15), compared to 73% (8/11) in the diazepam group (P = 0.026, Fisher's exact). The groups were not significantly different in age, weight, sex, seizure type, seizure duration, and appropriate anticonvulsant dosage. A prospective, randomized trial comparing lorazepam and diazepam is warranted to confirm the apparent advantage of lorazepam in reducing respiratory depression.
癫痫持续状态（SE）的抗惊厥治疗可能导致呼吸抑制，常常需要进行气管插管（ETI）。通过检查静脉注射地西泮或劳拉西泮（单独使用或与苯妥英联合使用）后儿童SE的ETI发生率，确定了抗惊厥药物对SE期间ETI频率的影响。回顾性分析了一所大学医院急诊科在28个月期间收治的142例16岁以下因癫痫发作入院的连续儿童的病历。38例（27%）确诊为SE。对SE患儿的病历进行了人口统计学、癫痫发作严重程度和治疗变量的审查。12例患者被排除，其中10例同时接受了苯巴比妥治疗。接受劳拉西泮治疗的患者ETI发生率为27%（4/15），而地西泮组为73%（8/11）（P = 0.026，Fisher精确检验）。两组在年龄、体重、性别、癫痫发作类型、发作持续时间和适当的抗惊厥药物剂量方面无显著差异。有必要进行一项比较劳拉西泮和地西泮的前瞻性随机试验，以证实劳拉西泮在减轻呼吸抑制方面的明显优势。
