Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Epilepsy Res. 2011 Mar;94(1-2):53-60. doi: 10.1016/j.eplepsyres.2011.01.006.
To retrospectively study effect and safety of propofol treatment in adult refractory generalised tonic clonic status epilepticus.
Therapy refractory status epilepticus (RSE) is defined as a status that does not respond to 1st or 2nd line of treatment. Different anaesthetics are used to treat RSE, but no definite recommendations or priority has been scientifically established.
Propofol has been the preferred agent for treating RSE at our intensive care unit since 2001. We present treatment mode, effect and outcome in 18 patients with 27 consecutive cases of RSE treated 2001-2010. Fifteen patients had 1 episode, and 3 patients had 2, 3 and 7 episodes, respectively. Mortality risk for each case of RSE was estimated using the Simplified Acute Physiology (SAPS) II score.
Probable trigger factors were identified for 22 of the 27 RSE episodes. In 16/27 episodes seizures lasted more than 2h before anaesthesia was induced. A mean total dose of 7885.1mg was given for a mean duration of 34.4h. Break through seizures occurred in 8 of the patients and in 2 episodes of RSE in one patient, i.e. 9/27 episodes of RSE. Propofol was changed to another anaesthetic agent in 2 episodes. Complications occurred in 17 of the RSE episodes, the most frequent was pneumonia (9/27). One patient had complications that could be related to a propofol infusion syndrome (PRIS). In 8 of 18 patients and 14/27 RSE episodes no sequelae occurred. Seven episodes were associated with mild and 4 with severe sequelae and 2 of the patients died. We found a trend only for SAPS II score being higher in patients with more severe sequelae.
Our data support propofol as an effective anaesthetic for treating RSE. Close clinical observation for possible PRIS is warranted if propofol is given for more than 48h.
回顾性研究丙泊酚治疗成人难治性全面强直阵挛状态癫痫的疗效和安全性。
治疗抵抗性癫痫持续状态（RSE）定义为对一线或二线治疗无反应的状态。不同的麻醉剂被用于治疗 RSE，但没有科学地确定明确的建议或优先级。
自 2001 年以来，我们的重症监护病房一直将丙泊酚作为治疗 RSE 的首选药物。我们介绍了 2001 年至 2010 年期间治疗的 18 例 27 例连续 RSE 患者的治疗模式、疗效和结局。15 例患者发作 1 次，3 例患者分别发作 2、3 和 7 次。每个 RSE 病例的死亡风险用简化急性生理学评分（SAPS）Ⅱ评分估计。
27 例 RSE 发作中确定了 22 例可能的触发因素。在 16/27 例发作中，在麻醉诱导前，癫痫发作持续时间超过 2 小时。平均总剂量为 7885.1mg，持续时间平均为 34.4 小时。8 例患者中有 8 例出现突破性发作，1 例患者中有 2 例 RSE 发作，即 27 例 RSE 发作中有 9 例。2 例 RSE 发作中，丙泊酚被另一种麻醉剂取代。17 例 RSE 发作出现并发症，最常见的是肺炎（9/27）。1 例患者出现可能与丙泊酚输注综合征（PRIS）相关的并发症。18 例患者中的 8 例和 27 例 RSE 发作中的 14 例无后遗症。7 例与轻度后遗症相关，4 例与重度后遗症相关，2 例患者死亡。我们发现，只有 SAPS Ⅱ评分较高的患者的后遗症更严重。
我们的数据支持丙泊酚作为治疗 RSE 的有效麻醉剂。如果丙泊酚的使用时间超过 48 小时，则需要密切临床观察是否发生 PRIS。
