Sheridan David C, Spiro David M, Nguyen Thuan, Koch Thomas K, Meckler Garth D
Department of Pediatrics, Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA.
Pediatr Emerg Care. 2012 Dec;28(12):1293-6. doi: 10.1097/PEC.0b013e3182768a6b.
Limited progress has been made in the past decade for abortive treatment of migraine headache in the pediatric emergency department (PED). Propofol, a general anesthetic, has been reported to be effective in the treatment of refractory headaches in adults at subanesthetic doses but never in the pediatric population. The goal of this study was to review our institution's experience with subanesthetic doses of propofol for the abortive treatment of pediatric migraine and compare propofol with standard abortive therapy in the PED.
Retrospective review of all patients discharged from the Oregon Health and Science University PED with a diagnosis of migraine headache from January 2010 to July 2011. Patients treated with subanesthetic doses of propofol were compared with matched controls who received standard abortive migraine therapy, defined as the combined use of a nonsteroidal anti-inflammatory medication, diphenhydramine, and prochlorperazine. Outcome variables of interest included reduction of pain as measured on a self-reported visual analog scale and length of stay after administration of initial abortive medication.
Patients who received subanesthetic doses of propofol achieved significantly greater reduction in pain scores (80.1% vs 61.1%; P < 0.05) compared with matched controls as well as shorter stay (122 minutes vs 203 minutes; P = 0.2) after treatment. No adverse effects (hypotension, respiratory depression, or hypoxia) were recorded in either group.
Propofol seems to be effective for the abortive treatment of pediatric migraine headache in the PED. Further prospective trials are warranted to either support or refute these initial findings.
在过去十年中，儿科急诊科（PED）对偏头痛进行的紧急治疗进展有限。丙泊酚作为一种全身麻醉剂，据报道在亚麻醉剂量下对成人难治性头痛有效，但从未用于儿科患者。本研究的目的是回顾我们机构使用亚麻醉剂量丙泊酚对儿童偏头痛进行紧急治疗的经验，并将丙泊酚与PED中的标准紧急治疗方法进行比较。
回顾性分析2010年1月至2011年7月从俄勒冈健康与科学大学PED出院的所有诊断为偏头痛的患者。将接受亚麻醉剂量丙泊酚治疗的患者与接受标准偏头痛紧急治疗的匹配对照组进行比较，标准偏头痛紧急治疗定义为联合使用非甾体类抗炎药、苯海拉明和异丙嗪。感兴趣的结果变量包括自我报告的视觉模拟量表测量的疼痛减轻程度以及首次使用紧急药物后的住院时间。
与匹配对照组相比，接受亚麻醉剂量丙泊酚治疗的患者疼痛评分显著降低（80.1%对61.1%；P<0.05），治疗后住院时间也更短（122分钟对203分钟；P=0.2）。两组均未记录到不良反应（低血压、呼吸抑制或低氧血症）。
丙泊酚似乎对PED中儿童偏头痛的紧急治疗有效。需要进一步的前瞻性试验来支持或反驳这些初步发现。
