Nagase Hiroaki, Nishiyama Masahiro, Nakagawa Taku, Fujita Kyoko, Saji Yohsuke, Maruyama Azusa
Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Pediatr Neurol. 2014 Jul;51(1):78-84. doi: 10.1016/j.pediatrneurol.2014.02.021. Epub 2014 Mar 4.
We conducted a retrospective study to compare the outcome of intravenous midazolam infusion without electroencephalography or targeted temperature management and barbiturate coma therapy with electroencephalography and targeted temperature management for treating convulsive refractory febrile status epilepticus.
Of 49 consecutive convulsive refractory febrile status epilepticus patients admitted to the pediatric intensive care unit of our hospital, 29 were excluded because they received other treatments or because of various underlying illnesses. Thus, eight patients were treated with midazolam and 10 with barbiturate coma therapy using thiamylal. Midazolam-treated patients were intubated only when necessary, whereas barbiturate coma therapy patients were routinely intubated. Continuous electroencephalography monitoring was utilized only for the barbiturate coma group. The titration goal for anesthesia was clinical termination of status epilepticus in the midazolam group and suppression or burst-suppression patterns on electroencephalography in the barbiturate coma group. Normothermia was maintained using blankets and neuromuscular blockade in the barbiturate coma group and using antipyretics in the midazolam group. Prognoses were measured at 1 month after onset; children were classified into poor and good outcome groups.
Good outcome was achieved in all the barbiturate coma group patients and 50% of the midazolam group patients (P = 0.02, Fisher's exact test).
Although the sample size was small and our study could not determine which protocol element is essential for the neurological outcome, the findings suggest that clinical seizure control using midazolam without continuous electroencephalography monitoring or targeted temperature management is insufficient in preventing neurological damage in children with convulsive refractory febrile status epilepticus.
我们进行了一项回顾性研究，比较在无脑电图监测或目标体温管理情况下静脉输注咪达唑仑与采用脑电图监测及目标体温管理的巴比妥类药物昏迷疗法治疗惊厥性难治性热性惊厥持续状态的疗效。
在我院儿科重症监护病房收治的49例连续惊厥性难治性热性惊厥持续状态患者中，29例因接受了其他治疗或存在各种基础疾病而被排除。因此，8例患者接受了咪达唑仑治疗，10例患者接受了硫喷妥钠巴比妥类药物昏迷疗法。接受咪达唑仑治疗的患者仅在必要时插管，而接受巴比妥类药物昏迷疗法的患者常规插管。仅对巴比妥类药物昏迷组进行连续脑电图监测。咪达唑仑组麻醉的滴定目标是临床终止癫痫持续状态，巴比妥类药物昏迷组是脑电图上出现抑制或爆发抑制模式。在巴比妥类药物昏迷组使用毯子和神经肌肉阻滞剂维持正常体温，在咪达唑仑组使用退烧药。在发病后1个月评估预后；将儿童分为预后不良和良好组。
巴比妥类药物昏迷组所有患者及咪达唑仑组50%的患者预后良好（P = 0.02，Fisher精确检验）。
尽管样本量小且我们的研究无法确定哪种方案要素对神经学转归至关重要，但研究结果表明，在无连续脑电图监测或目标体温管理的情况下使用咪达唑仑进行临床癫痫控制，不足以预防惊厥性难治性热性惊厥持续状态儿童的神经损伤。
