儿童惊厥性癫痫持续状态发作至抗惊厥药物给药的时间。
Time from convulsive status epilepticus onset to anticonvulsant administration in children.
作者信息
Sánchez Fernández Iván, Abend Nicholas S, Agadi Satish, An Sookee, Arya Ravindra, Brenton James Nicholas, Carpenter Jessica L, Chapman Kevin E, Gaillard William D, Glauser Tracy A, Goodkin Howard P, Kapur Kush, Mikati Mohamad A, Peariso Katrina, Ream Margie, Riviello James, Tasker Robert C, Loddenkemper Tobias
机构信息
From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY.
出版信息
Neurology. 2015 Jun 9;84(23):2304-11. doi: 10.1212/WNL.0000000000001673. Epub 2015 May 6.
OBJECTIVE
To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).
METHODS
This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE.
RESULTS
We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p25-p75) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset).
CONCLUSIONS
The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings.
目的
描述小儿惊厥性癫痫持续状态（SE）发作至给予抗癫痫药物（AED）的时间间隔。
方法
这是一项于2011年6月至2013年6月进行的前瞻性观察队列研究。纳入惊厥性SE的儿科患者（1个月至21岁）。为研究SE各阶段给予AED的时间，我们将研究人群限制为对2种或更多类AED治疗无效或需要持续输注以终止惊厥性SE的患者。
结果
我们纳入了81例患者（44例男性），中位年龄为3.6岁。首次、第二次和第三次AED给药的中位（第25百分位数-第75百分位数）时间分别为SE发作后28（6-67）分钟、40（20-85）分钟和59（30-120）分钟。考虑AED类别，78例（96.3%）患者的初始AED为苯二氮䓬类药物，在换用非苯二氮䓬类AED之前给予了2（2-3）剂苯二氮䓬类药物。非苯二氮䓬类AED的首次和第二次给药时间分别为69（40-120）分钟和120（75-296）分钟。在64例院外SE发作的患者中，40例（62.5%）患者在入院前未接受任何AED治疗。在医院环境中，首次和第二次院内AED给药分别在SE发作后8（5-15）分钟和16（10-40）分钟给予（对于院内SE发作的患者）或入院后（对于院外SE发作的患者）。
结论
无论是在院前还是院内环境中，从SE发作到给予AED以及从一类AED升级到另一类AED的时间均延迟。
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