Nishiyama Masahiro, Nagase Hiroaki, Tomioka Kazumi, Tanaka Tsukasa, Yamaguchi Hiroshi, Ishida Yusuke, Toyoshima Daisaku, Fujita Kyoko, Maruyama Azusa, Kurosawa Hiroshi, Uetani Yoshiyuki, Nozu Kandai, Taniguchi-Ikeda Mariko, Morioka Ichiro, Takada Satoshi, Iijima Kazumoto
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Brain Dev. 2018 Nov;40(10):884-890. doi: 10.1016/j.braindev.2018.08.001. Epub 2018 Aug 23.
Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) had commonly been used as second-line treatments for pediatric status epilepticus (SE) in Japan. However, there is no comparative study of these two treatments.
We included consecutive children who 1) were admitted to Kobe Children's Hospital because of convulsion with fever and 2) were treated with either fPHT or cMDL as second-line treatment for convulsive SE lasting for longer than 30 min. We compared, between the fPHT and cMDL groups, the proportion of barbiturate coma therapy (BCT), incomplete recovery of consciousness, mechanical ventilation, and inotropic agents.
The proportion of BCT was not significantly different between the two groups (48.7% [20/41] in fPHT and 35.3% [29/82] in cMDL, p = 0.17). The prevalence of incomplete recovery of consciousness, mechanical ventilation, and inotropic agents was not different between the two groups. After excluding 49 patients treated with BCT, incomplete recovery of consciousness 6 h and 12 h after onset was more frequent in the cMDL group than in the fPHT group (71.7% vs. 33.3%, p < 0.01; 56.6% vs. 14.2%, p < 0.01; respectively). Mechanical ventilation was more frequent in the cMDL group than in the fPHT group (32.0% vs. 4.7%, p = 0.01).
Our results suggest that 1) the efficacy of fPHT and cMDL is similar, although cMDL may prevent the need for BCT compared with fPHT, and 2) fPHT is relatively safe as a second-line treatment for pediatric SE in patients who do not require BCT.
在日本，磷苯妥英（fPHT）和持续静脉输注咪达唑仑（cMDL）通常被用作小儿癫痫持续状态（SE）的二线治疗药物。然而，尚无这两种治疗方法的比较研究。
我们纳入了连续的儿童患者，这些儿童1）因发热惊厥入住神户儿童医院，2）接受fPHT或cMDL作为持续超过30分钟的惊厥性SE的二线治疗。我们比较了fPHT组和cMDL组之间巴比妥类昏迷疗法（BCT）的比例、意识未完全恢复的情况、机械通气和血管活性药物的使用情况。
两组之间BCT的比例无显著差异（fPHT组为48.7%[20/41]，cMDL组为35.3%[29/82]，p = 0.17）。两组之间意识未完全恢复、机械通气和血管活性药物的发生率无差异。在排除49例接受BCT治疗的患者后，cMDL组在发病后6小时和12小时意识未完全恢复的情况比fPHT组更常见（分别为71.7%对33.3%，p < 0.01；56.6%对14.2%，p < 0.01）。cMDL组的机械通气比fPHT组更频繁（32.0%对4.7%，p = 0.01）。
我们的结果表明，1）fPHT和cMDL的疗效相似，尽管与fPHT相比，cMDL可能减少对BCT的需求，2）对于不需要BCT的小儿SE患者，fPHT作为二线治疗相对安全。
