Shaner D M, McCurdy S A, Herring M O, Gabor A J
Department of Neurology, University of California, Davis Medical Center, Sacramento 95817.
Neurology. 1988 Feb;38(2):202-7. doi: 10.1212/wnl.38.2.202.
In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p less than 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p less than 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.
在一项随机、非盲法的临床试验中，36例连续性全身惊厥性癫痫持续状态患者接受了地西泮与苯妥英联合治疗（DZ/DPH）或苯巴比妥（PB）治疗。如果在开始治疗后10分钟癫痫发作仍持续，则在PB治疗方案中加用苯妥英。PB组的累积惊厥时间（在主动惊厥运动中花费的总时间）比DZ/DPH组短（中位数分别为5分钟和9分钟，p<0.06）；PB组的反应潜伏期（从开始治疗到最后一次惊厥结束的时间）也较短（中位数分别为5.5分钟和15分钟，p<0.10）。PB治疗方案的累积惊厥时间中位数比DZ/DPH治疗方案短0至14分钟（95%置信区间）。同样，PB治疗方案的反应潜伏期中位数比DZ/DPH治疗方案长1分钟至短20分钟（95%置信区间）。两组的插管、低血压和心律失常发生率相似。PB组18例患者中有11例对苯巴比妥单药治疗有反应。我们得出结论，与DZ/DPH治疗方案相比，PB治疗方案起效迅速、安全性相当且具有某些实际优势。
