Shepherd S M
Division of Emergency Medicine, University of Florida Health Science Center/Jacksonville.
Emerg Med Clin North Am. 1994 Nov;12(4):941-61.
Significant advances in our understanding of the pathophysiology and evaluation and management of the patient in status epilepticus have markedly decreased associated morbidity and mortality in the last two decades. Any type of seizure can progress to status epilepticus. Identification and management of the cause is of particular importance for those patients for whom initial pharmacologic management fails. This subgroup of individuals tends to have important underlying metabolic, structural, toxic, or infectious causes that must be addressed. Those episodes associated with CNS pathology tend to have a more serious prognosis. Cause aside, appropriate, organized, and timely care will significantly effect outcome. Treatment goals are fourfold: (1) rapid stabilization of the individual, (2) expeditious termination of both clinical and electrical seizure activity, (3) determination and management of life-threatening precipitants, and (4) timely recognition and minimalization of any adverse physiologic sequelae of seizure activity. Benzodiazepines, phenytoin, and phenobarbital remain the most effective first-line and second-line pharmacologic agents. If these agents prove ineffective, appropriately monitored pentobarbital anesthesia appears to be the modality of choice and should be rapidly instituted.
在过去二十年中，我们对癫痫持续状态患者的病理生理学、评估及管理的理解取得了重大进展，显著降低了相关的发病率和死亡率。任何类型的癫痫发作都可能进展为癫痫持续状态。对于初始药物治疗失败的患者，病因的识别与管理尤为重要。这一亚组个体往往存在必须加以解决的重要潜在代谢、结构、毒性或感染性病因。那些与中枢神经系统病变相关的发作往往预后更严重。撇开病因不谈，恰当、有序且及时的护理将显著影响预后。治疗目标有四个：（1）迅速使个体稳定；（2）迅速终止临床和电发作活动；（3）确定并处理危及生命的诱因；（4）及时识别并尽量减少发作活动的任何不良生理后遗症。苯二氮䓬类药物、苯妥英和苯巴比妥仍然是最有效的一线和二线药物。如果这些药物证明无效，适当监测下的戊巴比妥麻醉似乎是首选方式，应迅速实施。
