咪达唑仑鼻内给药治疗儿童癫痫持续状态的Meta分析
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摘要
目的评价咪达唑仑经鼻腔给药控制儿童癫痫持续状态的有效性及安全性,为院前急救提供参考。方法计算机网上检索PubMed、Cochrane图书馆、中国期刊全文数据库和万方数据库,收集咪达唑仑对比地西泮治疗癫痫持续状态的随机对照研究(RCT),采用RevMan5.3软件对提取的数据进行分析。结果初检出257篇文献(PubMed 145篇,Cochrane图书馆78篇,CNKI 28篇,万方6篇),根据纳入与排除标准筛选,共有6篇RCT文献,465例病人纳入。Meta分析显示:(1)咪达唑仑经鼻腔给药的快速控制效果(10 min内)与地西泮经静脉给药无明显差异[RR值(95%CI)为:0.99(0.92,1.07),P=0.88],但较地西泮经直肠给药好[RR值(95%CI)为:1.14(1.05,1.25),P=0.003]。(2)咪达唑仑经鼻腔给药(鼻咪)的显效时间较地西泮经静脉给药短(地静)[RR值(95%CI)为:0.72(0.19,1.25),P=0.007]。(3)咪达唑仑经鼻腔给药与地西泮(静脉或直肠)不良反应(主要是呼吸抑制)差异无统计学意义[鼻咪vs.地静RR值(95%CI)为:0.29(0.01,6.69),P=0.44;鼻咪vs.地直RR值(95%CI)为:0.29(0.01,8.43),P=0.52]。结论咪达唑仑经鼻给药疗效确切、操作方便、起效迅速,可成为院外患儿父母、监护人等急救癫痫持续状态便捷而又可靠的选择,为送往医疗机构进一步诊治赢得宝贵时间。
Objective To evaluate the efficacy and safety of Midazolam in the treatment of children with status epilepticus(SE) and to provide reference for pre-hospital care.Methods A computer-based retrieval of PubMed,Cochrane library,Chinese Journal Full-text Database and Wanfang database was conducted to collect randomized controlled trials(RCT) of midazolam compared with diazepam in the treatment of status epilepticus.RevMan 5.3 software was used to analyze the extracted data.Results There were 257 articles(145 from PubMed,78 from Cochrane,28 from CNKI,6 from Wanfang) detected.According to the inclusion and exclusion criteria,a total of 6 articles were included in the study,covering a total of 465 cases.Meta-analysis results were as follows:there was no significant difference between intranasal Midazolam by fast control effect(within 10 min) and intravenous Diazepam [RR value(95%CI):0.99(0.92,1.07),P=0.88],but the fast control effect of intranasal Midazolam was better than that of rectal Diazepam [RR value(95%CI):1.14(1.05,1.25),P=0.003];intranasal Midazolam had shorter effective time than Diazepam [RR value(95%CI):0.72(0.19,1.25),P=0.007];there was no significant difference between intranasal Midazolam and intravenous or rectal Diazepam in adverse reactions(mainly respiratory inhibition) [intranasal Midazolam vs.intravenous Diazepam:RR value(95%CI):0.29(0.01,6.69),P=0.44;intranasal Midazolam vs.rectal Diazepam:RR value(95%CI):0.29(0.01,8.43),P=0.52].Conclusions Intranasal Midazolam has the advantages of definite efficacy,easy operation and fast acting,which can be used as a convenient and reliable choice for parents and guardians of pediatric patients in handling emergency SE to save time for further treatment in medical institutes.
Objective To evaluate the efficacy and safety of Midazolam in the treatment of children with status epilepticus(SE) and to provide reference for pre-hospital care.Methods A computer-based retrieval of PubMed,Cochrane library,Chinese Journal Full-text Database and Wanfang database was conducted to collect randomized controlled trials(RCT) of midazolam compared with diazepam in the treatment of status epilepticus.RevMan 5.3 software was used to analyze the extracted data.Results There were 257 articles(145 from PubMed,78 from Cochrane,28 from CNKI,6 from Wanfang) detected.According to the inclusion and exclusion criteria,a total of 6 articles were included in the study,covering a total of 465 cases.Meta-analysis results were as follows:there was no significant difference between intranasal Midazolam by fast control effect(within 10 min) and intravenous Diazepam [RR value(95%CI):0.99(0.92,1.07),P=0.88],but the fast control effect of intranasal Midazolam was better than that of rectal Diazepam [RR value(95%CI):1.14(1.05,1.25),P=0.003];intranasal Midazolam had shorter effective time than Diazepam [RR value(95%CI):0.72(0.19,1.25),P=0.007];there was no significant difference between intranasal Midazolam and intravenous or rectal Diazepam in adverse reactions(mainly respiratory inhibition) [intranasal Midazolam vs.intravenous Diazepam:RR value(95%CI):0.29(0.01,6.69),P=0.44;intranasal Midazolam vs.rectal Diazepam:RR value(95%CI):0.29(0.01,8.43),P=0.52].Conclusions Intranasal Midazolam has the advantages of definite efficacy,easy operation and fast acting,which can be used as a convenient and reliable choice for parents and guardians of pediatric patients in handling emergency SE to save time for further treatment in medical institutes.
引文
[1] CHENW B,GAO R,SU YY,et al.Valproate versus diazepam for generalized convulsive status epilepticus:a pilot study[J].Eur J Neurol,2011,18(12):1391-1396.
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[3] 陈卫碧,宿英英,高冉,等.全面惊厥性癫痫持续状态预后不良的相关因素分析 [J].神经疾病与精神卫生,2013,13(3):240-243
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[6] LOWENSTEIN DH,BLECK T,MACDONALD RL.It's time to revise the definition of status epilepticus[J].Epilepsia,1999,40(1):120-122.
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[8] TRINKA E,COCK H,HESDORFFER D,et al.A definition and classification of status epilepticus:report of the ilae task force on classification of status epilepticus[J].Epilepsia,2015,56(10):1515-1523.
[9] SADEGH AB.Comparison of intranasal administration of xylazine,diazepam,and midazolam in budgerigars (Melopsittacus undulatus):clinical evaluation[J].J Zoo Wildl Med,2013,44(2):241-244.
[10] DUNDEE JW,HALLIDAY NJ,HARPER KW,et al.Midazolam.A review of its pharmacological properties and therapeutic use[J].Drugs,1984,28(6):519-543.
[11] LAHAT E,GOLDMAN M,BARR J,et al.Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children:prospective randomised study[J].BMJ,2000,321(7253):83-86.
[12] MAHMOUDIA NT,ZADEHMM.Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children[J].Epilepsy Behav,2004,5(2):253-255.
[13] JAVADZADE HM,SHEIBANI K,HASHEMIEH M,et al.Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure:a randomized clinical trial[J].Iran J Pediatr,2012,22(1):1-8.
[14] THAKKER A,SHANBAG P.A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures[J].J Neurol,2013,260(2):470-474.
[15] FI?GIN T,GURER Y,TEZI? T,et al.Effects of intranasal midazolam and rectal diazepam on acute convulsions in children:prospective randomized study[J].J Child Neurol,2002,17(2):123-126.
[16] BHATTACHARYYA M,KALRA V,GULATI S.Intranasal midazolam vs rectal diazepam in acute childhood seizures[J].PediatrNeurol,2006,34(5):355-359.
[2] TIAN F,SU YY,CHEN WB,et al.RSE prediction by EEG patterns in adult GCSE patients[J].Epilepsy Res,2013,105(1/2):174-182.
[3] 陈卫碧,宿英英,高冉,等.全面惊厥性癫痫持续状态预后不良的相关因素分析 [J].神经疾病与精神卫生,2013,13(3):240-243
[4] CAMFIELD PR,CAMFIELD CS.Antiepileptic drug therapy:when is epilepsy truly intractable?[J].Epilepsia,1996,37(s1):S60-S65.
[5] Koren G.Intranasal midazolam for febrile seizures.a step forward in treating a common and distressing condition[J].BMJ,2000,321(7253):64-65.
[6] LOWENSTEIN DH,BLECK T,MACDONALD RL.It's time to revise the definition of status epilepticus[J].Epilepsia,1999,40(1):120-122.
[7] ENGEL JJ,International League Against Epilepsy (ILAE).A proposed diagnostic scheme for people with epileptic seizures and with epilepsy:report of the ILAE task force on classification and terminology[J].Epilepsia,2001,42(6):796-803.
[8] TRINKA E,COCK H,HESDORFFER D,et al.A definition and classification of status epilepticus:report of the ilae task force on classification of status epilepticus[J].Epilepsia,2015,56(10):1515-1523.
[9] SADEGH AB.Comparison of intranasal administration of xylazine,diazepam,and midazolam in budgerigars (Melopsittacus undulatus):clinical evaluation[J].J Zoo Wildl Med,2013,44(2):241-244.
[10] DUNDEE JW,HALLIDAY NJ,HARPER KW,et al.Midazolam.A review of its pharmacological properties and therapeutic use[J].Drugs,1984,28(6):519-543.
[11] LAHAT E,GOLDMAN M,BARR J,et al.Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children:prospective randomised study[J].BMJ,2000,321(7253):83-86.
[12] MAHMOUDIA NT,ZADEHMM.Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children[J].Epilepsy Behav,2004,5(2):253-255.
[13] JAVADZADE HM,SHEIBANI K,HASHEMIEH M,et al.Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure:a randomized clinical trial[J].Iran J Pediatr,2012,22(1):1-8.
[14] THAKKER A,SHANBAG P.A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures[J].J Neurol,2013,260(2):470-474.
[15] FI?GIN T,GURER Y,TEZI? T,et al.Effects of intranasal midazolam and rectal diazepam on acute convulsions in children:prospective randomized study[J].J Child Neurol,2002,17(2):123-126.
[16] BHATTACHARYYA M,KALRA V,GULATI S.Intranasal midazolam vs rectal diazepam in acute childhood seizures[J].PediatrNeurol,2006,34(5):355-359.