咪唑安定治疗小儿全身性癫痫持续状态的临床观察

目的探讨咪唑安定治疗小儿全身性惊厥性癫痫持续状态的临床疗效。方法将72例小儿全身性惊厥性癫痫持续状态患者随机分为两组，治疗组38例给予静脉注射负荷量咪唑安定0．3mg·kg^-1后，用注射泵持续泵人咪唑安定，从2μg·kg^-1·min^-1起，每15min增加1μg·kg^-1·min^-1，最大剂量10μg·kg^-1·min^-1，至惊厥停止后，维持给药24h。对照组给地西泮0．3mg·kg^-1静脉注射，最大剂量不超过10mg，惊厥未停止或又出现另一次惊厥发作者，15min后再次注射同等剂量地西泮，同时使用苯巴比妥20mg·kg^-1静脉注射，12h后按5mg·kg^-1肌注维持。结果（1）治疗组惊厥完全控制35例，无效3例；对照组惊厥完全控制25例，无效9例，两者之间差异有统计学显著意义（P〈0．05）；（2）治疗组停药后患儿完全恢复清醒状态时间平均（8．2±4．1）h，对照组平均（14．3±6．7）h，两者比较差异有统计学极显著意义（P〈0．01）；（3）治疗组惊厥控制时间平均为（38±23）min，对照组平均为（48±29）min，两者比较差异有统计学显著意义（P〈0．05）；（4）静注负荷量咪唑安定仅出现一过性心率和血压下降。结论咪唑安定治疗小儿全身性惊厥性癫痫持续状态疗效肯定。

Clinical observation on effect of midazolam in treatment of convulsive status epilepticus in children

Objective To investigate the effect of midazolam in treatment of convulsive status epilepticus （CSE） in children. Methods Seventy-two cases of children with CSE were randomly divided into two groups ： Treatment group （38 cases） were treated by intravenous infusion of midazolam 0. 3 mg·kg^-1 first, and then given continuous intravenous infusion of midazolam by the injection pump, the initial dose was 2μg·kg^-1·min^-1 ,and increasing 1 μg·kg^-1·min^-1 for every 15 minutes, the maximum dose reached 10 μg·kg^-1·min^-1, after the convulsions stopped, the drug continue maintained for 24 hours. Control group treated by intravenous injection of diazepam 0. 3 mg·kg^-1, the maximum dose was not exceeding 10 mg, if the convulsions did not stopped or occurred another convulsion, re-injected the same dose of diazepam after 15 minutes, and treated by intravenous injection of phenobarbital 20 mg·kg^-1 in the same time, the maintainous dose of 5 mg·kg^-1 was given by intramuscular injection 12 hours later. Results （ 1 ） There were 35 cases whose convulsions were completely controlled, and 3 cases were invalid in treatment group; And there were 25 cases whose convulsions were completely controlled, and 9 cases were invalid in control group （ P 〈 0. 05 ） ; （2） It took （8.2 ± 4. 1 ） h for treatment group to fully recover, and （ 14. 3 ±6. 7 ） h for control group（P〈0. 01） ; （3）It took （38 ±23） minutes for treatment group to control CSE, and （48 ±29） minutes for control group（ P 〈 0.05 ） ; （4） Intravenous injected loading dose of midazolam only caused transient heart rate and blood pressure drop. Conclusion The effect of midazolam in treatment of CSE in children was positive.