咪达唑仑联用地西泮控制复发性热性惊厥及再发预防的研究

目的研究咪达唑仑联用地西泮治疗对热性惊厥患儿惊厥复发预防的作用、药物不良反应，以及对语言发育、智力发育、运动功能发育的影响。 方法选择潮州市人民医院普通儿科与梅州市人民医院儿童内科自2017年1月至12月收治84例热性惊厥患儿作为研究对象，根据随机数字表法分为观察组和对照组，每组42例，并根据患儿的年龄组内分为6个月~2岁年龄段和2岁以上~6岁年龄段。观察组采用咪达唑仑联合地西泮进行治疗，对照组采用地西泮进行治疗。比较不同年龄段2组患儿在2年随访期内热性惊厥复发率、药物不良反应，以及入组治疗后第24个月时语言发育商（DQ）、贝利婴幼儿发展量表中智力发育指数（MDI）和运动发育指数（PDI）差异。 结果6个月~2岁年龄段，观察组患儿的热性惊厥复发率低于对照组，差异有统计学意义（χ²=4.251，P=0.039），2岁以上~6岁年龄段，2组患儿的热性惊厥复发率差异无统计学意义（χ²=0.555，P=0.458），观察组总的热性惊厥复发率低于对照组，差异有统计学意义（χ²=4.141，P=0.042）。2组患儿在不同年龄段以及总体不良反应发生率差异均无统计学意义（P>0.05）。所有患儿入组时的DQ、MDI、PDI差异均无统计学意义（P>0.05）。治疗后，观察组6个月~2岁年龄段的患儿在DQ、MDI评分上优于对照组，差异有统计学意义（P<0.05），但PDI差异无统计学意义（P>0.05）；2组在2岁以上~6岁年龄段患儿治疗后DQ、MDI、PDI差异均无统计学意义（P>0.05）。 结论咪达唑仑联用地西泮治疗可以降低6个月~2岁年龄段热性惊厥患儿的惊厥复发率，不增加药物不良反应发生率，并且使患儿的语言发育和智力发育得到有效改善，但是对2岁以上~6岁年龄段热性惊厥患儿无明显临床效益。

Midazolam combined with diazepam for the control and prevention of recurrent febrile convulsion

ObjectiveTo explore the effect of midazolam combined with diazepam on the prevention of convulsion recurrence in children with febrile convulsion, the adverse drug reactions, as well as the effects on language development, intellectual development and motor function development. MethodsEighty-four children with febrile convulsion given treatment from January to December 2017 in Meizhou People’s Hospital and Chaozhou People’s Hospital were selected as the study subjects. According to the random number method, the patients were divided into observation group and control group, with 42 patients in each group. Meanwhile, according to the age group of the children, they were divided into 6 months to 2 years old and 2-6 years old. The observation group was treated with midazolam combined with diazepam, while the control group was treated with diazepam. Then, the rates of recurrent febrile convulsion, adverse drug reactions, and the differences in language development quotient (DQ), mental development index (MDI) and psychomotive development index (PDI) in the bailey infant and child development scale were compared between the two groups during the 2-year follow-up period corresponding to two age bracket. ResultsSix months to 2 years of age, the observation group of children with febrile convulsions recurrence rate is lower than the control group, the difference was statistically significant (χ²=4.251, P=0.039), aged 2-6 years old age group, two groups of children with hot convulsions recurrence rate no statistical differences (χ²=0.555, P=0.458), the observation group convulsion recurrence rate is lower than the control group, the total thermal resistance difference was statistically significant (χ²=4.141, P=0.042). There was no statistically significant difference between the two groups in the incidence of adverse reactions at different ages (P>0.05). There were no statistically significant differences in DQ, MDI or PDI at the age of 6 months to 2 years old (P>0.05). After treatment, children in the observation group had statistically significant differences in DQ and MDI scores in the control group (P<0.05), but there was no statistical difference in PDI (P>0.05). There were no statistically significant differences in DQ, MDI and PDI before and after treatment in children aged 2-6 years old (P>0.05). ConclusionSingle dose midazolam combined with diazepam can reduce the recurrence rate of convulsion in children with febrile convulsion from 6 months to 2 years old, without increasing the incidence of adverse drug reactions, and the language development and intellectual development of the patients can be effectively improved. However, this method has no obvious clinical benefit for children with febrile convulsion from 2-6 years old.