背景:苯二氮卓类药物是推荐的急性癫痫发作的一线治疗方法。我们希望比较疗效,副作用,咪达唑仑经颊给药后的满意度,鼻内,或肌内途径治疗儿童在家中和急诊室(ER)的急性癫痫发作。
方法:前瞻性,随机化,在1个月至17岁急性癫痫发作持续时间超过5分钟的儿童中进行了对照试验.主要终点是药物给药10分钟内癫痫发作停止,30分钟内没有癫痫发作复发。
结果:在主组中,67例患者经颊途径接受咪达唑仑,60通过鼻内途径,69通过肌内途径,而在ER组中,37例患者接受口腔治疗,34接受鼻内治疗,34人接受了肌内咪达唑仑。在家庭和ER组中,肌内注射咪达唑仑后的主要终点分别为94.2%和85.3%,分别。鼻内咪达唑仑成功停止癫痫发作在家庭组中占93.3%,在ER组中占88.2%。在家庭组中,口腔途径的有效率为91%,在ER组中为78.4%。家组和内质网组的疗效差异无统计学意义(P=0.763和P=0.509)。分别。各组均无明显心肺事件发生。
结论:肌内,鼻内,口服咪达唑仑可以缓解院前和急诊环境中的大部分癫痫发作。我们的结果表明,在咪达唑仑的不同途径之间没有发现统计学上的显着差异。鼻内途径在护理人员中的满意率最高。
BACKGROUND: Benzodiazepines are the recommended first-line treatment of acute seizures. We wished to compare the efficacy, side effects, and satisfaction after midazolam administration by the buccal, intranasal, or
intramuscular route in the treatment of acute seizures in children at homes and in emergency room (ER).
METHODS: A prospective, randomized, controlled trial was performed in children aged one month to 17 years with acute seizures lasting longer than five minutes. The primary end point was seizure cessation within 10 minutes of drug administration and no seizure recurrence within 30 minutes.
RESULTS: In the home group, 67 patients received midazolam via buccal route, 60 via intranasal route, and 69 via
intramuscular route, whereas in the ER group, 37 patients received buccal, 34 received intranasal, and 34 received
intramuscular midazolam. The primary end point was achieved in 94.2% and 85.3% after
intramuscular midazolam in the home and ER groups, respectively. The intranasal midazolam was successful in stopping seizures in 93.3% in the home group and 88.2% in the ER group. The buccal route was effective in 91% in the home group and 78.4% in the ER group. There were no significant differences in efficacy between all groups (P = 0.763 and P = 0.509) among the home and ER groups, respectively. There were no significant cardiorespiratory events in all groups.
CONCLUSIONS: Intramuscular, intranasal, and buccal doses of midazolam resolved most seizures in prehospital and emergency settings. Our results indicate that there is no statistically significant difference detected between different routes of midazolam. Intranasal route showed the highest satisfaction rate among caregivers.