托吡酯快速负荷和咪达唑仑治疗难治性癫持续状态的疗效

Curative Effects of Rapid Loading of Topiramate and Midazolam on Refractory Status Epilepticus

目的比较托吡酯（topiramate,TPM）快速负荷与咪达唑仑（midazolam,MZ）治疗难治性癫持续状态（re-fractory status epilepticus,RSE）的临床疗效。方法将57例RSE患儿按不同的治疗方法分为2组：咪达唑仑组28例和托吡酯组29例。咪达唑仑组先采用MZ 0.1~0.2 mg.kg-1静脉推注,然后以0.1 mg.kg-1.h-1静脉泵泵注;30 min内仍发作者则继续加量,以0.05 mg.kg-1.h-1.次-1加量,加至0.4 mg.kg-1.h-1后,30 min内仍发作者则不再加量。托吡酯组先采用TPM 10 mg.kg-1.d-1分2次鼻饲或口服,连用2 d。2 d后改为5 mg.kg-1.d-1维持。2组患儿经首次方案治疗观察48 h无效则改为对应的另一治疗方案继续治疗并观察48 h。结果咪达唑仑组总有效率与托吡酯组比较差异无统计学意义（78.6%vs 89.7%,P〉0.05）。33例原发性癫所致RSE患儿中MZ治疗的有效率为76.5%,TPM治疗的有效率为93.8%;24例继发性/症状性癫所致RSE患儿中MZ治疗的有效率为81.8%,TPM治疗的有效率为84.6%。MZ治疗的有效率与TPM治疗的有效率比较差异均无统计学意义（均P〉0.05）。结论 TPM快速负荷量治疗RSE与MZ疗效相当,TMP可作为一种治疗RSE的选择。

Objective To compare the curative effects of rapid loading of topiramate（TPM） and midazolam（MZ） on refractory status epilepticus（RSE） in children.Methods Fifty-seven children with RSE were divided into two groups.In MZ treatment group（n=28）,MZ（0.1-0.2 mg·kg-1） was injected intravenously,followed by intravenous infusion（0.1 mg·kg-1·h-1）.If the seizure continued within 30 minutes,an additional dose of 0.05 mg·kg-1·h-1·time-1 was given.After the dose reached 0.4 mg·kg-1·h-1,MZ was not given additionally if the seizure did not continued within 30 minutes.In TPM treatment group（n=29）,TPM（10 mg·kg-1·-1） was administered nasally or orally in two divided doses for 2 days,followed by maintenance dose of 5 mg·kg-1·d-1.If the first treatment was ineffective during the first 24 hour of observation,corresponding treatment program was performed in both gorups.Results There was no significant difference in the total effective rate between MZ treatment group and TPM treatment group（78.6% vs 89.7%,P0.05）.Among the 33 children with primary epilepsy,the effective rate was 76.5% in children treated with MZ and 93.8% in children treated with TPM.Among the 24 children with secondary or symptomatic epilepsy,the effective rate was 81.8% in children treated with MZ and 84.6% in children treated with TPM.There was no significant difference in the effective rate between the two groups（P0.05）.Conclusion TMP is an effective treatment option in the treatment of RSE,and rapid loading of TPM and MZ have equivalent effects on RSE.