咪达唑仑联合地西泮、苯巴比妥治疗惊厥性癫痫持续状态患儿的疗效评价

Evaluation of the Efficacy of Midazolam in Combination with Diazepam and Phenobarbital in the Treatment of Children with convulsive continuous Status Epilepticus

目的分析咪达唑仑联合地西泮、苯巴比妥治疗惊厥性癫痫持续状态(CSE)患儿的疗效。方法选取河南科技大学第一附属医院2020年1月至2021年4月治疗的103例惊厥性癫痫患儿,采用电脑随机数字表法分为常规组(n=51)、治疗组(n=52)。常规组采用地西泮、苯巴比妥治疗,治疗组在常规组基础上联合咪达唑仑。治疗后对比两组有效率、临床症状改善情况、癫痫持续状态严重程度评分量表(STESS)、血清相关指标[血清甘丙肽(GAL)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S-100β蛋白)、脑源性神经营养因子(BDNF)]水平、不良反应及后遗症。结果治疗组有效率94.23%高于常规组80.39%,差异有统计学意义(P<0.05);治疗后两组惊厥控制时间、惊厥消失时间、高烧消退时间比较,治疗组短于常规组,差异有统计学意义(P<0.05);治疗后,两组STESS评分比较,治疗组低于常规组,差异有统计学意义(P<0.05);治疗后两组GAL、NSE、S-100β、BDNF指标比较,治疗组低于常规组,差异有统计学意义(P<0.05);治疗过程中不良反应发生率组间比较,差异无统计学意义(P>0.05);治疗结束后随访10周两组后遗症发生率比较,治疗组9.62%低于常规组25.49%,差异有统计学意义(P<0.05)。结论咪达唑仑、地西泮、苯巴比妥联合应用于惊厥性癫痫持续状态患儿,疗效确切,能有效改善临床症状,调节神经网络,减轻癫痫持续时间,降低后遗症发生率。

Objective To analyze the efficacy of midazolam combined with diazepam and phenobarbital in the treatment of children with convulsive continuous status epilepticus(CSE).Methods A total of 103 children with convulsive epilepsy treated in the first affiliated hospital of Henan university of science and technology from January 2020 to April 2021 were selected and divided into conventional group(n=51)and treatment group(n=52)according to computer random number table.The conventional group was treated with diazepam and phenobarbital,and the treatment group was treated with midazolam in combination with the conventional group.After treatment,the total efficiency,improvement of clinical symptoms,severity scale of persistent epilepsy(STESS),serum related indexes[serum glycopeptide(GAL),neuron-specific enolase(NSE),central nerve specific protein(S-100βprotein),brain-derived neurotrophic factor(BDNF)]levels,adverse effects and sequelae were compared between the two groups.Results The total effective rate of 94.23%in the treatment group was higher than that of 80.39%in the conventional group(P<0.05);the time to control convulsions,the time to disappear of convulsions and the time to subside of high fever were shorter in the treatment group than those in the conventional group after treatment(P<0.05);the STESS score was lower in the treatment group than that in the conventional group after treatment(P<0.05).The GAL,NSE,S-100β,BDNF indexes were lower in the treatment group than those in the conventional group(P<0.05);there was no statistically significant difference between groups in the incidence of adverse reactions during treatment(P>0.05);the incidence of sequelae in the two groups was lower in the treatment group 9.62%than that in the conventional group 25.49%at 10 weeks follow-up after treatment(P<0.05).Conclusion The combination of midazolam,diazepam,and phenobarbital in children with convulsive persistent epilepsy is effective in improving clinical symptoms,modulating neural networks,reducing the duration of epilepsy,and decreasing the incidence of sequelae.