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Neurology:麻醉药物治疗癫痫持续状态感染和死亡风险增高

2014-04-29 医者仁心1993 dxy

目前对于癫痫持续状态的治疗,一般首选持续静脉给药,但关于麻醉药物治疗癫痫持续状态的风险和受益的研究并不多,为了更好的指导临床麻醉药物治疗癫痫持续状态,于是进行了本项研究。【原文下载】 针对这种情况,来自瑞士巴塞尔大学医院神经科的Raoul Sutter博士等人进行了一项研究,研究的目的是评估不断持续静脉注射麻醉药物(IVADs)对伴有癫痫持续状态(SE)成年患者结局的风险,其研究结果在线发表于

目前对于癫痫持续状态的治疗,一般首选持续静脉给药,但关于麻醉药物治疗癫痫持续状态的风险和受益的研究并不多,为了更好的指导临床麻醉药物治疗癫痫持续状态,于是进行了本项研究。【原文下载】


针对这种情况,来自瑞士巴塞尔大学医院神经科的Raoul Sutter博士等人进行了一项研究,研究的目的是评估不断持续静脉注射麻醉药物(IVADs)对伴有癫痫持续状态(SE)成年患者结局的风险,其研究结果在线发表于 Neurology 杂志上,研究结论为与未使用IVADs的患者相比得知,使用IVADs的癫痫持续状态的患者具有较高的感染比例和死亡风险。

研究纳入在2005-2011年间,瑞士巴塞尔大学医院(一家三级学术医疗保健中心)重症监护病房里的所有发生过癫痫持续状态的171名患者。其中63例 (37%)接受静脉麻醉药物(IVAD)治疗,包括硫喷妥钠、咪达唑仑、异丙酚和/或大剂量苯巴比妥。纳入这项研究的成年患者平均年龄为64岁。

接受连续IVAD治疗的患者对一线和二线抗癫痫药物耐药,并依照标准方案进行治疗;29例仅接受咪达唑仑治疗,22例接受咪达唑仑和后续异丙酚治疗,12例在咪达唑仑之后接受巴比妥类药物治疗。两组非麻醉抗癫痫药的使用相似。计算以下指标的相对危险度(RR):癫痫发作控制的主要结局测量值,出院时格拉斯哥预后评分,以及死亡。泊松回归模型用于控制可能的混杂因素,并评估效果校正。

约翰霍普金斯大学的Kaplan医生介绍,在参与试验的171名患者中,37%的患者采用IVADs治疗,死亡率为18%。使用麻醉药的患者在癫痫持续状态期间有更多的感染,且死亡相对风险是未采用IVADs治疗患者的2.9倍,感染均在治疗期间发生,27例感染中的25例为呼吸道感染,其他2例为泌尿系感染。

该结果独立于可能的混杂因素(如癫痫持续状态持续时间和严重程度,非麻醉性三线抗癫痫药物以及主要的医学疾病)。针对不同级别的癫痫持续状态严重程度,该试验并没有显示出显著的结果修正。由于在服用一线和二线药物后再使用IVADs无效,因此难治性癫痫持续状态的治疗与IVADs使用之间具有相关性,对于有关IVADs风险和对难治性癫痫持续状态进行额外治疗后的结局,结果无统计学意义。

研究的结论提示人们应该关注有关IVADs不良反应,但仍需要进一步的随机对照试验以明确使用IVADs治疗癫痫持续状态患者结局的关系。该研究提供III级证据,与未使用IVADs的患者相比得知,使用IVADs的癫痫持续状态的患者具有较高的感染比例和死亡风险。

研究背景:

癫痫持续状态传统定义为连续发作之间意识尚未完全恢复又频繁再发或癫痫发作30分钟以上未自行停止。目前则认为,如果患者出现全面强直性阵挛性发作持续5分钟以上就有可能发生神经元损伤,对于CTCS患者若发作持续时间超过5分钟,就应考虑诊断为癫痫持续状态,并需要AEDs紧急处理。

癫痫持续状态是神经内科的常见急症,若不及时治疗可因高热、循环衰竭、电解质紊乱或神经元兴奋毒性损伤导致永久性脑损害,致残率和死亡率很高。对于癫痫持续状态的治疗,一般首选持续静脉给药,但关于麻醉药物用于癫痫持续状态的风险和获益的资料非常少,促使促成本研究。
多数舆论倡导者建议对难治性癫痫持续状态使用IVAD诱导癫痫发作的全面抑制,即EEG爆发性抑制模式或等电位EEG。神经重症监护学会强调了IVAD的作用,然而又指出目前缺乏支持的研究数据,故欧洲神经学会联盟则认为需要进一步研究。

原始出处:

Sutter R1, Marsch S, Fuhr P, Kaplan PW, Rüegg S.Anesthetic drugs in status epilepticus: risk or rescue? A 6-year cohort study.Neurology. 2014 Feb 25;82(8):656-64. doi: 10.1212/WNL.0000000000000009. Epub 2013 Dec 6.【原文下载】

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    2015-12-26 hixiaoluo

    值得收藏,学习,谢谢分享

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    2014-08-01 yinhl1978
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    2014-05-01 liuxiaona
  5. [GetPortalCommentsPageByObjectIdResponse(id=48093, encodeId=3adc480935e, content=值得收藏,学习,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=161, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:12:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1999412, encodeId=b4c9199941292, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Aug 01 18:42:00 CST 2014, time=2014-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255479, encodeId=dda612554e913, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1561559, encodeId=1107156155906, content=<a href='/topic/show?id=118142341b1' target=_blank style='color:#2F92EE;'>#增高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42341, encryptionId=118142341b1, topicName=增高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9415191444, createdName=liuxiaona, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1567568, encodeId=519a156e56801, content=<a href='/topic/show?id=118142341b1' target=_blank style='color:#2F92EE;'>#增高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42341, encryptionId=118142341b1, topicName=增高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9415191444, createdName=liuxiaona, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9225, encodeId=01129225c5, content=较高的感染比例和死亡风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5138101838, createdName=caijingru, createdTime=Wed Apr 30 22:19:00 CST 2014, time=2014-04-30, status=1, ipAttribution=)]
    2014-05-01 liuxiaona
  6. [GetPortalCommentsPageByObjectIdResponse(id=48093, encodeId=3adc480935e, content=值得收藏,学习,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=161, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:12:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1999412, encodeId=b4c9199941292, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Aug 01 18:42:00 CST 2014, time=2014-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255479, encodeId=dda612554e913, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1561559, encodeId=1107156155906, content=<a href='/topic/show?id=118142341b1' target=_blank style='color:#2F92EE;'>#增高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42341, encryptionId=118142341b1, topicName=增高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9415191444, createdName=liuxiaona, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1567568, encodeId=519a156e56801, content=<a href='/topic/show?id=118142341b1' target=_blank style='color:#2F92EE;'>#增高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42341, encryptionId=118142341b1, topicName=增高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9415191444, createdName=liuxiaona, createdTime=Thu May 01 05:42:00 CST 2014, time=2014-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9225, encodeId=01129225c5, content=较高的感染比例和死亡风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5138101838, createdName=caijingru, createdTime=Wed Apr 30 22:19:00 CST 2014, time=2014-04-30, status=1, ipAttribution=)]
    2014-04-30 caijingru

    较高的感染比例和死亡风险。

    0

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