修改德尔福共识肌注咪达唑仑用于早期癫痫持续状态治疗（ESET）在马来西亚

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy Pub Date : 2025-02-18 DOI:10.1016/j.seizure.2025.02.009

Hui-Yin Yow , Kheng-Seang Lim , Si-Lei Fong , Ann-Jo Lim , Chee-Toong Chow , Mohammad Aizuddin Azizah Ariffin , Siti Nasrina Yahaya , Sarah Shaikh Abdul Karim

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引用次数: 0

摘要

尽管肌注咪达唑仑（IM）被推荐作为癫痫持续状态（SE）的主要治疗方法，但其在马来西亚院前的使用仍然不理想。本研究旨在探讨马来西亚医疗保健专业人员对使用咪达唑仑作为院前SE抢救药物的认识、实践和障碍，并为其实施提供共识。方法于2024年3月22日至8月31日对马来西亚卫生保健专业人员进行在线横断面调查和修正德尔菲研究。采用改进的德尔菲过程从现有文献中得出共识，通过两轮德尔菲来评估每个问题的相关性、清晰度和重要性。如果90%或以上的参与者同意，则达成共识。结果137名受访医务人员中，89.1%的医务人员了解抢救用药。然而，只有62.0%的人认识到咪达唑仑的吸收和生物利用度优于直肠安定，78.1%的人意识到咪达唑仑在终止癫痫发作方面的疗效。参与SE管理的占69.3%，参与SE院前管理的占29.5% （n = 28）。只有35.7% （n = 10）报告院前人员被允许使用IM咪达唑仑进行SE管理，并且所有都需要医生的认可。值得注意的是，78.9%的参与者报告25%或更少的SE患者使用IM咪达唑仑治疗。主要障碍包括不熟悉（64.2%）和缺乏协议（62.1%）。在推荐咪达唑仑作为SE管理的一线治疗上达成了强烈的共识。结论虽然马来西亚的医疗保健专业人员了解院前癫痫发作紧急情况的抢救药物，但他们对咪达唑仑的益处缺乏了解。主要障碍包括不熟悉和缺乏协议，尽管对其一线使用有着强烈的共识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

A modified Delphi consensus on the use of intramuscular midazolam for early status epilepticus treatment (ESET) in Malaysia

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A modified Delphi consensus on the use of intramuscular midazolam for early status epilepticus treatment (ESET) in Malaysia

Objectives

Despite intramuscular (IM) midazolam being recommended as a primary treatment for status epilepticus (SE), its usage in Malaysian prehospital settings remains suboptimal. This study aimed to explore the awareness, practice, and barriers among healthcare professionals regarding the use of IM midazolam as a rescue medication for prehospital SE in Malaysia and provide a consensus for its implementation.

Methods

An online cross-sectional survey and modified Delphi study was conducted among healthcare professionals across Malaysia from 22 March to 31 August 2024. A modified Delphi process was used to develop a consensus from existing literature, with two Delphi rounds assessing the relevance, clarity, and importance of each question. Consensus was achieved if 90 % or more participants agreed.

Results

Among 137 responses, 89.1 % of healthcare professionals were aware of rescue medications. However, only 62.0 % recognized the superior absorption and bioavailability of IM midazolam over rectal diazepam, and 78.1 % were aware of its efficacy in terminating seizures. Of those (69.3 %) involved in SE management, 29.5 % (n = 28) were engaged in prehospital management of SE. Only 35.7 % (n = 10) reported that prehospital personnel were permitted to use IM midazolam for SE management and all required physician endorsement. Notably, 78.9 % of participants reported that 25 % or fewer patients with SE were treated with IM midazolam. The main barriers include unfamiliarity (64.2 %) and lack of protocols (62.1 %). A strong consensus was reached on the recommendation of IM midazolam as a first-line treatment for SE management.

Conclusion

While Malaysian healthcare professionals are aware of rescue medications for prehospital seizure emergencies, they lack an understanding of IM midazolam's benefits. Key barriers include unfamiliarity and lack of protocols despite strong consensus on its first-line use.

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来源期刊

Seizure-European Journal of Epilepsy 医学-临床神经学

CiteScore

5.60

自引率

6.70%

发文量

231

审稿时长

34 days

期刊介绍： Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.