劳拉西泮与地西泮治疗儿童惊厥性癫痫持续状态的疗效和安全性比较:一份循证病例报告

IF 0.2 Q4 PHARMACOLOGY & PHARMACY
Muhammad Habiburrahman, Widya Khairunnisa Sarkowi
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引用次数: 0

摘要

印度尼西亚仍然推荐安定治疗癫痫,但国际抗癫痫联盟越来越倾向于劳拉西泮。一些报告指出安定的效果较差并会产生副作用。本报告报道了一例难治性惊厥性癫痫持续状态(CSE)病例,患者为10个月大的婴儿,接受地西泮治疗,质疑静脉/直肠劳拉西泮是否比地西泮更好地治疗住院的CSE患儿。方法:遵循患者-干预-比较-结果(PICO)公式,我们在四个期刊数据库(Pubmed, Proquest, EBSCOHost和Cochrane)中检索证据。对符合纳入和排除标准的研究进行评价。结果:通过三个系统综述和荟萃分析,我们的临床问题得到了解决。一项研究显示,直肠用劳拉西泮比直肠用地西泮更有效地阻止癫痫发作(RR 2.86)。同时,两项研究发现静脉注射劳拉西泮与静脉注射地西泮在癫痫发作停止方面具有相似的疗效(RR分别为1.04和OR分别为1.03)。两种药物在停止癫痫发作所需的时间、额外剂量或辅助药物的必要性以及24小时内难治性癫痫发作的可能性方面均无显著差异。两项研究表明,静脉注射劳拉西泮可降低呼吸抑制的风险(RR分别为0.71和0.62)。无论何种给药途径,劳拉西泮比地西泮入院的概率更低(RR 0.15)。结论:静脉注射劳拉西泮和地西泮治疗CSE的效果相同,但直肠注射劳拉西泮比地西泮更能有效地阻止癫痫发作和防止复发。此外,劳拉西泮被认为更安全,尤其是静脉注射时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and Safety Comparison Between Lorazepam and Diazepam in Treating Convulsive Status Epilepticus in Children: An Evidence-Based Case Report
Introduction: Indonesia still recommends diazepam for epilepsy, but the International League Against Epilepsy increasingly favours lorazepam. Some reports indicate diazepam being less effective and causing side effects. This report presents a difficult-to-treat convulsive status epilepticus (CSE) case in a 10-month infant who received diazepam, questioning if intravenous/rectal lorazepam is a better initial therapy than diazepam for hospitalized children with CSE. Methods: Following the patient-intervention-comparison-outcome (PICO) formula, we searched for evidence in four journal databases (Pubmed, Proquest, EBSCOHost, and Cochrane). Studies meeting inclusion and exclusion criteria were appraised. Results: Through three systematic reviews and meta-analyses, our clinical query was addressed. One study revealed that rectal lorazepam was more effective in stopping seizures than rectal diazepam (RR 2.86). Meanwhile, two studies found that intravenous lorazepam exhibited similar efficacy in seizure cessation compared to intravenous diazepam (RR 1.04 and OR 1.03, respectively). Both drugs showed no significant difference in the time required to stop seizures or the necessity for additional doses or adjunctive medications to achieve such cessation, nor in the likelihood of refractory seizure within 24 hours. Two studies indicated that intravenous lorazepam had a reduced risk of respiratory depression (RR 0.71 and OR 0.62, respectively). Regardless of the administration route, lorazepam was linked to a lower probability of ICU admission (RR 0.15) than diazepam. Conclusion: Intravenous lorazepam and diazepam are equally effective for treating CSE, but rectal lorazepam is considered better at stopping seizures and preventing their recurrence compared to diazepam. Furthermore, lorazepam is deemed safer, especially when given intravenously.
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