咪达唑仑治疗癫痫持续状态疗效的系统评价  

A systematic review on efficacy of midazolam in treatment of status epilepticus

作　　者：张凌锋[1] 郑金瓯[1] 黄东红[1] 曹月[1] 

机构地区：[1]广西医科大学第一附属医院神经内科,广西南宁530021

出　　处：《中国新药与临床杂志》2014年第3期182-189,共8页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的系统评价咪达唑仑治疗癫痫持续状态(SE)的临床疗效。方法电子检索CENTRAL、Pubmed、Embase和中国生物文献数据库文献(CBM),全面收集咪达唑仑治疗SE的随机对照试验(RCT),采用Cochrane系统评价方法评价纳入RCTs的方法学质量后,提取试验组与对照组的治疗有效率、显效时间、不同给药方式给药时间、10 min内显效率、呼吸抑制发生率等数据,采用RevMan 5.1.4软件对提取的数据进行分析。计数资料使用Mantel-Haenszel法进行Meta分析,计量资料则使用倒方差法进行Meta分析,若各研究具有同质性选用固定效应模型,若各研究具有异质性则选用随机效应模型。结果共纳入7个RCTs,共854例。经口腔黏膜给咪达唑仑与经直肠给地西泮治疗SE有效率差异有显著意义(P=0.008,RR=1.25,95%CI:1.06~1.48);经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE的有效率无显著差异(P=0.91,RR=1.00,95%CI:0.95~1.05)。经口腔黏膜给咪达唑仑比经直肠给地西泮治疗SE的显效时间短或相似;经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE差异无显著意义(P=0.07,SMD=0.31,95%CI:-0.02~0.63)。经非静脉途径给咪达唑仑给药时间比经静脉途径给地西泮给药时间短(P<0.000 1,SMD=-1.21,95%CI:-1.70^-0.71)。结论经非静脉途径给咪达唑仑比经非静脉途径给地西泮治疗SE疗效更可靠,与经静脉途径给地西泮的疗效相当,但经非静脉途径给药时间更短,可早期控制SE。咪达唑仑安全性良好。AIM To evaluate the efficacy and safety of midazolam monotherapy for status epilepticus （SE） treatment. METHODS A systematic search of literature was performed for randomized controlled trials （RCTs） of midazolam for SE treatment in CENTRAL, Pubmed, Embase and the Chinese Biomedical Literature Database （CBM）. The quality of the included RCTs was evaluated by Cochrane Collaboration. Mantel-Haenszel and inverse variance were used for categorical data and measurement data analysis, respectively. Fixed effects model and random effects model were chosen for the research with homogeneity or heterogeneity, respectively.Meta-analyses were performed with RevMan 5.1.4 software. RESULTS Seven RCTs were included with a total of 854 cases. Midazolam via buccal administration showed better effects on seizure cessation （P = 0.008, RR = 1.25, 95%CI： 1.06 - 1.48） and onset of drug action （P = 0.07, SMD = 0.31, 95%CI： -0.02 - 0.63） compared with diazepam via rectal administration. Nonintravenous （non- IV） injection of midazolam showed comparative effect on seizure cessation （P = 0.91, RR = 1.00, 95%CI： 0.95 - 1.05） , and onset of drug action with intravernous （IV） administration of diazepam. Additionally, non-IV of midazolam exhibited less duration for drug release compared with IV of diazepam （P 〈 0.000 1, SMD - -1.21, 95%CI： -1.70 - - 0.71）. CONCLUSION Non-1V of midazolam has greater effects on SE treatment than diazepam via non-IV administration, and has similar effects as IV administration of diazepam. But for the time of drug delivery, non- IV of midazolam shows less duration compared midazolam should be used for control of SE earlier with IV of diazepam. Therefore, non- IV administration of and midazolam has better safety.

关 键 词：咪达唑仑 地西泮 癫痫 部分性 持续状态 META分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]