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本文目的旨在评估文献及探讨针对成人癫持续状态(SE)各种治疗策略的证据等级。我们对1966年～2005年1月间MEDLINE和EMBASE上发表的相关文献及2005年1月～2009年1月间最新版本的所有相关出版物进行检索。此外,还对Cochrane临床对照试验注册中心(CENTRAL)进行检索。推荐就是基于这些文献以及我们对主题词相关参考文献的判断并通过建立共识的方式获得。若缺乏证据但共识明确,我们提出良好实践指导。全面性惊厥性癫持续状态(GCSE)的推荐治疗路径为直接予以4～8 mg劳拉西泮或10 mg地西泮,继以18 mg/kg苯妥英静脉注射。如首次给药后癫发作仍持续10 min以上,建议再次予以4 mg劳拉西泮或10 mg地西泮静脉注射。难治性GCSE需要麻醉剂量的巴比妥、咪唑安定或异丙酚治疗,药物剂量需以脑电图发放被抑制来滴定至少24 h。非惊厥性SE的初始治疗取决于其发作类型和病因。复杂部分性SE的初始治疗同GCSE,若难治则予以左乙拉西坦、苯巴比妥或丙戊酸等非麻醉类药物。对于不明显的SE(subtle SE),大多需要静脉注射麻醉药。
The purpose of this article is to evaluate the literature and to explore the level of evidence for various treatment strategies for adult status epilepticus (SE). We searched all relevant publications published at MEDLINE and EMBASE between January 1966 and January 2005 and all relevant publications in the most up-to-date version between January 2005 and January 2009. In addition, the Cochrane Central Register of Controlled Trials (CENTRAL) was searched. The recommendations are based on these documents and our judgment on the relevant references of the keywords and are obtained through consensus building. In the absence of evidence but a clear consensus, we provide good practice guidance. The recommended course of treatment for GCSE is 4 to 8 mg of lorazepam or 10 mg of diazepam, followed by a 18 mg / kg phenytoin intravenous injection. If the onset of epileptic seizures persists for more than 10 minutes after the first dose, it is recommended that 4 mg of lorazepam or 10 mg of diazepam be given intravenously again. Refractory GCSE requires an anesthetic dose of barbiturate, midazolam, or propofol, and drug doses should be titrated for at least 24 h with inhibition of EEG delivery. The initial treatment of non-convulsive SE depends on the type and etiology of the attack. The initial treatment of complex partial SE is the same as GCSE, and if it is refractory, it is given non-narcotic drugs such as levetiracetam, phenobarbital or valproic acid. For the subtle SE, intravenous anesthetics are mostly needed.