Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage
Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage
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DOI：
10.1227/01.neu.0000249207.66225.d9
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发表时间：
2007-01-01
期刊：
影响因子：
4.8
通讯作者：
Kim, Dong H.
中科院分区：
文献类型：
--
作者：
Chumnanvej, Sorayouth;Dunn, Ian F.;Kim, Dong H.
目的：苯妥英钠（PHT）是蛛网膜下腔出血后广泛应用的药物，通常持续数周或数月。除了已知的副作用外，PHT的使用还与认知障碍和不良结局相关。为了降低PHT并发症的发生率，我们将多周预防性治疗方案改为3天疗程。本研究评估了癫痫发作率和不良事件的变化。方法：从1998年7月至2002年6月，453例自发性蛛网膜下腔出血患者接受了治疗。在前9个月，79名患者接受PHT治疗，直到出院，除非首先发生药物反应。在过去的39个月中，PHT在入院后3天停止（370例患者），除非有癫痫病史（4例患者）。本研究对前瞻性收集的数据进行了回顾性分析，随访期为出院后3至12个月。结果：3天PHT方案在统计学上显着降低了PHT并发症的发生率（P = 0.002）。在第一阶段，79例患者中有7例（8.8%）发生超敏反应，而第二阶段370例患者中有2例（0.5%）发生超敏反应。短期和长期癫痫发作患者的百分比没有显著变化。在第一阶段，住院期间的癫痫发作率为1.3%;在第二阶段，为1.9%（P = 0.603）。在平均6.7个月的随访期内，第一阶段53名幸存者中有3名（5.7）经历了癫痫发作（包括住院期间癫痫发作的患者）。在第二阶段，12（4.6%）的261名幸存者经历了癫痫发作，平均随访期为5.4个月（P = 0.573）。结论：3天的PHT预防方案是足够的，以防止癫痫发作的蛛网膜下腔出血患者。药物反应显著减少，但癫痫发作率没有变化。短期PHT给药可能是一种上级治疗范例。
Objective: Phenytoin (PHT) is widely administered after subarachnoid hemorrhage, often for several weeks or months. In addition to known side effects, PHT use has been correlated with cognitive disability and poor outcome. To reduce the rate of PHT complications, we converted from a multi-week prophylactic regimen to a 3-day course of treatment. This study evaluates the changes in seizure rates and adverse events.Methods: From July 1998 to June 2002, 453 patients with spontaneous subarachnoid hemorrhage were treated. In the first 9 months, 79 patients were administered PHT until discharged from the hospital, unless a drug reaction occurred first. In the last 39 months, PHT was discontinued 3 days after admission (370 patients), unless there was a history of epilepsy (four patients). This study represents a retrospective analysis of prospectively collected data, with follow-up periods of 3 to 12 months after discharge.Results: The 3 day PHT regimen produced a statistically significant reduction (P = 0.002) in the rate of PHT complications. In the first period, seven (8.8%) out of 79 patients experienced a hypersensitivity reaction, compared with two (0.5%) out of 370 patients in the second period. The percentage of patients having seizures, both short- and long-term, did not change significantly. In the first period, the seizure rate during hospitalization was 1.3%; in the second period, it was 1.9% (P = 0.603). At an average follow-up period of 6.7 months, three (5.7) out of 53 survivors in the first period experienced a seizure (including those who had a seizure during hospitalization). In the second period, 12 (4.6%) out of 261 survivors experienced a seizure at an average follow-up period of 5.4 months (P = 0.573).Conclusion: A 3-day regimen of PHT prophylaxis is adequate to prevent seizures in subarachnoid hemorrhage patients. Drug reactions are significantly reduced, but seizure rates do not change. Short-term PHT administration may be a superior treatment paradigm.