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首页> 外文期刊>Neurosurgery >Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage.
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Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage.

机译：蛛网膜下腔出血后三天苯妥英钠的预防是足够的。

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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.
机译：目的：蛛网膜下腔出血后广泛使用苯妥英（PHT），通常持续数周或数月。除已知的副作用外，PHT的使用还与认知障碍和不良预后相关。为了降低PHT并发症的发生率，我们将预防措施从多周转为治疗3天。这项研究评估了癫痫发作率和不良事件的变化。方法：自1998年7月至2002年6月，治疗453例自发性蛛网膜下腔出血患者。在最初的9个月中，除非首先发生药物反应，否则79例患者接受了PHT直至出院。在过去的39个月中，入院3天后停用PHT（370例患者），除非有癫痫病史（4例）。这项研究代表对前瞻性收集数据的回顾性分析，出院后的随访时间为3到12个月。结果：3天的PHT方案使PHT并发症的发生率在统计学上显着降低（P = 0.002）。在第一阶段中，有79名患者中有七名（8.8％）发生了超敏反应，而在第二阶段中，有370名患者中有两名（0.5％）出现了超敏反应。短期和长期发作的患者百分比均无明显变化。在第一阶段，住院期间的癫痫发作率为1.3％。在第二阶段，这一比例为1.9％（P = 0.603）。平均随访期为6.7个月，第一期的53名幸存者中有3名（5.7％）发生了癫痫发作（包括住院期间发生癫痫发作的患者）。在第二期中，在261名幸存者中有12名（4.6％）经历了癫痫发作，平均随访期为5.4个月（P = 0.573）。结论：预防性治疗3天的PHT方案足以预防蛛网膜下腔出血患者的癫痫发作。药物反应显着降低，但癫痫发作率没有改变。短期PHT给药可能是一种更好的治疗范例。

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