癲癇發作為創傷型蜘蛛膜下腔出血常見的併發症，而 phenytoin 可預防早發性 癲癇的發生。本研究採電腦資料庫取樣 2004 年 1 月至 2005 年 6 月間，創傷型蜘蛛 膜下腔出血之患者進行回溯性分析，希望提供日後更合理、有效的用藥參考。評估 項目包括藥物使用人數、使用劑量及天數、血中濃度監測、副作用及入院時創傷嚴 重度。
本研究報告共含 128 位病患，88 位男性及 40 位女性，平均年齡為 45±7 歲。 將創傷發生後 24 小時內使用與未使用 phenytoin 預防癲癇發作且住院天數大於 7 天 之 83 位病患資料作進一步分析，33 位使用及 50 位未使用的病患中，分別有 4 位及1 位發生早發性癲癇(12.1% vs 2%)，可能與使用劑量及入院時創傷嚴重度有關。使 用天數皆超過 7 天，增加醫院醫療成本。有 15.2%病患發生過敏反應，其中 1 位演 變為嚴重的史蒂芬強森症候群。
由以上研究結果顯示應再加強臨床藥事服務。建議醫師們應依照病患體重計算 藥物初始劑量，常規性監測血中濃度，使用適當天數，除減低醫院的醫療成本外， 更能確保藥物使用療效。務必讓相關醫護人員了解藥物正確的給予方式及可能會發 生的副作用與何時應和醫師主動聯絡。
Seizure is the common complication of traumatic subarachnoid hemorrhage (SAH). Phenytoin is the most commonly administered antiepileptic agent for prevention of early posttraumatic seizures. In order to develop more effective and safer clinical guidelines for prescribing phenytoin, we performed a retrospective drug utilization evaluation (DUE) of patients who were listed on a computer database had traumatic SAH between January 2004 and June 2005. The evaluation includes number of patients use phenytoin, dosage and duration, therapeutic drug monitoring (TDM), side effects and GCS.
According to our research, there were 128 patients enrolled totally, including 88 males and 40 females. The average age was 45±7 years old. Excluding hospitalized less than 7 days, patients were grouped base on whether received phenytoin within 24hrs after injury. There were 33 patients received medication but 4 of them with early seizure (12.1%). Among 50 patients did not received medication, one of them have early seizure (2%). The result may relate to the dosage and GCS. The patients we studied received phenytoin all used longer than 1 week, it increases hospital cure cost. 15.2% of patients use phenytoin has allergic action.
Loading dose of phenytoin based on patient’s weight, routine monitoring phenytoin levels and using orrect duration of therapy not only can reduce medical cost for hospital but also ensure the effectiveness of medication. The health care team must understand the correct way to offer medication, the common caused side effects and the timing to get in contact with physicians.
