Johnson J, Wrenn K
Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
Am J Emerg Med. 2001 Jul;19(4):293-4. doi: 10.1053/ajem.2001.24471.
The objective of the study was to evaluate how often intravenous (IV) fosphenytoin is used when oral phenytoin loading is possible. The methods included a retrospective chart review of all patients receiving IV fosphenytoin in the emergency department. We prospectively derived criteria that identify patients with seizures who could receive oral phosphenytoin loading (awake on arrival, alert, no emesis, and lack of endotracheal intubation, repeated seizures, or status epilepticus after arrival). The setting of the study was at an urban, university hospital emergency department with an annual census of 55,000 patients. The outcomes included the number of patients receiving IV fosphenytoin who could have received oral phenytoin loading. From February 1997 to June 1999, 55 patients received IV fosphenytoin. Thirty of these patients (55%, 95% confidence interval 41%-68%) were felt to have received fosphenytoin appropriately. The remaining 25 (45%, 95% confidence interval 32%-59%) patients could have been loaded orally with phenytoin. In a single institution, fosphenytoin administration is inappropriate almost half the time. Oral phenytoin loading is less expensive and safe.
该研究的目的是评估在有可能进行口服苯妥英钠负荷给药的情况下，静脉注射（IV）磷苯妥英钠的使用频率。方法包括对急诊科所有接受静脉注射磷苯妥英钠的患者进行回顾性病历审查。我们前瞻性地制定了标准，以识别那些可以接受口服磷苯妥英钠负荷给药的癫痫患者（到达时清醒、警觉、无呕吐，且到达后无气管插管、反复癫痫发作或癫痫持续状态）。该研究在一家城市大学医院急诊科进行，年接诊量为55000名患者。结果包括那些本可以接受口服苯妥英钠负荷给药却接受了静脉注射磷苯妥英钠的患者数量。1997年2月至1999年6月，有55名患者接受了静脉注射磷苯妥英钠。其中30名患者（55%，95%置信区间41%-68%）被认为接受磷苯妥英钠治疗是恰当的。其余25名患者（45%，95%置信区间32%-59%）本可以口服苯妥英钠进行负荷给药。在单一机构中，几乎有一半的时间磷苯妥英钠的使用是不恰当的。口服苯妥英钠负荷给药成本更低且更安全。
