Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI 48824, USA.
Epilepsy Res. 2009 Dec;87(2-3):268-71. doi: 10.1016/j.eplepsyres.2009.09.016. Epub 2009 Oct 24.
To study the incidence and extent of the occasionally noted hypotension after intravenous (IV) infusions of fosphenytoin (FOS) and levetiracetam (LEV) in patients presenting with acute cerebral symptoms.
Retrospective data collection of consecutive patients with acute cerebral symptoms who received IV infusions of a single dose of 750 mg or more of either fosphenytoin or levetiracetam and had documented blood pressure values in the 2h prior and the 2h after their IV infusion.
More than 10 mmHg drop in the systolic, diastolic and MBP was observed in the FOS group following the IV infusion (-16.82 mmHg, -11.60 mmHg, and 13.34 mmHg, respectively). However, there was not a significant change in the MBP after LEV infusion (1.54 mmHg, 1.84 mmHg, and 1.74 mmHg for systolic, diastolic and MBP change, respectively). The difference in the systolic, diastolic and MBP changes between the two groups was statistical significant (all p values are <0.0001) after adjusting for age, clinical presentations of the patients and if they were on any antihypertensive medication in the hospital. Sixty two percent of patients who received FOS had >10 mmHg decrease in their MBP. In the LEV group, only 2 of the 50 patients (4%) had >10 mmHg decrease in their MBP. The difference in proportion of the patients with >10 mmHg drop in MBP between the two study groups is also statistically significant (p<0.001) for age, clinical presentations of the patients and if they were on any antihypertensive medication in the hospital.
IV infusion of FOS in subjects presenting with acute cerebral symptoms may cause significant decreases in their blood pressure. This was not seen in patients receiving IV LEV infusions. Since maintaining adequate cerebral perfusion pressure is a key point in the management of patients with acute cerebral symptoms, the results of this study may carry a clinical impact on the management of this subgroup of patients.
研究静脉注射（IV）使用磷苯妥英（FOS）和左乙拉西坦（LEV）治疗急性脑症状患者后，偶尔出现的低血压的发生率和程度。
回顾性收集连续接受单剂量 750mg 或更多 FOS 或 LEV 静脉输注且在静脉输注前 2 小时和后 2 小时记录血压值的急性脑症状患者的临床资料。
FOS 组静脉输注后收缩压、舒张压和平均动脉压分别下降超过 10mmHg（分别为-16.82mmHg、-11.60mmHg 和 13.34mmHg）。然而，LEV 输注后平均动脉压没有显著变化（收缩压、舒张压和平均动脉压变化分别为 1.54mmHg、1.84mmHg 和 1.74mmHg）。调整年龄、患者临床表现以及入院时是否使用降压药物后，两组间收缩压、舒张压和平均动脉压变化的差异具有统计学意义（所有 p 值均<0.0001）。62%接受 FOS 的患者平均动脉压下降超过 10mmHg。在 LEV 组中，仅 50 名患者中的 2 名（4%）平均动脉压下降超过 10mmHg。两组间平均动脉压下降超过 10mmHg 的患者比例差异也具有统计学意义（p<0.001），与年龄、患者临床表现以及入院时是否使用降压药物有关。
在急性脑症状患者中静脉注射 FOS 可能会导致血压显著下降，而接受 LEV 静脉输注的患者则没有出现这种情况。由于维持足够的脑灌注压是急性脑症状患者治疗的关键，因此本研究结果可能对这组患者的治疗具有临床意义。
