University of Western Ontario, London Health Sciences, Center, London, Ontario, Canada.
J Cardiothorac Vasc Anesth. 2011 Apr;25(2):299-305. doi: 10.1053/j.jvca.2010.08.004. Epub 2010 Oct 29.
Cardiac surgery, mainly in the form of coronary artery bypass graft surgery, is known to be associated with a risk of injury to the central and peripheral nervous systems. The most commonly encountered central nervous system injury associated with cardiac surgery continues to be stroke, with seizures occurring less commonly but with significant consequences. Seizures in the cardiac surgery recovery unit (CSRU) always cause great concern to the attending physicians and families of the patient. Therefore, it is of critical importance that the attending physician has an accurate and efficient approach to the differential diagnosis, investigations, and management of these patients, who represent a unique group requiring specific investigations and management.
A review and discussion of experience with seizures in the CSRU.
Cardiac surgery poses a significant threat to the nervous system through various mechanisms although newer technologies and surgical techniques have led to improved outcomes in recent years. Although the incidence of seizures remains low, the causes and management are relatively unique in this setting, including a probable "toxic syndrome" related to certain antibiotics or other perioperative drugs such as tranexamic acid. A targeted approach based on recognizing focal versus generalized seizures, a careful review of history and medications, and a focused workup will lead the clinician to choosing the most effective therapy when one is required. Special concerns regarding the side effect profile of phenytoin in this setting have led to valproate and levetiracetam becoming useful alternatives, which are effective and well tolerated. The incidence of nonconvulsive seizures in the CSRU remains to be elucidated with prospective monitoring studies, as does their effect on outcome.
心脏手术，主要形式是冠状动脉旁路移植术，已知与中枢和周围神经系统损伤的风险相关。与心脏手术相关的最常见的中枢神经系统损伤仍然是中风，而癫痫发作虽较少见，但后果严重。心脏手术恢复单元（CSRU）中的癫痫发作总是引起主治医生和患者家属的极大关注。因此，主治医生必须对这些患者进行准确且有效的鉴别诊断、检查和管理，这一点至关重要。这些患者代表了一个需要特殊检查和管理的独特群体。
对 CSRU 中癫痫发作的经验进行回顾和讨论。
尽管新技术和外科技术近年来使结果有所改善，但心脏手术通过多种机制对神经系统构成重大威胁。尽管癫痫发作的发生率仍然较低，但在这种情况下，病因和管理相对独特，包括与某些抗生素或其他围手术期药物（如氨甲环酸）相关的可能“中毒综合征”。基于识别局灶性与全身性癫痫发作、仔细回顾病史和药物使用情况以及进行有针对性的检查，临床医生可以在需要时选择最有效的治疗方法。在这种情况下，苯妥英的副作用特征特别令人关注，导致丙戊酸钠和左乙拉西坦成为有用的替代品，它们有效且耐受性良好。CSRU 中非惊厥性癫痫发作的发生率仍需通过前瞻性监测研究来阐明，其对结果的影响也是如此。
