Sneed R C, Morgan W T
Department of Rehabilitation Medicine, University of Alabama, Birmingham 35233.
Arch Phys Med Rehabil. 1988 Sep;69(9):682-4.
The medical records of 11 brain-injured patients, simultaneously on enteral tube feeding and phenytoin, were retrospectively reviewed for evidence of interference of phenytoin absorption. One case demonstrated no interference. Three cases suggested depression of serum phenytoin levels by enteral formula, but the contribution of other factors could not be ruled out. Seven cases did appear to reflect a direct alteration of phenytoin levels by enteral formula. To achieve adequate serum phenytoin levels, patients may need (1) large oral phenytoin doses above that recommended while on continuous enteral feedings, (2) administration of oral phenytoin between intermittent enteral feedings, or (3) a choice of alternative anticonvulsants which have been shown to be unaffected by enteral formula.
对11例同时接受肠内管饲和苯妥英治疗的脑损伤患者的病历进行回顾性研究，以寻找苯妥英吸收受干扰的证据。1例未显示干扰。3例提示肠内营养制剂使血清苯妥英水平降低，但不能排除其他因素的影响。7例似乎确实反映了肠内营养制剂对苯妥英水平的直接改变。为达到足够的血清苯妥英水平，患者可能需要：(1) 在持续肠内喂养期间口服高于推荐剂量的大剂量苯妥英；(2) 在间歇性肠内喂养期间给予口服苯妥英；或(3) 选择已证明不受肠内营养制剂影响的替代抗惊厥药物。
