Bauer L A, Edwards W A, Dellinger E P, Raisys V A, Brennan C
J Trauma. 1983 Dec;23(12):1058-60. doi: 10.1097/00005373-198312000-00007.
Total (bound + unbound) and unbound phenytoin serum concentrations were measured in ten male comatose head trauma patients and ten male epileptic patients. Serum biochemistry and complete blood cell counts were normal for both groups, except albumin concentrations were below normal in the head trauma patients for nutritional reasons. Total phenytoin concentrations were 6.8 +/- 1.8 mcg/ml for the head trauma patients and 14.5 +/- 3.0 mcg/ml for the epileptic patients (p less than 0.0002) even though phenytoin doses were similar. However, unbound phenytoin concentrations were within the therapeutic range of 1 to 2 mcg/ml for both groups and were not significantly different. Had only the total concentrations been measured, phenytoin doses might have been increased inappropriately in the head trauma patients. The reason head trauma patients had therapeutic unbound concentrations despite lower total concentrations was that the unbound per cent of phenytoin was higher in these patients (21 +/- 3.2%) than in the epileptic patients (10 +/- 1.3%, p less than 0.0002).
对10名男性昏迷性头部创伤患者和10名男性癫痫患者测量了血清中苯妥英的总浓度（结合型+非结合型）和非结合型浓度。两组患者的血清生化指标和全血细胞计数均正常，但因营养原因，头部创伤患者的白蛋白浓度低于正常水平。尽管苯妥英剂量相似，但头部创伤患者的苯妥英总浓度为6.8±1.8 mcg/ml，癫痫患者为14.5±3.0 mcg/ml（p<0.0002）。然而，两组患者的非结合型苯妥英浓度均在1至2 mcg/ml的治疗范围内，且无显著差异。如果仅测量总浓度，头部创伤患者的苯妥英剂量可能会被不恰当地增加。头部创伤患者尽管总浓度较低但非结合型浓度处于治疗范围的原因是，这些患者中苯妥英的非结合百分比（21±3.2%）高于癫痫患者（10±1.3%，p<0.0002）。
