Ward M M, Barbaro N M, Laxer K D, Rampil I J
Department of Neurosurgery, University of California, San Francisco, USA.
Epilepsia. 1996 Jan;37(1):98-101. doi: 10.1111/j.1528-1157.1996.tb00519.x.
Surgical treatment is increasingly used for patients with medically re fractory seizures. Valproate (VPA) is an effective, widely used anticonvulsant in this patient population, but believed by some researchers to increase surgical bleeding because of quantitative thrombocytopenia and functional defects in platelet aggregation. Because we have observed no clinical evidence that perioperative administration of VPA increases blood loss or complications related to postoperative bleeding in patients undergoing temporal lobectomy at our institution, we sought to test this hypothesis. We made a retrospective review of the medical records of all patients who underwent epilepsy surgery at the University of California, San Francisco Medical Center, from September 1986 through January 1993. Patients who had a temporal lobectomy and whose medical records documented preoperative platelet counts and pre- and postoperative hematocrit and hemoglobin values were included. We excluded patients who had cranial surgery before temporal lobectomy and those with intracranial neoplasms or vascular malformations. Patients were divided into two groups: those who received VPA in the immediate preoperative period and those who had not received VPA recently. We compared the estimated surgical blood loss and the estimated change in red blood cell (RBC) volume between groups by unpaired t tests. The charts of 87 consecutive patients qualified for inclusion in the study. Patients in the VPA group had relative (but not absolute) thrombocytopenia preoperatively (235 +/- 64 vs. 277 +/- 69 k in the No-VPA group). There were no differences in the estimated blood loss, RBC volume, or in the incidence of postoperative transfusion. VPA apparently does not increase complications of hemostasis during therapeutic surgical resections for epilepsy. Therefore, we do not recommend routinely discontinuing VPA before craniotomy.
手术治疗越来越多地用于药物难治性癫痫患者。丙戊酸盐（VPA）是这类患者中一种有效且广泛使用的抗惊厥药物，但一些研究人员认为，由于定量血小板减少和血小板聚集功能缺陷，它会增加手术出血。因为我们在本院未观察到临床证据表明围手术期使用VPA会增加接受颞叶切除术患者的失血量或与术后出血相关的并发症，所以我们试图验证这一假设。我们对1986年9月至1993年1月在加利福尼亚大学旧金山分校医学中心接受癫痫手术的所有患者的病历进行了回顾性研究。纳入接受颞叶切除术且病历记录了术前血小板计数以及术前和术后血细胞比容及血红蛋白值的患者。我们排除了在颞叶切除术之前接受过颅脑手术的患者以及患有颅内肿瘤或血管畸形的患者。患者分为两组：术前即刻接受VPA的患者和近期未接受VPA的患者。我们通过非配对t检验比较了两组之间估计的手术失血量和估计的红细胞（RBC）体积变化。连续87例患者的病历符合纳入本研究的条件。VPA组患者术前有相对（但非绝对）血小板减少（VPA组为235±64，未接受VPA组为277±69 k）。在估计失血量、RBC体积或术后输血发生率方面没有差异。在癫痫治疗性手术切除过程中，VPA显然不会增加止血并发症。因此，我们不建议在开颅手术前常规停用VPA。
