摘要
Background/Aims Seizure activity in patients with acute liver failure (ALF) ma y increase cerebral oxygen requirements and worsen cerebral edema. Recently, pro phylactic phenytoin has been recommended to suppress sub-clinical seizure activ ity evident on electroencephalographic monitoring. To determine the clinical uti lity of prophylactic phenytoin therapy in patients with ALF. Methods Forty two p atients with ALF were randomized.Twenty patients were given prophylactic phenyto in and 22 patients acted as controls. The baseline clinical and biochemical feat ures were similar in the two groups and patients with≥2 poor prognostic variabl es were equally represented. Results Sixteen patients in the phenytoin group, an d 15 in the control group developed cerebral edema (P=0.38). Mechanical ventilat ion was required in 10 and 12 patients in the phenytoin and control groups, resp ectively, (P=0.77). Seizures occurred in 5(22.7%) control patients and 5 (25%) phenytoin treated patients(P=0.86). Fourteen (70%) patients randomized to phen ytoin and 15 (68.2%) control patients died (P=0.89). Conclusions Seizure was co mmon in patients with ALF. Prophylactic use of phenytoin did not prevent cerebra l edema, seizures or need for mechanical ventilation, and did not improve surviv al.
Background/Aims Seizure activity in patients with acute liver failure (ALF) ma y increase cerebral oxygen requirements and worsen cerebral edema. Recently, pro phylactic phenytoin has been recommended to suppress sub-clinical seizure activ ity evident on electroencephalographic monitoring. To determine the clinical uti lity of prophylactic phenytoin therapy in patients with ALF. Methods Forty two p atients with ALF were randomized.Twenty patients were given prophylactic phenyto in and 22 patients acted as controls. The baseline clinical and biochemical feat ures were similar in the two groups and patients with≥2 poor prognostic variabl es were equally represented. Results Sixteen patients in the phenytoin group, an d 15 in the control group developed cerebral edema (P=0.38). Mechanical ventilat ion was required in 10 and 12 patients in the phenytoin and control groups, resp ectively, (P=0.77). Seizures occurred in 5(22.7%) control patients and 5 (25%) phenytoin treated patients(P=0.86). Fourteen (70%) patients randomized to phen ytoin and 15 (68.2%) control patients died (P=0.89). Conclusions Seizure was co mmon in patients with ALF. Prophylactic use of phenytoin did not prevent cerebra l edema, seizures or need for mechanical ventilation, and did not improve surviv al.
