成人中-重型创伤性脑损伤住院患者预防性抗癫痫治疗指南解读  

Literature interpretation:Guidelines for seizure prophylaxis in adults hospitalized with moderate-severe traumatic brain injury——a clinical practice guideline for health care professionals from the Neurocritical Care Society

作　　者：吕文漪 侯梦雪 张琳琳 周建新 Lyu Wenyi;Hou Mengxue;Zhang Linlin;Zhou Jianxin(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070 [2]首都医科大学附属北京世纪坛医院,北京100038

出　　处：《中国急救医学》2024年第12期1023-1028,共6页Chinese Journal of Critical Care Medicine

摘　　要：目前创伤性脑损伤(TBI)住院患者的预防性抗癫痫治疗存在较大差异,包括抗癫痫药物(ASMs)的使用、药物选择和疗程,尚无针对中-重型TBI住院患者预防性抗癫痫治疗的指南。2024年2月,美国神经重症学会(NCS)在《神经重症杂志》(Neurocrit Care)发表了《美国神经重症学会临床实践指南:成人中-重型创伤性脑损伤住院患者预防性抗癫痫治疗指南》(以下简称为2024版指南)。2024版指南着眼于三个临床问题,通过系统综述和荟萃分析,基于GRADE方法给出了相应推荐意见:①对于中-重型TBI住院患者,可以使用预防性ASMs(首次住院期间)或不使用ASMs;②中-重型TBI住院患者如果使用预防性ASMs时,左乙拉西坦应优先于苯妥英/磷苯妥英使用;③中-重型TBI住院患者如果使用预防性ASMs时,建议短疗程(≤7 d)使用,而非长疗程(>7 d)。本文对该指南进行解读,以供参考。There are great differences in the clinical use of seizure prophylaxis for patients hospitalized with traumatic brain injury(TBI),including the use,duration,and type of prophylactic antiseizure medications(ASMs).Currently,there are no guidelines available that address the utility of seizure prophylaxis in the patients hospitalized with moderate-severe TBI.In February 2024,the Neurocritical Care Society(NCS)published the Guidelines for seizure prophylaxis in adults hospitalized with moderate-severe TBI:a clinical practice guideline for health care professionals from the Neurocritical Care Society in the journal of Neurocritical Care.The guideline focuses on three clinical questions.The systematic review and meta-analysis,and Grading of Recommendations,Assessment,Development and Evaluation(GRADE)methodology were used to generate recommendations:①Either prophylactic ASMs(initiated during index hospitalization)or no ASMs could be used in the patients hospitalized with moderate-severe TBI.②If prophylactic ASMs are used in the patients hospitalized with moderate-severe TBI,the NCS guideline panel suggests levetiracetam should be used rather than phenytoin/fosphenytoin for seizure prophylaxis.③If prophylactic ASMs are used in the patients hospitalized with moderate-severe TBI,the NCS guideline panel suggests a short duration of drug usage(≤7 days)versus a longer duration of drug usage(>7 days).This paper gives a brief interpretation of this guideline.

关 键 词：创伤性脑损伤 癫痫 预防性 抗癫痫药物 指南 左乙拉西坦 短疗程 脑电图监测 

分 类 号：R651.15[医药卫生—外科学]