目的:静脉(IV)推动(IVP)是左乙拉西坦的替代给药方法,但是在急性癫痫患者的负荷剂量中,与静脉搭载(IVPB)相比,评估它的证据有限,特别是在癫痫持续状态(SE)患者中。本研究旨在比较IVP与IVPB左乙拉西坦负荷剂量的有效性和安全性。
方法:这是一项单中心序贯回顾性研究,对接受静脉左乙拉西坦负荷剂量(>2000mg或≥20mg/kg)治疗急性或疑似癫痫发作的成年(≥18岁)患者进行。主要结果是给药时间,IVP与IVPB剂量之间的比较。次要结果包括不良事件(AE)的发生率,拯救苯二氮卓类药物或抗癫痫药物给药,插管,和重症监护病房(ICU)入院组之间。
结果:共纳入246例患者;116例接受IVP,130例接受IVPB负荷剂量。中位年龄为56岁;大多数患者为男性(62%)和白人(60%),并目睹了癫痫发作(67%)。在IVP和IVPB组中,32例(27.5%)和46例(35.4%)患者的SE给药剂量,分别。IVP组的中位给药时间较短(12vs.38分钟,p<.001)。心动过缓(1.7%vs.2.3%,p=.99),低血压(7.8%vs.12%,p=.30),镇静(6%vs.12.3%,p=.09),插管(10%vs.8%,p=.37),ICU入院(32%vs.39%,p=.31),和抢救药物管理(8.6%vs.14.6%p=.10)组间相似。在SE患者中,IVP与更短的给药时间相关(12vs.44分钟,p=.003)和调整年龄后入住ICU的几率较低,剂量,癫痫持续状态严重程度评分,和癫痫发作史(调整后的比值比=.23,95%置信区间=.06-.81)。
结论:与IVPB相比,IVP减少了左乙拉西坦给药的时间,并且与更多的不良事件无关。救援人员使用,插管,和ICU入院相似,但IVP可能会减少SE患者的ICU入住。前瞻性研究应评估IVP与IVPB的有效性。
OBJECTIVE: Intravenous (IV) push (IVP) is an alternative administration method for levetiracetam, but evidence evaluating it compared to IV piggyback (IVPB) for loading doses in acutely seizing patients is limited, particularly in patients with status epilepticus (SE). This study aimed to compare the efficiency and safety of IVP versus IVPB levetiracetam loading doses.
METHODS: This was a single-center sequential retrospective study conducted in adult (≥18 years) patients who received an IV levetiracetam loading dose (>2000 mg or ≥20 mg/kg) for acute or suspected seizure. The primary outcome was time to administration, compared between doses given as IVP versus IVPB. Secondary outcomes included rates of adverse events (AEs), rescue benzodiazepine or antiseizure medication administration, intubation, and intensive care unit (ICU) admission between groups.
RESULTS: A total of 246 patients were included; 116 received IVP and 130 received IVPB loading doses. Median age was 56 years; most patients were male (62%) and White (60%) and had witnessed seizures (67%). Doses were administered for SE in 32 (27.5%) and 46 (35.4%) patients in the IVP and IVPB arms, respectively. Median time to administration was shorter in the IVP group (12 vs. 38 min, p < .001). Bradycardia (1.7% vs. 2.3%, p = .99), hypotension (7.8% vs. 12%, p = .30), sedation (6% vs. 12.3%, p = .09), intubation (10% vs. 8%, p = .37), ICU admission (32% vs. 39%, p = .31), and rescue medication administration (8.6% vs. 14.6% p = .10) were similar between groups. In SE patients, IVP was associated with shorter time to administration (12 vs. 44 min, p = .003) and lower odds of ICU admission after adjustment for age, dose, Status Epilepticus Severity Score, and seizure history (adjusted odds ratio = .23, 95% confidence interval = .06-.81).
CONCLUSIONS: IVP reduced time to levetiracetam administration versus IVPB and was not associated with more AEs. Rescue agent use, intubation, and ICU admission were similar between arms, but IVP may reduce ICU admissions in SE patients. Prospective studies should assess the effectiveness of IVP versus IVPB.