115例癫痫患者丙戊酸钠血药质量浓度的监测与分析

目的分析丙戊酸钠治疗癫痫患者的血药质量浓度检测结果,探讨丙戊酸钠的合理用药。方法采用高效液相色谱法检测丙戊酸钠的血药质量浓度,统计分析丙戊酸钠的血药质量浓度与癫痫控制疗效、药物不良反应和联用药物等因素的影响。结果在115例癫痫患者中,丙戊酸钠血药质量浓度在50~100μg·mL~(-1)范围内有74例(64.35%);低于50μg·mL~(-1)有31例(26.95%);高于100μg·mL~(-1)有10例(8.70%),丙戊酸钠有效治疗血药质量浓度为50~100μg·mL~(-1),在此质量浓度范围内抗癫痫的效果优于不足此质量浓度抗癫痫的效果,但丙戊酸钠血药质量浓度高于此范围,其不良反应亦增加。卡马西平和苯妥英钠可能降低丙戊酸钠的血药质量浓度从而影响疗效。结论丙戊酸钠血药质量浓度个体差异大,且受药物间相互作用等多种因素影响,临床为实现个体化用药,应常规监测血药质量浓度。

Monitoring and analysis of plasma concentration of sodium valproate in 115 epilep-tic patients

Objective To analyze the blood concentration monitoring result of sodium valproate (VPA) in patients with epilepsy and to investigate the rational use of VPA .Methods Serum VPA concentration was determined by high performance liquid chromatog‐raphy (HPLC) .The correlation between the serum drug concentration and the clinical efficacy ,the adverse drug reaction and the combination drugs were analyzed .Results Among the therapeutic drug monitoring data of sodium valproate in 115 cases ,74 cases (64 .35% ) were within the serum concentration (50‐100 μg · mL -1 ) ,31 cases (26 .95% ) were less then 50μg · mL -1 ,and 10 ca‐ses (8 .70% ) were higher than 100 μg · mL -1 .The effective blood concentration was 50‐100 μg · mL -1 .The antiepileptic effect within this concentration range was better than out of this concentration range ,above this concentration range may increase the ad‐verse drug reactions of VPA .Carbamazepine and phenytoin sodium may reduce the plasma concentration of valproate and interfer the therapeutic effect .Conclusion Serum concentrations of sodium valproate varied greatly in epileptic cases ,which were affected by multi‐factors such as drug interactions .For the realization of individual administration ,the drug blood concentration should be mo‐nitored routinely .