卡马西平、奥卡西平相关尿潴留

1例72岁女性患者,因带状疱疹后遗神经痛服用卡马西平0.1 g、2次/d,1 d后出现尿潴留,停药并予导尿术治疗后恢复正常。停用卡马西平后4 d,患者服用奥卡西平0.3 g、2次/d,次日再次出现尿潴留、排尿困难,停用奥卡西平,留置导尿管并给予抗感染治疗,7 d后排尿恢复正常。     

氟桂利嗪联合卡马西平治疗偏头痛36例疗效分析

目的：探讨氟桂利嗪联合卡马西平治疗偏头痛的临床疗效。方法：将108例偏头痛患者随机分为实验组和对照Ⅰ、Ⅱ组各36例,实验组给予氟桂利嗪5mg,每日2次口服,卡马西平开始0．1g／次,每日2次,第2日后每隔1日增加0．1～0．2g,餐后口服,疼痛缓解后,给予0．4～0．8州分次服用维持治疗;对照Ⅰ组单独给予氟桂利嗪5mg,每日2次口服：对照Ⅱ组给予卡马西平口服,方法同实验组,3个月为1个疗程。结果：实验组治愈16例,显效9例,有效7例,有效率为88．9％;对照Ⅰ组治愈2例,显效5例。有效12例,有效率为52．8％;对照Ⅱ组治愈1例,显效4例,有效13例,有效率为50．0％。实验组与对照Ⅰ、Ⅱ组治疗有效率比较,差异有统计学意义。结论：氟桂利嗪联合卡马西平治疗偏头痛优于单独使用氟桂利嗪或卡马西平的治疗效果。     

重症卡马西平过敏1例报告

患者,女,46岁,因发热、抽搐2个月,加重伴全身皮肤红肿3d入院。患者2个月前无明显诱因出现发热,体温达38．7℃,伴阵发性全身抽搐,小便失禁。曾在保定某医院诊断为：病毒性脑炎、脑膜炎和癫痫持续状态,给予抗病毒、抗炎、抗癫痫治疗后仍有发热,体温在37．5℃左右,偶有抽搐,口服卡马西平0．2g,3次／d,自动出院。出院后一直服用卡马西平0．2g,3次／d。于本次入院前再次高热,体温高达41℃,抽搐频繁,于当地社区静脉滴注青霉素治疗,并自行加大卡马西平剂量,改为0．4g,3次,d,口服,3d前出现全身皮肤发红、水肿、眼睛不能睁开,精神、饮食差,有时胡言乱语。     

口服佐匹克隆片6个月骤停致癫痫发作1例

1例25岁男性患者因失眠连续6个月口服佐匹克隆片15～37．5mg不等,最大量达180mg,突然停药2d后出现癫痫发作,考虑为佐匹克隆戒断症状。给予口服卡马西平片0．1g,每天2次,未再出现肢体抽搐发作。停用佐匹克隆片,出院后3个月回访未再有肢体抽搐发生。建议应用佐匹克隆片治疗失眠时宜小剂量、短期、间断使用。     

卡马西平致严重过敏反应1例

患儿，男，10岁，因发热伴全身皮疹15d就诊。15d前患儿因患“癫痫”口服卡马西平0．2g，每日3次，治疗4d后出现发热，体温38C左右，在外院静脉滴注青霉素等治疗4d后全身出现红斑、丘疹、疱疹等多形性皮疹，躯干部、面部较密集，遂停用“卡马西平、青霉索”等药物，给予抗过敏治疗8d，皮疹逐渐消退，体温降至正常。因抽搐再次服用卡马西平每次0．2g，口服2次后全身叉出现多形性皮疹，较前严重并伴颜面部充血、水肿，张口困难，治疗3d后转入我处。     

卡马西平相关白细胞及血小板减少

1例58岁女性患者因枕大神经痛入院.入院后血常规:WBC 4.90×109/L,PLT 273×109/L.给予患者卡马西平0.1 g,2次/d.次日,卡马西平改为0.1 g,3次/d,并合用氯硝西泮、罗通定及兰索拉唑.2 d后,头痛症状加重,卡马西平加量至0.2 g,3次/d,且加入氨酚双氢可待因片联用.8 d后患者躯干可见散在皮下出血点;复查血常规:WBC 2.87×109/L,PLT4×109/L.停用卡马西平,其他药物继续使用,并给予酚磺乙胺、甲泼尼龙及血小板等治疗.治疗5 d后,血常规恢复正常.     

过量卡马西平中毒及脑电图异常二例

例1：男,26岁,发作性抽搐3个月余,嗜睡伴恶心、呕吐24h入院。平素口服卡马西平0．3g／d。2009年3月14日中午患者与家人生气后一次性口服卡马西平40片（患者清醒后述说）,15：00家人发现患者恶心、呕吐,呕吐为非喷射性,呕吐物为胃内容物,同时发现患者多睡,叫之不醒,未诊治。于第2日下午就诊于我院,来院途中患者清醒,能正常回答问话,后收入院。     

甘草对大鼠体内卡马西平药代动力学的影响

目的：研究甘草对卡马西平及其代谢产物10,11-环氧卡马西平在大鼠体内的药代动力学影响。方法：12只实验大鼠随机分为生理盐水对照组和甘草实验组,甘草提取物（0.5 g/kg,1次/d）连续给药7 d后,卡马西平灌胃给药后按时间点连续采样,采用HPLC法测定卡马西平及其代谢产物。计算并比较主要药动学参数。结果：对照组和实验组的卡马西平主要药动学参数Cmax、tmax、t1/2、AUC0→24 h、AUC0→∞、MRT差异均无统计学意义（P〉0.05）,而10,11-环氧卡马西平的Cmaxt、max和AUC0→24 h同样无统计学意义（P〉0.05）。结论：甘草连续给药7 d后不影响卡马西平在大鼠体内的药代动力学。     

叶酸治疗癫痫精神运动性发作体会

本文以叶酸加卡马西平治疗癫痫精神运动性发作取得良好效果，现分析如下，供同道参考。1．处方：卡马西平0．1g，叶酸10mg，日服3次，连用7d；以后给维持量卡马西平0．ig，日3次，叶酸sing，日1次。2．典型病例：王XX，男，24岁，于出生4个月时因外伤引起癫瘤病，呈间歇性发作，长期服用苯妥英钢，12岁因病放弃就学。1星期前半夜间无意识呼叫，无意识乱开门，继之口不能语，流诞不止，不穿衣裤，两天不肯进食就诊。就诊时反应迟钝、呆笑状，问诊不能作答，遂以上方准之，10h后症状改善，两天后意识完全恢复，能自己进食，回答问题。嘱其照…     

卡马西平治疗三叉神经痛的临床效果分析

目的观察与评价卡马西平治疗三叉神经痛的临床效果。方法94例三叉神经痛患者随机均分为治疗组和对照组各47例，治疗组采用卡马西平治疗，对照组采用苯妥英钠治疗。比较2组患者治疗前后的VAS评分及治疗后的疗效。结果治疗后1周、2周、3周治疗组VAS评分均显著低于对照组，差异有统计学意义（P〈0．05）。治疗组总有效率为95．7％高于对照组的74：5％，差异有统计学意义（P〈0．05）。结论卡马西平治疗能有效地缓减患者的三叉神经痛，不良反应小，值得临床广推应用。     

Gabapentin for decerebrate rigidity: a case report

A 48-year-old woman suddenly lost consciousness as a result of a right rostral pontine tegmentum haemorrhage. The patient presented with decerebrate rigidity (DR) and regained full consciousness 5 days after the initial onset. The patient was given gabapentin 1200 mg/day nasogastrically and her DR significantly improved, although other antiepileptic drugs such as phenytoin and carbamazepine were given in larger dosages to decrease muscle hypertonicity. The patients' preserved consciousness and motor-evoked potentials to transcranial magnetic stimulation indicated a derangement of the extrapyramidal tracts with preservation of the pyramidal tracts. This case report discusses the possible mechanisms of action of gabapentin in DR.     

氯苯那敏口服诱发痫性发作

1例40岁女性患者因皮肤瘙痒给予维生素C0.2g及氯苯那敏4mg口服。2h后患者出现头昏、乏力,非喷射性呕吐。随后出现四肢强直,口吐白沫,呼之不应,持续1～2min,后又出现2次同样发作。入院后第3天脑电图示中度异常,给予地西泮及卡马西平,患者症状未再发生。     

卡马西平致过敏反应综合征一例

患者,女,68岁,因三叉神经痛口服卡马西平,剂量从0.1 g,bid逐渐增至0.2 g,bid,第16天出现颌下、颈部淋巴结肿大;第28天出现发热、皮疹;第35天停药热退;第39天胃与食道不适、吞咽困难、内痔出血,3d后好转;皮疹1月余消退,后遗皮肤色素沉着及淋巴结肿大。     

Carbamazepine poisoning: treatment with plasma exchange

Lethal cases due to carbamazepine overdose have been reported. There are contradicting reports about the efficiency of hemodialysis, hemoperfusion and plasmapheresis for the treatment of carbamazepine poisoning. We present a case of carbamazepine intoxication successfully managed with plasma exchange. The patient was a 15-year-old girl. On admission there was no evidence of trauma, Glascow Coma Scale scored 6. Further questioning of the parents revealed the patient had taken at least 23 tablets of Tegretol (4.6 g) 6 h before the admission. The carbamazepine level was 190 micromol/l. Orogastric lavage was followed by activated charcoal. Within 20 h after admission there was no improvement in her neurological status. It was thus decided to perform plasmapheresis. At the end of the procedure she started to respond to verbal stimuli. Carbamazepine level immediately after the procedure was 101 micromol/l, and at the 36th, 60th and 84th hours were 72, 33 and 20 micromol/l, respectively. The patient was discharged on the fourth day. We have not observed any rebound in our patient. Thus we suggest that simple plasma exchange by plasma replacement is a cheaper and effective method for the treatment of intoxication with carbamazepine or similar drugs.     

静脉滴注大剂量甲氨蝶呤致亚急性神经中毒

1例20岁男性患者因骨肉瘤给予2个周期大剂量甲氨蝶呤化疗(8 g/m2)。第2次化疗后第7天,患者突然出现言语不畅、左手麻木、恶心、乏力,后逐渐进展为失语、双上肢强直、双下肢麻木。实验室检查:白细胞计数12.5×109/L,红细胞计数3.6×1012/L,血红蛋白111 g/L,血小板计数101×109/L。头部CT扫描未见异常。给予吸氧。约3 h后症状好转。第2天下午患者在无诱因情况下又出现相似症状。颅脑磁共振成像、弥散加权成像、脑电图、心脏多普勒超声、颈动脉超声检查均正常。静脉滴注马来酸桂哌齐特和胞磷胆碱,2 d后症状消失。     

Effect of carbamazepine initiation and discontinuation on antithrombotic control in a patient receiving warfarin: case report and review of the literature

A 72-year-old Caucasian woman with paroxysmal atrial fibrillation had been taking warfarin therapy for 5 years with a stable international normalized ratio (INR). Her dentist then prescribed carbamazepine 200 mg/day to control facial nerve pain. At her next physician visit about 2 weeks after the start of the carbamazepine, the patient's INR had dropped from 3.3 to 1.3; she reported no contributing changes in her diet or warfarin dosage, nor had she taken other interacting drugs. Her warfarin dosage was increased, and the INR returned to the target range of 2.0-3.0 approximately 2 months later. The patient's INR remained stable for approximately 6 more months, until she had facial surgery. During that time, her warfarin was discontinued for 5 days, and the patient had stopped taking the carbamazepine because she had no pain. One month later, her INR increased from 2.2 to 3.6. She did not experience any thrombotic or hemorrhagic episodes. Warfarin undergoes hepatic metabolism through cytochrome P450 2C9, and carbamazepine induces this isoenzyme. Inducing warfarin metabolism necessitates an increase in the warfarin dosage to maintain the INR in the therapeutic target range. To our knowledge, this is the first report documenting the effect of the carbamazepine initiation and discontinuation in a patient receiving anticoagulation therapy with warfarin. In patients taking warfarin, clinicians should monitor the INR closely when carbamazepine is started or discontinued, or when either dosage is changed.     

卡马西平致排尿困难

1例75岁男性前列腺癌患者,因带状疱疹后神经痛,服用卡马西平0.1 g,2次/d。2 d后,患者出现尿流变细、尿频无力和分段尿。5 d后,卡马西平增至0.2 g,2次/d,患者排尿困难加重,遂用导尿管排尿。停用该药,次日,患者自行排尿增多,第5天完全恢复正常。     

卡马西平致红斑狼疮样综合征

1例女性患者,14岁时因癫痫口服卡马西平,由初始剂量300 mg/d逐渐增至600 g/d。服药10年后,患者出现腹腔积液和血小板减少。其血小板计数5×109/L。停用卡马西平,改用左乙拉西坦。实验室检查示抗核抗体1∶320,抗双链DNA抗体261 IU/ml。考虑红斑狼疮样综合征和卡马西平有关,给予泼尼松治疗,患者的腹腔积液逐渐消退。停用卡马西平50 d后血小板计数103×109/L,检测抗核抗体和抗双链DNA抗体均为阴性,红斑狼疮样综合征症状未再出现。     

注射用奥沙利铂疑致三叉神经痛

1例60岁女性患者,因胃癌术后接受FolFox方案(奥沙利铂150mg+替加氟0.75 g),辅以康艾注射液40 mL化疗.行第三次静脉滴注化疗时,用药后第3天,患者出现左侧面部及口腔过电样疼痛,呈发作性,伴张口困难,经神经内科会诊确诊为三叉神经痛.遂给予卡马西平片0.1g,每日3次,服用1d后,患者出现头晕,遂停用卡马西平,1周后患者三叉神经痛症状自行消失.