成人颅脑疾病围术期预防性应用丙戊酸钠血药浓度监测分析

目的 分析我院成人颅脑疾病围术期预防性应用丙戊酸钠(VPA)血药浓度监测情况,并探究影响监测结果的因素,为临床个体化用药提供参考.方法 采用UPLC-MS/MS法对我院2019年3月至11月预防性应用丙戊酸钠的76例颅脑疾病患者进行血药浓度测定,并收集用药剂量、剂型,患者性别、年龄、体重、肝肾功能和合并用药等信息,对监...

Monitoring and analysis of blood concentration of sodium valproate in prevention of craniocerebral diseases during perioprative period in adults

Objective To analyze the monitoring of VPA blood concentration in adult patients with craniocerebral diseases in perioperative period,and to explore the factors influencing the results,so as to provide reference for clinical individualized medication.Methods The blood concentration of VPA in 76 patients with craniocerebral diseases who received preventive treatment from March to November 2019 was measured by UPLC-MS/MS.The data of dosage,form,gender,age,body weight,liver and kidney function and combined medication were collected,and the monitoring results and the above factors were statistically analyzed.Results Statistical analysis showed that the average blood concentration of VPA in 76 patients was(51.00±35.22)μg/ml,which was in the effective concentration range in 29 patients(38.2%),while in 41 patients(53.9%)it was lower than the effective concentration range,and in 6 patients(7.9%)it was higher than the effective concentration range.There were 4 cases with epileptic symptoms,in which VPA blood concentration of 2 cases was lower than the effective concentration range,2 in the effective concentration range,but there were no significant adverse reactions.In terms of dosage,the average blood concentration of VPA was(43.65±34.56)μg/ml at the initial dosage of 10~15 mg/kg,which was lower than the effective concentration range,only 38.1% were in the range.In terms of gender and age,the percentage of female patients with VPA concentration higher than the effective concentration range was 18.2%,significantly higher than that of male patients(P<0.05).The average VPA blood concentration in the 45~59 years old group was(58.21±33.51)μg/ml,higher than that in other age groups,but there was no significant difference in the effective concentration range(P>0.05).In terms of drug form,the average blood concentration of the injection group was(54.89±35.77)μg/ml,higher than that of the general tablets [(45.98±36.58)μg/ml] and sustained-release tablets [(35.27±29.43)μg/ml].In terms of liver and kidney function,the blood concentration in patients with abnormal liver function was lower than that in patients with normal liver function,and the average blood concentration of VPA in patients with abnormal kidney function was higher than that in patients with normal kidney function,which might be related to the influence of liver and kidney function on drug metabolism and excretion,but there was no significant difference(P>0.05).In terms of combined medication,11 of the 76 patients used carbapenems.The average blood concentration [(23.82±23.62)μg/ml] and the proportion in the effective concentration range(9.1%)were significantly lower than those without carbapenems(P<0.05).Conclusion The results of this study show that during the perioperative period of preventive application of VPA in craniocerebral diseases,the proportion of VPA blood concentration reaching the effective concentration range at the conventional dose may not be high,and the gender,age,drug form and combination use of drugs affect the VPA blood concentration,so it is necessary to pay attention to monitoring its blood concentration,and it is suggested to adjust drug use by regularly monitoring the blood concentration based on the clinical effect in time,promoting the individualized administration of VPA,so as to improve the preventive effect of drug and reduce adverse drug reactions.