丙戊酸钠缓释片治疗不同年龄段癫痫患者血药浓度监测分析

目的：监测丙戊酸钠缓释片治疗不同年龄段癫痫患者的血药浓度，并对数据进行分析，为临床合理用药提供参考。方法：2013年1月-2015年12月，收治癫痫患者123例，其中成人41例（成人组），儿童60例（儿童组），老人22例（老人组）；3组均用丙戊酸钠缓释片规律治疗（20~30 mg·kg^-1·d^-1，1~2次/d，po），并采用高效液相色谱法进行血药浓度测定。结果：丙戊酸钠缓释片治疗儿童、成人、老人癫痫疗效肯定（有效率分别达80.00%，95.12%与95.45%）；药品不良反应（ADR）与血药浓度间有统计学意义（P<0.05），且当血药浓度>100 mg·L^-1时ADR明显增多，达60.00%；3组间比较ADR发生情况无统计学意义（P>0.05）；在降低各类型癫痫发作频次、疗效方面和血药浓度控制方面成人组和老人组均优于儿童组（P<0.05）。结论：丙戊酸钠缓释片治疗儿童、成人和老人癫痫均有效，但仍存差异。丙戊酸钠缓释片治疗成人和老人癫痫是适宜的，但对于年龄偏小的儿童来说并不是最好的，此为临床用药提供参考。不良反应随血药浓度上升而明显增多，临床用药时应注意血药浓度监测。

Monitoring and analysis of serum concentrations of valproate sodium retard tablets in epilepsy patients of different ages

OBJECTIVE Serum concentrations of valproate sodium retard tablets were monitored for epilepsy patients of different ages, and analyzed to provide a reference for clinical rational drug use. METHODS From January 2013 to December 2015, 123 epilepsy patients, including 41 adults (adult group), 60 children (children group) and 22 elderly patients (elderly group), were enrolled. Patients of 3 groups were treated with valproate sodium retard tablets (20-30 mg·kg^-1·d^-1,1-2 times/d, p.o.). HPLC method was used to determine serum concentrations. RESULTS In epilepsy patients, sodium valproate retard tablets showed affirmative curative effects (effective rates were 80.00%, 95.12% and 95.45%, respectively). Statistical significance was observed for correlation between ADR and blood drug concentration (P<0.05). When the blood drug concentration >100 mg·L^-1, ADR increased significantly up to 60.00%. The incidence of ADR was not significantly different between the 3 groups (P>0.05). The adult group and elderly group were all superior to children group in reducing frequency of epileptic seizure, efficacy and control over blood concentrations (P<0.05). CONCLUSION Valproate sodium retard tablets show varied effects in all groups of patients with epilepsy. Valproate sodium retard tablets are appropriate adult and elderly epilepsy patients rather than in younger children. The adverse drug reaction increases significantly with increase of the serum concentration, and blood concentration should be monitored during clinical medication.