托吡酯对癫患儿酸碱平衡及电解质代谢影响的研究

Effect of topiramate on acid-base balance and electrolytes metabolism in epileptic children.

目的 探讨托吡酯(TPM)对癫患儿酸碱平衡、电解质代谢的影响。方法 将2 0 0 2年3月至2 0 0 3年1 0月于河北医科大学附属第二医院儿科就诊的46例癫患儿根据治疗方法不同分成2组:( 1 )单药组2 6例(单独服用TPM) ;( 2 )联合用药组2 0例,为TPM与卡马西平(CBZ)、丙戊酸钠(VPA)、硝基安定(NZP)等联合应用。分别观察用药前(A时段)、用药后1～3个月(B时段)、用药3～1 2个月(C时段) 3个时段血气及电解质变化。结果 单药组血浆HCO- 3(mmol/L)A时段( 2 0 .1 0±2 .48) ,B时段( 1 6 .2 7±1 .0 6) ,C时段( 1 7 .82±1 . 79) ;联合用药组血浆HCO- 3(mmol/L)A时段( 2 2 . 1 0±2. 57) ,B时段( 1 5 .63±1 . 65) ,C时段( 1 6. 1 3±1 .0 7)。与本组A时段比较,两组用药后不同时段差异均分别具有显著性意义(P <0 . 0 1 )。但两组之间各时段差异均无显著性意义(P >0 .0 5)。结论 TPM可致癫患儿代偿性阴离子间隙正常型高氯性代谢性酸中毒。

Objective To investigate the effect of topiramate (TPM) on acid-base balance and electrolytes metabolism. Method All 46 epileptic children who had normal function of liver and kidney were divided into two groups: Single drug group(TPM only) and Combined drug group(combination of TPM with CBZ, VPA or NZP). The changes of blood gas and electrolytes were observed in three different times: before drug (Time A), 1～3 months after drug (Time B) and 3～12 months after drug (Time C). Results HCO - 3 of plasma (mmol/L) in Single drug group was 20.10±2.48,16.27±1.06 and 17.82±1.79 in Time A, Time B and Time C, respectively. HCO - 3 of plasma(mmol/L) in Combined drug group was 22.10±2.57,15.63±1.65 and 16.13±1.07 in Time A, Time B and Time C, respectively. For these two groups, there was significant difference of HCO - 3 in Time B and C compared with Time A (P<0.01), but no difference between the two groups (P>0.05). Conclusion TPM can induce normal anion gap metabolic acidosis and electrolytes disorder in epilepsia children.