抗癫痫药物血药浓度监测的作用及价值

The effect of monitoring concentration of antiepileptic drugs in blood plasma and its value

目的:通过血药浓度监测了解常用抗癫痫药在儿科临床应用中血药浓度与药物疗效及不良反应的关系,以防止或减少药物不良反应的发生。方法:采用FPIA法测定228例癫痫患儿单一使用抗癫痫药物(AED)的血药浓度,并对药物剂量、疗效和药物不良反应的关系进行分析,所有患儿经过一年以上随访。结果:228例中192例(84.2%)在有效血药浓度范围内,癫痫发作控制有效183例(80.3%),发生不良反应55例(24.1%)。结论:剂量过大和特异体质是抗癫痫药发生不良反应的主要原因;不同类型的AED所导致的不良反应有明显差异;选择抗癫痫药物类型不当和药物剂量过低是造成治疗效果不满意的重要因素。

Objective: To understand the adverse drug reaction of antiepileptic drugs (AEDs) taking place daily in pediatric clinic, and to monitor the concentration of AEDs in blood plasm, especially in the patients with liver and kidney function damaged. Methods: 228 patients were divided into four groups: phenobarbital(PB) group, sodium valproate (VPA) group, carbamazepine (CBZ) group and clonazepam (CNP) group. The concentration of AEDs in blood plasm was detected with Fluoirescence immunoassay (FPIA). All patients were followed up by regular visits for a long time of over one year. The emergence of AEDs with the dosage, the therapeutic efficacy, adverse drug reaction and their interrelation were recorded. Results: There were 192 cases(84.2%)within the valid range of AEDs concentration. 183(80.3%) cases were controlled effectively. 55 patients had the poisonous side effect, with an incidence of 24.1%. Conclutions: The poisonous side effect was mainly caused by too big dosage of AEDs and the idiosyncrasy tending to resist AEDs. There was obvious difference in adverse drug reaction with different types of AEDs. Improper selection and too small dosage of AEDs were important causes of unsatisfied treatment.