546例丙戊酸钠血药浓度监测结果分析

Results Analysis on Serum Concentration Monitoring of Sodium Valproate in 546 Cases

目的促进丙戊酸钠的临床合理应用。方法采用荧光偏振免疫分析法测定546例年龄为3个月～87岁的癫痫患者服用丙戊酸钠的797例次稳态血药浓度,并对结果进行分析。结果412例次(51.69%)丙戊酸钠血药浓度在有效治疗范围(50～100μg/mL)内,64例次(8.03%)高于100μg/mL,321例次(40.28%)低于50μg/mL;不同年龄段的血药浓度有效治疗范围无明显差异;服用丙戊酸钠缓释片后有63.37%的血药浓度在有效治疗范围内,明显高于普通片(50.29%);合用卡马西平、苯妥英钠时,可使丙戊酸钠血药浓度降低,且三者联合服用时更明显,而合用妥泰、R-氨酪酸、氯硝安定时,血药浓度均无明显变化。结论丙戊酸钠血药浓度个体差异大,且受药物间相互作用等多种因素的影响,因此在服药期间应适时监测血药浓度并及时调整剂量,以提高临床疗效、降低不良反应。

Objective To investigate the relationship between the steadystate plasma concentration and the clinical efficacy of sodium valproate so as to guide its clinical rational administration. Methods 797 case-times serum concentrations of oral sodium valproate in 546 epileptic patients at the age from 3 months to 87 years were determined by fluorescence polarization immunoassay, then the results were analyzed. Results 412 caseimes（51.69% ）were within the effective serum concentration（50-100 μg/mL）, 64 case-times （8.03%） were higher than 100 μg/mL and 321 case-times （40.3%） were less than 50 μg/mL. The serum concentration in different ages had no obvious difference in effective therapeutic range. After taking Sodium Valproate Sustained Release Tablets, 63.37% of serum concentrations were within the effective range, which was higher than that after taking the conventional tablets. Taking carbamazepine combined with phenytoin sodium could decrease the serum concentration of sodium valproate, and the decrease was more conspicuous when taking the trigeminy of sodium valproate, phenytoin sodium and carbamazepine. The serum concentration of sodium valproate had no obvious change when taking the trigeminy of topamax, R- aminobutyric acid and clonazepam. Conclusion Serum concentrations of sodium valproate varied greatly in epileptic patients, which are affected by multi factors such as drug interaction. Therefore during the period of medication treatment, the serum drug concentration should be monitored at the appropriate time and the dosage of the drugs should be adjusted in time for improving the clinical therapeutic effect and reducing the adverse reactions.