丙戊酸预防性治疗周期性呕吐综合征疗效探讨

A clinical observation of preventive effect of sodium valproate for refractory cyclic vomiting syndrome

目的 探讨丙戊酸预防顽固性周期性呕吐的疗效.方法 对1998年1月～2009年1月在重庆三峡中心医院用丙戊酸预防顽固性周期性呕吐综合征的27例病例资料进行回顾性分析.治疗组患儿男17例,女10例,发病年龄3～14岁,平均年龄8.2岁;丙戊酸的使用剂量为18.3～32mg·kg^-1·d^-1,平均为23.2mg·kg^-1·d^-1,口服起始剂量为5～10 mg·kg^-1·d^-1,每天2次,逐渐增加,一般不超过30～40mg·kg^-1·d^-1.患儿自入组接受治疗起的下年1月始定点随访,根据疗效判定后续治疗,待发作控制3年后,丙戊酸缓慢减停.结果 3年后随访时,20例仍在继续丙戊酸治疗,5例已成功停药,而2例换药治疗;24例（88.9%）发作次数控制〉50%,17例（63%）完全控制,9例（33.3%）体重增重〉10%,无人出现肝功异常.结论 临床上对于阿米替林、赛庚啶、普萘洛尔预防周期性呕吐综合征无效的患者,可考虑用丙戊酸预防.

Objective To observe preventive effect of sodium valproate for refractory cyclic vomiting syndrome （CVS） of children. Methods The clinical data of 27 children （17males and 10 females, aged 3 - 14 years, mean age： 8.2 years old） with refractory cyclic vomiting syndrome who were given sodium valproate for preventing refractory CVS in Children＇ s Branch Hospital of Chongqing Three Gorges Central Hospital in a period from January, 1998 to January, 2009 were retrospectively analyzed. All children had been failed in prevention of refractory CVS with amitriptyline, cyproheptadine and/or propranolol before sodium valproate therapy. The average dosage of sodium valproate was 23.2 · kg^-1 · d ^-1 （range：18.3 -32 nag· kg^-1 · d ^-1 ）, the oral initial dosage was 5 - 10 nag · kg^-1 · d ^-1 , twice a day, thereafter, the dosage was increased gradually and the maximum couldn＇ t exceed 30 -40mg · kg^-1 · d ^-1 . The follow-up started from January of the next year, and aftertreatment was determined according to the efficiency. The dosage of sodium valproate was decreased slowly and stopped eventually at 3 year after the illness had been controlled. Results In the last follow-up, 20 patients remained sodium valproate therapy, 5 patients were weaned off sodium valproate with ongoing efficacy, and 2 patients had ceased due to inefficacy for other drugs. 24 patients＇ more than 50% of onset frequencies were controlled （88.9%） , and onset of 17 children （20.8%） was fully controlled. The weight gain of 9 patients （33.3%） was more than 10% of original body weight and no abnormal liver function was found. Conclusion In clinic,sodium valproate is an option for CVS in children when the drugs such as amitriptyline, cyproheptadine and/or propranolol is ineffective.