癫痫治疗中丙戊酸钠血药浓度与疗效、不良反应的关系

The relationship between plasma concentration of sodium valproate and efficacy and adverse reactions during epilepsy treatment

目的研究癫痫治疗中丙戊酸钠血药浓度与疗效、不良反应关系。方法选取2017年3月至2018年9月入院的114例癫痫患者作为研究对象,所有患者给予丙戊酸钠治疗,分析丙戊酸钠血药浓度与疗效、不良反应之间的关系,以及不同年龄、不同性别患者丙戊酸钠血药浓度分布情况。结果丙戊酸钠血药浓度50~100 mg/L的治疗总有效率显著高于血药浓度<50 mg/L、>100 mg/L(P<0.05)。丙戊酸钠血药浓度<50 mg/L时,2~14岁的患者占比显著高于15~59岁、≥60岁患者,差异具有统计学意义(P<0.05)。不同性别患者的丙戊酸钠血药浓度分布情况无显著差异(P>0.05)。丙戊酸钠血药浓度>100 mg/L的不良反应总发生率显著高于血药浓度<50 mg/L及50~100 mg/L,差异具有统计学意义(P<0.05)。结论处于有效丙戊酸钠血药浓度范围患者能够获得较好疗效,但存在个体差异。随着血药浓度增加患者不良反应大幅上升,主要存在消化系统、血液系统不良反应,治疗中应强化对血药浓度和不良反应进行观察。儿童低于正常血药浓度比例较高,为保证治疗效果,应提升其用药依从性,尽量整片吞服。

Objective To study the relationship between plasma concentration of sodium valproate and efficacy and adverse reactions during epilepsy treatment.Methods A total of 114 patients with epilepsy admitted from March 2017 to September 2018 were selected as the study objects.All patients were treated with sodium valproate.The relationship between plasma concentration of sodium valproate and efficacy,adverse reactions,and the distribution of plasma concentration of plasma valproate in different age and gender were analyzed.Results The total effective rate of treatment of sodium valproate in 50-100 mg/L was significantly higher than that in<50 mg/L and>100 mg/L(P<0.05).When the plasma concentration of sodium valproate was<50 mg/L,the proportion of patients aged 2-14 years was significantly higher than those aged 15-59 years and≥60 years,and the differences were statistically significent(P<0.05).There was no significant difference in plasma concentration distribution of sodium valproate in different ages(P>0.05).The total incidence of adverse reactions of sodium valproate in plasma concentration>100 mg/L was significantly higher than that in plasma concentration<50 mg/L and 50-100 mg/L,and the differences were statistically significent(P<0.05).Conclusion Patients in the range of effective plasma concentration of sodium valproate can obtain better curative effect,but there are individual differences.With the increase of plasma concentration,adverse reactions of patients increased significantly,mainly in digestive system and plasma system.It is necessary to strengthen the observation of plasma concentration and adverse reactions during treatment.The proportion of children's plasma concentration below normal is higher.To ensure the therapeutic effect,the compliance of children should be improved and swallowed as much as possible.