2016-2018年我院856例患者的丙戊酸钠血药浓度监测结果分析

Analysis of Blood Concentration Monitoring Results of Sodium Valproate in 856 Patients of Our Hospital from 2016 to 2018

目的:为临床合理使用丙戊酸钠提供参考。方法:采用回顾性分析方法,收集2016年1月-2018年12月在武汉科技大学附属天佑医院行丙戊酸钠治疗药物监测的856例患者的监测结果及相关病例资料,统计患者使用丙戊酸钠的剂型、治疗药物监测次数、丙戊酸钠稳态血药浓度监测结果达标情况、给药剂量调整情况以及与卡马西平、氟康唑、碳青霉烯类药物的联用情况等。采用Fisher精确检验分析影响丙戊酸钠稳态血药浓度达标的因素。结果:856例患者共行1270例次丙戊酸钠治疗药物监测,其中男性407例、女性449例,年龄(38.2±13.8)岁,体质量(52.3±10.0)kg。1270例次监测中,有554例次的丙戊酸钠稳态血药浓度在50~100μg/mL范围内,达标率为43.6%。多次监测的患者达标率高于单次监测患者,末次监测达标患者的给药剂量高于首次监测达标患者的给药剂量。丙戊酸钠缓释片组患者的达标率高于丙戊酸钠普通片组,未合用卡马西平/氟康唑组患者的达标率高于合用卡马西平组和合用氟康唑组,未合用碳青霉烯类药物组患者的达标率高于合用碳青霉烯类药物组(P均小于0.05)。结论:临床药师应重视丙戊酸钠治疗药物监测,加强患者及其家属相关知识的宣教,尽量使用丙戊酸钠缓释片;当患者合用碳青霉烯类药物或卡马西平、氟康唑时会降低丙戊酸钠的达标水平,需对丙戊酸钠剂量作相应调整。

OBJECTIVE:To reference for the rational use of sodium valproate in clinic.METHODS:By retrospective analysis,blood concentration monitoring results of sodium valproate and medical record data in 856 patients were collected from the Affiliated Tianyou Hospital of Wuhan University of Science and Technology during Jan.2016-Dec.2018.The dosage form of sodium valproate,monitoring times of therapeutic drugs,monitoring results of steady-state blood concentration of sodium valproate up to the standard,dosage adjustment and the combination with carbamazepin,fluconazol and carbapenem drugs were analyzed.Fisher exact test was used to analyze the factors influencing the steady-state blood concentration of sodium valproate up to the standard.RESULTS:A total of 1270 cases of sodium valproate were monitored in 856 patients,involving 407 males and 449 females,with age of(38.2±13.8)years and body mass of(52.3±10.0)kg.Among 1270 cases of monitoring,steady-state blood concentration of sodium valproate in 554 cases were in the range of 50-100μg/mL,and 43.6%of which reached the standard.The rate of reaching the standard in patients with multiple monitoring was higher than patients with single monitoring;the dosage of patients with last monitoring reaching the standard was higher than that of patients with the first monitoring reaching the standard.The rate of reaching the standard in Sodium valproate sustained-release tablet group was higher than general Sodium valproate tablet group;the carbamazepin/fluconazol free group was higher than the carbamazepin combination group and fluconazol combination group;the carbapenem free group was higher than the carbapenem combination group(all P<0.05).CONCLUSIONS:Clinical pharmacists should pay attention to the monitoring of sodium valproate treatment drugs,strengthen the publicity and education of patients and their families,and try to use Sodium valproate sustained-release tablets.When patients additionally receive carbapenem drugs like carbamazepin or fluconazol,the standard level of sodium valproate will be reduced,then the dosage of sodium valproate should be adjusted.