神经外科围术期使用丙戊酸钠导致高氨血症的临床分析

Clinical analysis on hyperammonemia by perioperative sodium valproate injection in neurosurgery patients

目的研究神经外科围术期使用丙戊酸钠注射液与高血氨症的关系。方法回顾性分析中国人民解放军总医院神经外科2019年1月—6月在围术期使用丙戊酸钠注射液预防癫痫的46例患者的血氨水平及其他临床特征。结果出现高氨血症的患者24例,血氨水平正常的患者22例。两组患者间用药前血ALT及DBIL水平的差异有统计学意义;其他指标的差异无统计学意义。用药后两组间指标的差异均无统计学意义;高氨血症组与正常组间的血药浓度值差异有统计学意义。高氨血症组有3例患者出现急性意识障碍。所有患者除血氨水平外,其他各项检验指标均在正常值范围。高氨血症组患者用药后血ALT与血氨水平呈中等程度正相关。结论尽管肝功能指标和丙戊酸血药浓度与使用丙戊酸后的血氨升高有一定关系,但安全的治疗范围并不一定能规避潜在不良事件的发生,建议临床加强监测。

Objective To investigate the relationship between hyperammonemia and the perioperative application of sodium valproate injection.Methods The blood ammonia status and other clinical features of perioperative patients from January to June 2019 were collected and retrospectively analyzed according to inclusion criteria.Results A total of 46 patients were enrolled,in which 24 patients in the hyperammonemia group and 22 in the normal group.There were significant differences in pre-ALT and pre-DBIL between the two groups.There was no difference in the indexes between groups after treatment.Blood drug concentration of valproate differentiated between the two groups.Three patients in the hyperammonemia group developed acute confusion.Except for blood ammonia,all the values of testing indicators were within the normal range.There was a moderate positive correlation between ALT and blood ammonia level in the hyperammonemia group.Conclusions Although,liver function index and plasma concentration of valproic acid are related to the increase of blood ammonia.Safe treatment range may not be able to avoid the occurrence of potential adverse events.It is recommended to enhance monitoring.