【摘要】 目的:分析丙戊酸钠(VPA)、卡马西平(CBZ)血药浓度监测(TDM)结果,探讨血药浓度与患者年龄、临床疗效、不良反应之间的关系,为临床合理用药提供参考。方法:采用回顾性分析方法,收集我院2015年3月~2016年3月共计2 608例次VPA和CBZ的TDM监测数据,统计患者性别、年龄、临床诊断、用药情况、用法用量、最后一次服药时间、采血时间、血药浓度等相关资料,并进行比较分析。结果:2 608例次TDM监测数据中,VPA 2 205例次,CBZ 403例次;血药浓度在治疗窗范围内分别为1 123例次(50.93%),292例次(72.46%)。2 205例次VPA的TDM数据中单药治疗1 814例次(82.27%),血药浓度低于治疗窗下限790例次(43.55%),控制癫痫发作的总有效率为56.07%;在治疗窗内921例次(50.77%),总有效率为88.27%;高于治疗窗上限103例次(5.68%),总有效率为81.55%。259例次(64.27%)CBZ单药治疗中,血药浓度低于治疗窗下限58例次(22.39%),总有效率为48.28%;在治疗窗内195例次(72.29%),总有效率为79.49%;高于治疗窗上限6例次(2.32%),总有效率为83.34%。VPA联合其他抗癫痫药物治疗391例次,主要是与左乙拉西坦、拉莫三嗪等新型抗癫痫药物联用(87.21%)。不同患者年龄对VPA、CBZ血药浓度影响较为显著(P<0.05)。结论:VPA、CBZ血药浓度个体差异大,其疗效及不良反应与血药浓度密切相关。血药浓度监测能为临床合理用药提供重要依据,对提高癫痫治疗的安全性和有效性具有重要指导意义。更多还原

【Abstract】 Objective: To analyze the serum concentration results of sodium valproate( VPA) and carbamazepine( CBZ) and explore the relationship between the serum concentration and age,clinical efficacy and adverse reactions to provide reference for the rational clinical use. Methods: Retrospective analysis was used to collect the clinical data of the patients from March 2015 to March2016,including gender,age,clinical diagnosis,medication,usage and dosage,the last medication time,sampling time,blood concentration and the other related data,and the data were compared and analyzed. Results: Totally 2608 samples were collected,including 2 205 ones for VPA and 403 ones for CBZ. Totally 1 123 cases( 50. 93%) of VPA and 292 cases( 72. 46%) of CBZ were within the range of therapeutic windows. In the 2 205 cases of VPA,1 814 cases( 82. 27%) were with single drug treatment,and the serum concentration lower than the lower limit of therapeutic window accounted for 790 cases( 43. 55%) with the effective rate of 43. 55% for epilepsy. The serum concentration within the range of therapeutic window accounted for 921 cases( 50. 77%) with the effective rate of88. 27% for epilepsy,and that higher than the higher limit of therapeutic window accounted for 103 cases( 5. 68%) with the effective rate of 81. 55%. As for CBZ,the number was 58 cases( 22. 39%) with the effective rate of 48. 28%,195 cases( 72. 29%) with the effective rate of 79. 49% and 6 cases( 2. 32%) with the effective rate of 83. 34%,respectively. Totally 391 cases( 87. 21%) of VPA combined with the other antiepileptic drugs,such as levetiracetam and lamotrigine. The effect of age on the serum concentration of VPA and CBZ was significant( P < 0. 05). Conclusion: There are great individual differences in serum concentration of VPA and CBZ among patients. The therapeutic effect and adverse reactions of VPA and CBZ are closely related to the serum concentration. Monitoring the serum concentrations may provide evidence for the rational administration and plays an important role in the treatment of epilepsy.更多还原