【摘要】 目的探讨美罗培南对丙戊酸钠稳态血药浓度的影响,为临床合理用药提供参考。方法选择新疆维吾尔自治区人民医院2015年1月至2017年9月联合应用美罗培南和丙戊酸钠并监测丙戊酸钠稳态血药浓度的27例住院患者,分析合用美罗培南前后丙戊酸钠血药浓度的变化及其变化幅度。结果 27例患者在合用美罗培南前丙戊酸钠血药浓度均达到治疗浓度(50~100 mg/L),合用美罗培南后其血药浓度为2~28 mg/L,均降到治疗浓度范围以下,下降幅度为(78±15)%,与合用美罗培南前比较明显降低[(15±10)mg/L比(71±18)mg/L],差异有统计学意义(t=15.408,P<0.001)。依据合用美罗培南前丙戊酸钠血药浓度将27例患者分为50~60 mg/L组(9例)、>60~70 mg/L组(8例)、>70 m/L组(10例),3组患者合用美罗培南后丙戊酸钠血药浓度均低于合用前[(9±6)mg/LL比(51±7)mg/L,(15±5)mg/L比(66±3)mg/L,(15±11)mg/L比(88±13)mg/L](均P<0.05),但3组间下降幅度比较差异无统计学意义(P>0.05)。依据丙戊酸钠用法用量将27例患者分为0.25 g、3次/d组(6例),0.4 g、3次/d组(13例),0.5 g、2次/d组(8例),3组患者合用美罗培南后丙戊酸钠血药浓度均低于合用前[(7±6)mg/L比(64±20)mg/L,(16±12)mg/L比(74±20)mg/L,(15±9)mg/L比(71±16)mg/L](均P<0.05),但3组间下降幅度比较差异无统计学意义(P>0.05)。结论美罗培南与丙戊酸钠联合用药可使丙戊酸钠血药浓度显著降低,临床上应避免二者联用。更多还原

【Abstract】 Objective To analyze the effect of meropenem on the steady state plasma concentration of sodium valproate.Methods Twenty-seven in-patients taking meropenem and sodium valproate in People’s Hospital of Xinjing Uygur Autonomous Region were enrolled from January 2015 to September 2017.Steady state plasma-sodium valproate concentration was monitored; changes of the plasma-sodium valproate concentration after taking meropenem were analyzed.Results Steady state plasma-sodium valproate concentration in 27 patients was 50-100 mg/L before taking meropenem and it decreased to 2-28 mg/L after taking meropenem,which was below the therapeutic concentration range; the drop range was(78 ±15)%; the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem[(15 ± 10) mg/L vs(71 ± 18) mg/L](t = 15.408, P <0.001).According to plasma-sodium valproate concentration before taking meropenem,27 patients were divided into 50-60 mg/L group(n =9), >60-70 mg/L group(n =8) and >70 mg/L group(n =10); the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem in all 3 groups[(9 ± 6) mg/L vs(51 ± 7) mg/L,( 15 ± 5) mg/L vs(66 ±3) mg/L,(15 ± 11) mg/L vs(88 ± 13) mg/L](P <0.05); the drop range showed no significant difference among groups(P >0.05).According to dosage of sodium valproate, 27 patients were divided into 0.25 g, 3 times/d group(n=6), 0.4 g, 3 times/d group(n = 13) and 0.5 g, 2 times/d group(n=8); the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem in all 3 groups[(7±6)mg/L vs(64±20)mg/L,(16±12)mg/L vs(74±20)mg/L,(15±9)mg/L vs(71 ± 16) mg/L]( P < 0.05); the drop range showed no significant difference among groups( P >0.05) ·Conclusion Steady state plasma concentration of sodium valproate can be lowered by meropenem; combined use of sodium valproate and meropenem should be avoided in clinical practice.更多还原