| 高伟祺,李志宏,陈维红.丙戊酸钠在神经外科颅脑疾病手术后预防癫痫发作的合理应用[J].中国药事,2017,(5):565-570 |
| 丙戊酸钠在神经外科颅脑疾病手术后预防癫痫发作的合理应用 |
| Rational Application of Sodium Valproate in the Prevention of Epilepsy after Operation of Brain Disease in Department of Neurosurgery |
| 投稿时间：2016-07-09 |
| DOI：10.16153/j.1002-7777.2017.05.018 |
| 中文关键词: 血药浓度监测 病例分析 神经外科 丙戊酸钠 合理用药 药学监护 |
| 英文关键词: blood drug concentration monitoring case analysis neurosurgery sodium valproate rational application pharmaceutical care |
| 基金项目: |
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| 中文摘要: |
| 目的：探讨神经外科颅脑疾病手术后正确使用丙戊酸钠（VPA）的方法，以达到预防术后癫痫发作的目的。方法：以2015年1月至6月在山西大医院神经外科进行过VPA血药浓度监测的91例患者为研究对象，对其中血药浓度偏低或偏高的患者展开病例资料分析。结果：调查数据显示，共有28例（30.77%）患者在服用常规剂量的VPA后，血药浓度低于（25例 27.47%）或高于（3例 3.30%）50~100 μg·mL-1的有效血药浓度范围；5例与美罗培南合用后，VPA的血药浓度均在10 μg·mL-1以下，远远低于有效血药浓度的下限。结论：VPA在神经外科的预防性使用过程中，要全面考虑用药时机、合并用药、个体差异等情况，同时要对丙戊酸钠脑病（VHE）进行鉴别，并进行血药浓度监测，加强药学监护，以提高治疗的安全性和有效性。 |
| 英文摘要: |
| Objective: To explore the rational application of sodium valproate after the operation of brain diseases in department of neurosurgery, so as to achieve the goal of preventing postoperative seizures. Methods: A total of 91 patients admitted in department of neurosurgery in a hospital from January to June 2015 were enrolled for the study. These patients were monitored by blood drug concentration. The patients with the low or high blood drug concentration were analyzed. Results: The VPA blood drug concentration monitoring results showed 30.77% of patients (28 cases) were below (25 cases, 27.47%) or above (3 cases, 3.30%) the safe range 50-100 μg·mL-1 after taking a conventional dose of VPA. Results of the 5 cases who received meropenem combined with VPA administration indicated the plasma concentrations of VPA were below 10μg·mL-1, which was far below the theoretical range. Conclusion: The factors such as the medication timing, combined medication, individual differences and so on should be fully taken into consideration in VPA use to prevent epilepsy in Department of Neurosurgery. Meanwhile, the valproate encephalopathy (VHE) need to be identified and the pharmaceutical care need to be strengthened, so as to improve the safety and effectiveness of treatment. |
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