癫痫外科术后丙戊酸诱发高血氨脑病临床分析  

Clinical analysis of valproate-induced hyperammonemic encephalopathy after epilepsy surgery

作　　者：钱会 杨帆[1] 梁爽爽[1] 于晓曼 梁树立[1] 张绍辉 QIAN Hui;YANG Fan;LIANG Shuang-shuang(Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital ,Beijing 100048, China)

机构地区：[1]中国人民解放军总医院第一附属医院神经外科,北京100048

出　　处：《临床神经外科杂志》2018年第3期161-164,共4页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81771388);UCB IIS(Investigator initiated Study)资助项目(2095401)

摘　　要：目的探讨癫痫术后应用丙戊酸钠导致高血氨脑病的临床特点和诊治经验。方法回顾性分析2012年2月至2017年12月6例癫痫灶切除术后出现高血氨脑病患者的临床资料,分析临床症状与血氨水平的关系,及治疗与预后。结果 6例患者中,男2例,女4例,均为术后用丙戊酸钠3~7 d出现进行性意识障碍加重,血氨水平偏高。经及时停用丙戊酸,并给予降血氨药物治疗,患者的意识均逐步恢复正常,痊愈出院。结论丙戊酸钠致高血氨脑病是罕见的药物并发症,可导致严重后果。对其早期识别和诊断非常重要,及时停用丙戊酸,并进行降血氨治疗,预后良好。Objective To explore the clinical features and the experience of diagnosis and treatment of the patients with valproate-induced hyperammonemic encephalopathy（ VHE） after epilepsy surgery. Methods The clinical symptoms,blood ammonia and its relationship with prognosis of 6 patients with valproate-induced hyperammonemic encephalopathy（ VHE） underwent epilepsy surgery from February 2012 to December 2017 were analyzed retrospectively,and the diagnosis and treatments experiences were summarized. Results There were 6 patients with VHE,including 2 men and 4 women. All of them presented clinical symptoms with progressive unconsciousness and high blood ammonia 3 to 7 days after surgery. After VHE was diagnosed,valproic acid must be immediately stopped and medicines should be administrated to reduce blood ammonia. All patients recovered consciousness and normal blood ammonia in 8 days. Conclusions VHE is a rare complication,which can lead to serious consequences. Early identification and diagnosis were very important. The patients had good prognosis after valproate withdrawal and symptomatic treatment timely.

关 键 词：癫痫 丙戊酸脑病 高血氨 

分 类 号：R651.1[医药卫生—外科学]