碳青霉烯类药物联合丙戊酸钠治疗重症感染合并癫痫患者血药浓度及其肝肾损害  

Blood drug concentration and liver and kidney damage of carbapenem drugs combined with sodium valproate in the treatment of severely infected patients with epilepsy

作　　者：傅启伟 符林瑜 FU Qi-wei;FU Lin-yu(Hainan Anning Hospital,Haikou,Hainan 570105,China;不详)

机构地区：[1]海南省安宁医院药剂科,海南海口570105 [2]海南省第五人民医院药剂科,海南海口570206

出　　处：《中华医院感染学杂志》2020年第20期3080-3084,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金面上项目(817371)。

摘　　要：目的分析不同碳青霉烯类抗菌药物联合丙戊酸钠治疗重症感染合并癫痫对丙戊酸钠血药浓度变化。方法回顾性分析海南省安宁医院药剂科和海南省第五人民医院药剂科采用碳青霉烯药物联合丙戊酸钠治疗的重症感染合并癫痫患者95例的临床资料,根据用药情况分为A组(比阿培南)、B组(亚胺培南)、C组(美罗培南),分析联合碳青霉烯药物前后丙戊酸钠血药浓度,分析不同程度肾功能损伤(不同肝功能分级)对碳青霉烯药物联合前后丙戊酸钠血药浓度的影响。结果A组、B组、C组联合用药后丙戊酸钠血药浓度均降低,从低至高依次为A组、C组、B组,下降幅度从高至低依次为A组、C组、B组,差异均有统计学意义(P<0.05)。A组、B组、C组肾功能损伤程度分布、肝功能Child-Pugh分级,差异无统计学意义。肾损伤越重,比阿培南、亚胺培南、美罗培南日均剂量越低(P<0.05)。不同肾功能损伤组联合碳青霉烯药物(比阿培南、亚胺培南、美罗培南)前,丙戊酸钠血药浓度比较差异无统计学意义;联合用药后丙戊酸钠血药浓度下降,且肾功能正常组下降幅度较损伤患者大(P<0.001),但轻度损伤与中重度损伤丙戊酸钠血药浓度下降幅度,差异无统计学意义。不同肝功能分级组联合用药前丙戊酸钠血药浓度,差异无统计学意义,用药后Child-Pugh A级、B级、C级间比较,差异均有统计学意义(P<0.001)。结论比阿培南、亚胺培南、美罗培南联合丙戊酸钠后会降低丙戊酸钠血药浓度,这种相互作用主要在肝脏,应尽量避免联用。OBJECTIVE To analyze the changes of sodium valproate blood concentration of different carbapenem drugs combined with sodium valproate in the treatment of severe infection with epilepsy.METHODS The clinical data of 95patients with severe infection and epilepsy treated with carbapenem drugs combined with sodium valproate in the Pharmacy Department of Hainan Anning Hospital and the Pharmacy Hospital of Hainan Fifth People's Hospital were retrospectively analyzed,and were classified as A Group(biapenem),group B(imipenem),group C(meropenem)according to the medication status.The blood concentration of sodium valproate before and after the combination of carbapenem drugs were analyzed,and the effect of different renal impairment(different liver function grades)on the blood concentration of sodium valproate before and after carbapenem drug combination were analyzed.RESULTS The blood concentration of sodium valproate in group A,group B,and group C all decreased after the combined treatment,from low to high,they were group A,group C,and group B.The descending range was group A,group C,and group B from high to low,the difference was statistically significant(P<0.05).There were no significant differences in the distribution of renal function impairment and the Child-Pugh classification of liver function in group A,B and C.The more severe the kidney injury was,the lower the average daily dose of apenem,imipenem,and meropenem was used(P<0.05).There was no significant difference in the blood concentration of sodium valproate before combining carbapenem drugs(biapenem,imipenem,meropenem)in different renal function impairment groups.The blood concentration of sodium valproate decreased after combination medication,and the decrease in the normal renal function group was significently greater than that of the injured patients(P<0.001).However,there was no significant difference in the decrease in the blood concentration of sodium valproate between364'mild injuries and moderate to severe injuries.There was no significant differen

关 键 词：碳青霉烯类药物 丙戊酸钠 重症感染合并癫痫 血药浓度 肝肾功能 

分 类 号：R742.1[医药卫生—神经病学与精神病学]