丙戊酸钠致高血氨脑病的文献病例分析  

Literature case analysis of hyperammonemic encephalopathy caused by sodium valproate

作　　者：王利媛 李晶 段自皞 王法财 蒋俊杰 Li-Yuan WANG;Jing LI;Zi-Hao DUAN;Fa-Cai WANG;Jun-Jie JIANG(Department of Pharmacy,Lu’an Hospital of Anhui Medical University(Lu’an People’s Hospital of Anhui Province),Lu’an 237005,Anhui Province,China)

机构地区：[1]安徽医科大学附属六安医院/六安市人民医院药学部,安徽六安237005

出　　处：《药物流行病学杂志》2023年第12期1417-1424,共8页Chinese Journal of Pharmacoepidemiology

基　　金：六安市科技计划项目(2022lakj005)。

摘　　要：目的探讨丙戊酸钠致高血氨脑病不良反应的发生情况及临床特点,为临床安全用药提供参考。方法计算机检索CNKI、WanFang Data、VIP、PubMed和Web of Science数据库,搜集丙戊酸钠致高血氨脑病的中英文文献病例报道,检索时限为建库至2023年3月,提取相关信息进行统计分析。结果纳入37篇文献,共41例患者,其中男性28例(68.3%),女性13例(31.7%),年龄5~78岁,中位年龄41岁。大多数患者均无基础疾病,实验室检查血氨浓度均高于正常范围,临床主要表现为神经系统损害如认知障碍、嗜睡、昏迷等意识障碍;经停药、换药及对症治疗后患者意识均逐渐恢复,血氨浓度恢复正常。结论丙戊酸钠致高血氨脑病临床上不易识别和发现,应用此类药物时应密切监测患者临床表现及血药浓度,一旦发现异常应及时对症处理,保障患者用药安全。Objective To investigate the occurrence and clinical characteristics of the adverse reactions of hyperammonemic encephalopathy caused by sodium valproate and provide reference for the safe clinical use of the drug.Methods CNKI,WanFang Data,VIP,PubMed and Web of Science databases were electronically searched to collect case reports on valproate-induced hyperammonemic encephalopathy from the inception to March 2023.The extracted data was conducted for statistical analysis.Results A total of 37 documents with 41 patients were finally included.Among them,28 patients(68.3%)were males and 13 patients(31.7%)were females,aged 5 to 78 years,the median age was 41 years;most of the patients had no underlying diseases but the blood ammonia concentrations of them were abnormally high in laboratory tests,and the main clinical manifestations were neurological impairment such as cognitive impairment,drowsiness,coma and other disorders of consciousness.After drug discontinuation,drug switch and symptomatic treatment,they gradually recovered consciousness and the blood ammonia concentrations returned to normal.Conclusion It is not easy to recognize and detect the high blood ammonia encephalopathy caused by the application of sodium valproate in clinical practice,so the clinical performance and blood concentration of this drug should be closely monitored,and once the abnormalities are detected,patients should be treated symptomatically in time to ensure the safety of the drug use.

关 键 词：丙戊酸钠 高血氨脑病 药品不良反应 病例分析 

分 类 号：R969[医药卫生—药理学]