血药浓度监测在卡马西平中毒老年癫痫患者诊断和治疗中的临床应用  

Clinical study of blood concentration monitoring in the diagnosis and treatment of carbamazepine poisoning in elderly patients with epilepsy

作　　者：项瑾 曹国君[1] 陆美娟 XIANG Jin;CAO Guojun;LU Meijuan(Department of Clinical Laboratory,Huashan Hospital,Fudan University,Shanghai 201907,China)

机构地区：[1]复旦大学附属华山医院检验科,上海201907

出　　处：《检验医学与临床》2024年第8期1153-1156,共4页Laboratory Medicine and Clinic

基　　金：上海市科学技术委员会“科技创新行动计划”(21Y11900600);上海市“医苑新星”青年医学人才培养资助计划青年医学人才类临床检验项目[沪卫人事(2021)99号]。

摘　　要：目的探讨卡马西平血药浓度监测在识别老年癫痫患者潜在药物中毒风险中的价值,为卡马西平服用过量所致毒性反应的诊断和治疗提供参考依据。方法分析1例卡马西平中毒慢性老年癫痫患者的临床资料及其诊断和治疗过程。以“卡马西平中毒”“卡马西平过量”为检索词分别对中国知网、PubMed数据库建库至2023年发表的文献进行检索。结果卡马西平在正常用法、用量下,仍然会发生药物过量毒性反应。症状可表现为血药浓度峰值极高、肝肾功能受损、神志不清、意识障碍、失语、癫痫反复发作、血压升高等。此时对老年癫痫患者进行补液利尿治疗有效。文献检索结果:共检索到可用的中文文献67篇,英文文献147篇。结合病例分析和文献复习,该文总结了卡马西平中毒的致病因素、临床诊断、治疗方法及血药浓度监测的重要性。结论老年癫痫患者应定期进行抗癫痫治疗药物监测以及时调整给药剂量,规避抗癫痫药物治疗时潜在的中毒风险。Objective To investigate the value of carbamazepine blood concentration monitoring in identifying the potential risk of drug poisoning in elderly patients with epilepsy and to provide reference for the diagnosis and treatment of toxic reactions caused by carbamazepine overdose.Methods To analyze the clinical data,diagnosis and treatment of an elderly patient with epilepsy caused by carbamazepine poisoning.Using“carbamazepine poisoning”and“carbamazepine overdose”as the search terms,the literature published from the establishment of the database to 2023 was searched in CNKI and PubMed database.Results Overdose toxicity of carbamazepine could still occur under normal usage and dosage.Symptoms could be manifested as extremely high blood drug concentration,impaired liver and kidney function,confusion,disturbance of consciousness,aphasia,recurrent seizures and increased blood pressure.At this time,rehydration and diuresis therapy was effective for elderly patients with epilepsy.Literature search results:a total of 67 Chinese articles and 147 English articles were retrieved.Combined with case analysis and literature review,the article summarized the pathogenic factors,clinical diagnosis,treatment and the importance of blood concentration monitoring of carbamazepine poisoning.Conclusion Elderly patients with epilepsy should be regularly monitored for antiepileptic drugs and adjust the dosage in time to avoid the potential risk of toxicity during antiepileptic drug treatment.

关 键 词：癫痫 老年人 卡马西平 药物过量 神经系统疾病 卒中 痴呆 

分 类 号：R742.1[医药卫生—神经病学与精神病学]