六种抗癫痫药物的血药浓度监测结果分析  

Analyses of blood concentration monitoring results of six antiepileptics

作　　者：张颖[1] 孙玉鹤 周甜甜 韩露 赵保红 Zhang Ying;Sun Yuhe;Zhou Tiant ian;Han Lu;Zhao Baohong(The Second People's Hospital of Zhengzhou City,Zhengzhou 450006,Henan,China)

机构地区：[1]郑州市第二人民医院,河南郑州450006

出　　处：《临床心身疾病杂志》2024年第4期120-125,共6页Journal of Clinical Psychosomatic Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号2018020740,LHGJ20210728)。

摘　　要：目的 分析六种不同抗癫痫药物的血药浓度监测结果,以期为抗癫痫药物合理使用提供重要参考。方法 回顾性收集810例癫痫患者(单一抗癫痫用药674例、二联抗癫痫用药114例、三联抗癫痫用药20例,四联抗癫痫用药2例)基本资料,观察患者单一使用抗癫痫药物有效血药浓度测定结果、疗效及安全性,按性别、年龄及联合用药进行分类,分析其对有效血药浓度测定结果的影响。结果 810例癫痫患者中138例单一使用丙戊酸钠(17.04%),处于有效血药浓度范围79例,占比57.25%;6例单一使用苯妥英钠(0.74%),处于有效血药浓度范围0例;42例单一使用卡马西平(5.19%),处于有效血药浓度范围27例,占比64.29%;280例单一使用奥卡西平(34.57%),处于有效血药浓度范围255例,占比91.07%;149例单一使用拉莫三嗪(18.40%),处于有效血药浓度范围98例,占比65.77%;59例单一使用左乙拉西坦(7.28%),处于有效血药浓度范围20例,占比33.90%。共有555例获有良好疗效,总有效率为82.34%,42例出现不良反应,不良反应总发生率为6.23%。不同性别患者单一使用卡马西平和拉莫三嗪有效浓度测定结果比较,差异均有统计学意义(P<0.05或0.01);不同年龄患者单一使用六种抗癫痫药物血浓度测定结果差异均无统计学意义(P>0.05)。136例联合用药中,有34例处于有效浓度范围内,占25.00%。联合用药共有102例获有效,总有效率为75.00%,低于单一用药的总有效率82.34%(χ^(2)=3.980,P<0.05);联合用药共有17例出现不良反应,不良反应总发生率为12.50%,高于单一用药的不良反应总发生率6.23%(χ^(2)=6.585,P<0.05)。结论 血药浓度监测可为临床用药提供重要指导,但癫痫患者个体差异大,需结合患者自身实际合理斟酌应用抗癫痫药物。Objective To analyze the blood concentration monitoring results of six different antiepileptics in order to provide important reference for rational use of antiepileptics.Methods The basic data of 810 epilepsy patients(674 cases on single antiepileptic,114 dual antiepileptics,20 triple,2 quadruple)were retrospectively collected.The determination results of effective blood concentration,efficacy and safety of single antiepileptic were observed,stratified according to gender,age and drug combination,and their influences on determination results of effective blood concentration analyzed.Results Of 810 epileptic patients 138(17.04%)received sodium valproate alone,79(57.25%)were in the effective blood concentration range,and accounted for 57.25%.Six ones(0.74%)received phenytoin sodium alone,and none was in the effective blood concentration range.Forty-two ones(5.19%)received carbamazepine alone,27 were in the effective blood concentration range,and accounted for 64.29%.280 ones(34.57%)received oxcarbazepine alone,255 were in the effective blood concentration range,and accounted for 91.07%.149 ones(18.40%)received lamotrigine alone,98 were in the effective blood concentration range,accounting for 65.77%.59 ones(7.28%)received levetiracetam alone,20 were in the effective blood concentration range,accounting for 33.90%.A total of 555 patients had good curative effect,the total effective rate was 82.34%,42 ones developed adverse reactions,and the total incidence of adverse reactions was 6.23%.Difference in the effective concentration determination results of of lamotrigine and carbamazepine alone was statistically significant(P<0.05 or 0.01).differences in blood concentration determination results of patients with different ages taking one drug of six antiepileptics weren't statistically significant(P>0.05).Of 136 patients on combined drug 34 were in the range of effective concentration,accounted for 25.00%.The combined drug was effective in 102 cases,the total effective rate 75.00%and was lower than 82.34%of single drug

关 键 词：癫痫 抗癫痫药物 血药浓度监测 个体化治疗 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R969.3[医药卫生—临床医学]