碳青霉烯类药对急诊应用丙戊酸钠救治癫痫有效性影响的真实世界研究  

A real-world study of the effect of carbapenems on the efficacy of sodium valproate in the treatment of epilepsy in the emergency department

作　　者：潘雯 丁晶 罗雯怡 李艳丽 李晓宇 Pan Wen;Ding Jing;Luo Wenyi;Li Yanli;Li Xiaoyu(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai200032,China;Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]复旦大学附属中山医院神经内科,上海200032

出　　处：《中华神经科杂志》2024年第12期1326-1334,共9页Chinese Journal of Neurology

摘　　要：目的利用真实世界数据分析治疗前7 d内或在治疗过程中使用过碳青霉烯类药是否会降低癫痫持续状态(SE)和癫痫成簇发作(SC)患者应用丙戊酸钠的有效率。方法收集2017—2021年于复旦大学附属中山医院急诊静脉应用丙戊酸钠的SE和SC患者的临床资料,以丙戊酸钠注射后未能终止癫痫发作作为主要终点,采用单因素分析和多因素回归模型分析应用碳青霉烯类药是否为丙戊酸钠治疗失败的独立风险因素。结果最终纳入142例SE患者和181例SC患者。应用单因素分析发现治疗前7 d内或在治疗中使用过碳青霉烯类药是SC患者丙戊酸钠治疗失败的危险因素(χ^(2)=5.498,P=0.019),但并非SE患者应用丙戊酸钠治疗失败的危险因素(χ^(2)=3.015,P=0.082)。经过多因素分析发现,使用碳青霉烯类药是丙戊酸钠未能终止SC患者癫痫发作的独立危险因素(OR=3.462,95%CI 1.180~10.157);发病至用药间隔时间≥4 h增加了SE患者丙戊酸钠治疗失败的风险(OR=4.591,95%CI 1.443~14.607);同时使用苯二氮䓬类药则能减少SE患者丙戊酸钠治疗失败的风险(OR=0.300,95%CI 0.128~0.703)。结论SC患者在治疗前7 d内或治疗中使用过碳青霉烯类药可能会导致丙戊酸钠治疗失败,在临床上可参考SC患者的用药记录后决定是否选用丙戊酸钠作为终止患者癫痫发作的药物。Objective Using real-world data to analyze whether the administration of carbapenems within 7 days before the treatment or during the treatment will reduce the effectiveness of sodium valproate in patients with status epilepticus(SE)and seizure clusters(SC).Methods The clinical data of SE and SC patients who received intravenous administration of sodium valproate in the Department of Emergency of Zhongshan Hospital,Fudan University from 2017 to 2021 were collected.The main endpoint was the failure to terminate epileptic seizures after sodium valproate injection.Univariate analysis and multivariate Logistic regression model were used to analyze whether the carbapenems was an independent risk factor for the failure of sodium valproate treatment.Results Finally,142 SE patients and 181 SC patients were included.Univariate analysis revealed that the use of carbapenems within 7 days before or during the treatment was a risk factor for the failure of sodium valproate treatment in SC patients(χ^(2)=5.498,P=0.019),but was not a risk factor for the failure of sodium valproate treatment in SE patients(χ^(2)=3.015,P=0.082).Through multiple factor analysis,it was found that the use of carbapenems was an independent risk factor for the seizures not terminatd by sodium valproate in SC patients(OR=3.462,95%CI 1.180-10.157);the interval between onset and medication≥4 hours increased the risk of sodium valproate treatment failure in SE patients(OR=4.591,95%CI 1.443-14.607);simultaneously using benzodiazepines could reduce the risk of sodium valproate treatment failure in SE patients(OR=0.300,95%CI 0.128-0.703).Conclusions The use of carbapenems by SC patients within 7 days before or during treatment may lead to the failure of sodium valproate treatment.In clinical practice,the use of sodium valproate as a medication to terminate seizures in SC patients can be determined based on their medication records.

关 键 词：丙戊酸 药物相互作用 碳青霉烯类 癫痫持续状态 癫痫成簇发作 

分 类 号：R742.1[医药卫生—神经病学与精神病学]