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目的:为临床抗癫痫药物(AEDs)的合理使用提供科学参考。方法:对采用荧光偏振免疫(FPIA)法对丙戊酸钠、卡马西平、苯妥英钠、苯巴比妥进行血清浓度监测结果进行回顾性统计分析。结果:共监测638例次,359例次(56.27%)血药浓度位于治疗窗内,202例次(31.66%)低于治疗窗,70例次(10.97%)高于治疗窗,7例次(1.10%)未检出血清浓度;各AEDs血清浓度位于治疗窗的比例分别为卡马西平78.65%、苯巴比妥60.00%、丙戊酸钠57.48%、苯妥英钠23.08%,其中卡马西平、丙戊酸钠、苯妥英钠血清浓度位于治疗窗内癫痫治疗有效率分别为72.86%、90.57%、94.44%,明显高于其他浓度范围(χ2卡马西平=6.324,P卡马西平=0.012;χ2丙戊酸钠=122.782,P丙戊酸钠=0.000;χ2苯妥英钠=19.584,P苯妥英钠=0.000),而苯巴比妥在各浓度范围有效率差异无统计学意义(χ2=3.403,P=0.065);53例次联合用药中,12例次血清浓度在治疗窗内,占联合用药例次的22.64%。结论:对癫痫患者进行血清浓度监测,实施个体化给药,对促进抗癫痫药物安全、有效、合理使用具有重要意义。
Objective: To provide a scientific reference for the rational use of clinical antiepileptic drugs (AEDs). Methods: The serum concentration of sodium valproate, carbamazepine, phenytoin and phenobarbital was monitored by fluorescence polarization immunoassay (FPIA). Results: A total of 638 cases were monitored, 359 cases (56.27%) were in the therapeutic window, 202 cases (31.66%) were lower than the therapeutic window, 70 cases (10.97%) were higher than the therapeutic window, (1.10%) did not detect the serum concentration; each AEDs serum concentration in the therapeutic window ratio were carbamazepine 78.65%, phenobarbital 60.00%, sodium valproate 57.48%, phenytoin 23.08%, of which carbamazepine , Valproate and phenytoin were 72.86%, 90.57% and 94.44%, respectively, which were significantly higher than other concentration range (χ2 = 6.324, P = 0.012; χ2 valproate = 122.782, P sodium valproate = 0.000; χ2 phenytoin = 19.584, P phenytoin = 0.000), while there was no significant difference in the efficiency of phenobarbital in each concentration range (χ2 = 3.403, P = 0.065). Among the 53 sub-combinations, the serum concentrations of 12 cases in the treatment window accounted for 22.64% of the combined cases. Conclusion: It is of great significance to monitor serum concentration of epilepsy patients and administer individualized drugs in order to promote the safe, effective and rational use of antiepileptic drugs.