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目的:观察苯巴比妥高血浓度长期治疗急性脑炎伴难控制和反复发作癫痫(acute encephalitis with refractory,repetitive partial seizures,AERRPS)患者的安全性。方法:2003年7月至2008年9月期间入院的脑炎患者,符合Sakuma于2001年提出的AERRPS诊断标准的患者入组,给药方法:200mg苯巴比妥静脉推注或肌内注射后,再以1~1.5mg/(kg.h)静脉滴注或200mg肌内注射或静脉推注,每2~4h1次,每日总量在1.2~2.4g,使苯巴比妥血浓度在24h左右达到100μg/ml。维持时间24~100d。观察苯巴比妥高血浓度治疗时患者的血压、心率及心律、呼吸、皮肤反应、意识、瞳孔、癫痫发作情况,并进行血常规检查、生化分析及长程脑电图监测。预后观察至少6个月。结果:苯巴比妥高血浓度维持期间,5例患者均处于昏迷状态,格拉斯哥昏迷评分(GCS)3~5分,脑电图监测未见爆发-抑制模式。脑干反射大部分保留。自主呼吸全部消失。3例窦性心动过速,2例室性或室上性心动过速。2例血压下降至64~86/40~55mmHg。5例患者的ALT57~385IU/L,AST38~365IU/L,γ-GT54~542IU/L,血氨升高至103.7μmol/L,皮肤不良反应很轻。肾功能未受影响。当苯巴比妥血浓度降至50μg/ml以下时,患者意识和自主呼吸恢复,不良反应基本消退。结论:苯巴比妥高血浓度长期治疗可能致严重不良反应,因此AER-RPS患者使用苯巴比妥高血浓度长期治疗期间必须使用人工辅助呼吸,严密监测,并及时处理出现的不良反应,以利于患者安全。
Objective: To observe the safety of long-term treatment of acute encephalitis with refractory and repetitive partial seizures (AERRPS) in patients with high blood concentration of phenobarbital. METHODS: Patients with encephalitis who were admitted to hospital between July 2003 and September 2008 were enrolled in a study that met Sakure’s diagnostic criteria for AERRPS in 2001. Administration: 200 mg phenobarbital intravenously or intramuscularly , Then 1 ~ 1.5mg / (kg.h) intravenous infusion or intramuscular injection of 200mg or intravenous injection, every 2 ~ 4h1 times daily total amount of 1.2 ~ 2.4g, phenobarbital blood concentration of 24h to 100μg / ml. Maintain time 24 ~ 100d. Observe the blood pressure, heart rate and heart rate, respiration, skin reaction, consciousness, pupils, seizures, blood routine examination, biochemical analysis and long-term EEG monitoring of phenobarbital high blood concentration treatment. Prognosis observed for at least 6 months. Results: During the maintenance period of phenobarbital high blood concentration, all 5 patients were in a coma. The Glasgow Coma Scale (GCS) was 3 to 5 minutes. There was no outbreak-inhibitory pattern in EEG monitoring. Brainstem reflexes are mostly reserved. Spontaneous breathing all disappear. 3 cases of sinus tachycardia, 2 cases of ventricular tachycardia or supraventricular tachycardia. 2 cases of blood pressure dropped to 64 ~ 86/40 ~ 55mmHg. ALT 57 ~ 385IU / L, AST38 ~ 365IU / L, γ-GT54 ~ 542IU / L and blood ammonia increased to 103.7μmol / L in 5 patients. The skin adverse reactions were very mild. Renal function is not affected. When the blood concentration of phenobarbital dropped below 50μg / ml, patient awareness and spontaneous respiration recovered, and adverse reactions subsided. Conclusion: Long-term treatment with phenobarbital high blood concentration may cause serious side effects. Therefore, the use of phenobarbital high blood concentration in patients with AER-RPS must use artificial respiration during long-term treatment, closely monitor and timely treatment of adverse reactions, To facilitate patient safety.