丙戊酸钠联合左乙拉西坦治疗癫痫的59例不良反应的案例分析
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摘要
目的研究丙戊酸钠联合左乙拉西坦治疗癫痫时出现的一系列不良反应及其引发的机制与应对措施。方法收集我院2013年6月至2016年6月收治的1 024例使用丙戊酸钠联合左乙拉西坦治疗的癫痫患者(年龄≤70岁)的病例资料,对患者的入院情况、诊断资料、丙戊酸钠联合左乙拉西坦的血液浓度、病情变化、不良反应及相关情况进行归纳分析,尤其对施用丙戊酸钠联合左乙拉西坦的不良反应进行具体分析。结果使用丙戊酸钠联合左乙拉西坦治疗的1 024例患者中,有59例患者出现不同程度的不良反应,其中出现不良反应数量居前3的分别为神经系统34例(57.6%)、内分泌系统15例(25.4%)、皮肤过敏反应6例(10.2%)、其他罕见不良反应(大小便失禁,肝中毒)4例(6.8%)。采取剂量调整、换药、停药及对症治疗后,所有患者均恢复良好。在上述药物不良反应患者中,儿童仅占3.4%;中老年人群用药后发生不良反应的比例最高,分别为35.6%及39.0%。结论中老年人为丙戊酸钠联合左乙拉西坦不良反应的高发人群,神经系统病变是丙戊酸钠联合左乙拉西坦发生不良反应的危险因素。
Objective To study a series of adverse reactions,triggering factors and countermeasures in the treatment of epilepsy with sodium valproate combined with levetiracetam.Methods A total of 1 024 cases of epileptic patients who were treated with sodium valproate combined with levetiracetam(age below 70 years) were collected from June 2013 to June 2016,and the hospitalization,diagnostic data,concentration of sodium valproate,blood concentration of levetiracetam,change of the condition,adverse reaction and the related conditions were analyzed.In particular,the adverse reactions of sodium valproate combined with levetiracetam were analyzed.Results There were 59 cases of adverse reactions in 1 024 patients who were treated with sodium valproate combined with levetiracetam.The top three adverse reactions were ADR in nervous system(34 cases,57.6%) and endocrine system(15 cases,25.4%) and skin allergy reaction(6 cases,10.2%),and there were other rare adverse reactions(loss of bowel movement and liver poisoning)(4 cases,6.8%).After adjusting the dose,stopping or withdrawing drugs and administering symptomatic treatment,all the patients with adverse reactions recovered well.Among the above-mentioned adverse drug reactions,children accounted for only 3.4%;the proportion of adverse reactions occurring in the middle-aged and elderly groups was the highest(35.6% and 39.0%,respectively).Conclusion The middle-aged and elderly people are the major population of adverse reaction of sodium valproate combined with levetiracetam,and neurological disorders are the risk factors.
Objective To study a series of adverse reactions,triggering factors and countermeasures in the treatment of epilepsy with sodium valproate combined with levetiracetam.Methods A total of 1 024 cases of epileptic patients who were treated with sodium valproate combined with levetiracetam(age below 70 years) were collected from June 2013 to June 2016,and the hospitalization,diagnostic data,concentration of sodium valproate,blood concentration of levetiracetam,change of the condition,adverse reaction and the related conditions were analyzed.In particular,the adverse reactions of sodium valproate combined with levetiracetam were analyzed.Results There were 59 cases of adverse reactions in 1 024 patients who were treated with sodium valproate combined with levetiracetam.The top three adverse reactions were ADR in nervous system(34 cases,57.6%) and endocrine system(15 cases,25.4%) and skin allergy reaction(6 cases,10.2%),and there were other rare adverse reactions(loss of bowel movement and liver poisoning)(4 cases,6.8%).After adjusting the dose,stopping or withdrawing drugs and administering symptomatic treatment,all the patients with adverse reactions recovered well.Among the above-mentioned adverse drug reactions,children accounted for only 3.4%;the proportion of adverse reactions occurring in the middle-aged and elderly groups was the highest(35.6% and 39.0%,respectively).Conclusion The middle-aged and elderly people are the major population of adverse reaction of sodium valproate combined with levetiracetam,and neurological disorders are the risk factors.
引文
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[11]武强,黎红华,濮捷,等.丙戊酸钠注射液联合左乙拉西坦治疗难治性癫痫持续状态的临床观察[J].临床军医杂志,2013,41(6):608-610.
[12]麦玉珍,李踔,占婷婷.左乙拉西坦联合丙戊酸钠注射液治疗癫痫持续状态的效果及安全性分析[J].中国当代医药,2017,24(22):33-35.
[13]樊丽霞.左乙拉西坦联合丙戊酸钠治疗外伤性癫痫的疗效观察[J].医学信息,2014,27(6):68-69.
[14]喻东山.丙戊酸钠的不良反应[J].医药导报,2011,30(2):265-268.
[15]Durá-TravéT,Gallinas-Victoriano F,Malumbres-Chacón M,et al.Vitamin D deficiency in children with epilepsy taking valproate and levetiracetam as monotherapy[J].Epilepsy Res,2018,139:80-84.
[2]Zhang Q,Yang F,Hu Z,et al.Resting-state fMRI revealed different brain activities responding to valproic acid and levetiracetam in benign epilepsy w ith central-temporal spikes[J].Eur Radiol,2017,27(5):2137-2145.
[3]周小龙,张鹏.传统抗癫痫药物与新抗癫痫药物对癫痫患者身体成分及脂代谢的影响[J].实用药物与临床,2017,20(4):419-423.
[4]刘立丽,曾艳.丙戊酸钠血药浓度临床分析[J].实用药物与临床,2013,16(5):429-432.
[5]李俊秀,田杨,舒倩宜.丙戊酸钠在病毒性脑炎癫痫型中的应用[J].实用药物与临床,2006,9(3):162-163.
[6]Jain KK.An assessment of levetiracetam as an anti-epileptic drug[J].Expert Opin Investig Drugs,2000,9(7):1611-1624.
[7]Kumaravel P,Melchias G,Vasanth N,et al.Epigallocatechin gallate attenuates behavioral defects in sodium valproate induced autism rat model[J].Res J Pharmacy Technol,2017,10(5):1477-1472.
[8]王华,吴保敏,于一兵.左乙拉西坦添加治疗小儿癫痫的临床观察[J].实用药物与临床,2011,14(5):435-437.
[9]麦少珍,何敬成,杜斌.丙戊酸钠联合左乙拉西坦治疗小儿癫痫的疗效及安全性[J].中国医院用药评价与分析,2016,16(7):908-910.
[10]孙小平.丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的临床效果观察[J].临床合理用药杂志,2018,11(7):73-75.
[11]武强,黎红华,濮捷,等.丙戊酸钠注射液联合左乙拉西坦治疗难治性癫痫持续状态的临床观察[J].临床军医杂志,2013,41(6):608-610.
[12]麦玉珍,李踔,占婷婷.左乙拉西坦联合丙戊酸钠注射液治疗癫痫持续状态的效果及安全性分析[J].中国当代医药,2017,24(22):33-35.
[13]樊丽霞.左乙拉西坦联合丙戊酸钠治疗外伤性癫痫的疗效观察[J].医学信息,2014,27(6):68-69.
[14]喻东山.丙戊酸钠的不良反应[J].医药导报,2011,30(2):265-268.
[15]Durá-TravéT,Gallinas-Victoriano F,Malumbres-Chacón M,et al.Vitamin D deficiency in children with epilepsy taking valproate and levetiracetam as monotherapy[J].Epilepsy Res,2018,139:80-84.