105例门诊儿童癫痫患者用药合理性分析
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摘要
目的:了解成都市妇女儿童中心医院(以下简称"我院")门诊儿童癫痫患者的用药情况及其合理性,促进临床合理用药。方法:对2016年3—6月于我院门诊接受治疗的105例癫痫患儿的治疗用药使用情况进行回顾性分析,并对其中22例患儿的家属进行电话回访,追踪实际治疗用药和控制情况,统计分析临床治疗用药各环节中存在的问题。结果:105例门诊儿童癫痫患者的药物治疗以单药治疗为主(88例,占83.81%),部分难治性癫痫病例采用了联合用药;丙戊酸钠口服液的使用年龄范围最广(4个月至11岁),其次为左乙拉西坦片(2~11岁),而丙戊酸钠缓释片均用于6岁以上患儿,奥卡西平片均用于5岁以上患儿。存在部分超说明书用药情况,包括10例超年龄用药和2例超剂量用药,主要涉及药物均为左乙拉西坦片。失访3例,实际回访19例,其中用药后未发作11例(占57.89%),用药后发作减少6例(占31.58%),总有效率为89.47%。结论:我院门诊儿童癫痫患者的治疗用药存在一定的不合理情况,有必要开展住院和门诊患者的抗癫痫药血药浓度监测,并对患者及家属进行用药教育。
OBJECTIVE: To investigate the drug application status and rationality in children with epilepsy in outpatient department from Chengdu Women and Children's Central Hospital( hereinafter referred to as "our hospital"). METHODS: Retrospective analysis was conducted on drug application status in 105 children with epilepsy who admitted into outpatient department of our hospital from Mar. 2016 to Jun. 2016. And 22 families of the children were return visited by telephone for tracking and controlling of the actual treatment,and then problems existed in different procedures of clinical medication were statistically analyzed. RESULTS: The drug treatment for 105 children with epilepsy mainly focused on monotherapy( 88 cases,83. 81%),and some cases with intractable epilepsy were treated with drug combination. Valproate oral solution had the widest range of ages( from 4 months to 11 years old),followed by Levetiracetam tablets( from 2 years old to 11 years old),yet Sodium valproate retard tablets were used for children aged 6 years old or more,and Oxcarbazepine tablets were used for children aged 6 years old or more. There were still some problems of off label drug use,including 10 cases with over age medication and 2 cases with overdose,mainly concentrated in Levetiracetam tablets. In addition,there were 3 cases of defaulters,19 cases of actual return visiting,among which 11 cases( 57. 89%) had no seizure after medication and 6 cases( 31. 58%) had decreasing seizure after medication, with total effective rate of 89. 47%. CONCLUSIONS: There are still some irrational phenomenon in medication for children with epilepsy in outpatient department of our hospital. It is necessary to monitor the blood drug concentration of antiepileptic drugs and medication education for the patients and their families.
OBJECTIVE: To investigate the drug application status and rationality in children with epilepsy in outpatient department from Chengdu Women and Children's Central Hospital( hereinafter referred to as "our hospital"). METHODS: Retrospective analysis was conducted on drug application status in 105 children with epilepsy who admitted into outpatient department of our hospital from Mar. 2016 to Jun. 2016. And 22 families of the children were return visited by telephone for tracking and controlling of the actual treatment,and then problems existed in different procedures of clinical medication were statistically analyzed. RESULTS: The drug treatment for 105 children with epilepsy mainly focused on monotherapy( 88 cases,83. 81%),and some cases with intractable epilepsy were treated with drug combination. Valproate oral solution had the widest range of ages( from 4 months to 11 years old),followed by Levetiracetam tablets( from 2 years old to 11 years old),yet Sodium valproate retard tablets were used for children aged 6 years old or more,and Oxcarbazepine tablets were used for children aged 6 years old or more. There were still some problems of off label drug use,including 10 cases with over age medication and 2 cases with overdose,mainly concentrated in Levetiracetam tablets. In addition,there were 3 cases of defaulters,19 cases of actual return visiting,among which 11 cases( 57. 89%) had no seizure after medication and 6 cases( 31. 58%) had decreasing seizure after medication, with total effective rate of 89. 47%. CONCLUSIONS: There are still some irrational phenomenon in medication for children with epilepsy in outpatient department of our hospital. It is necessary to monitor the blood drug concentration of antiepileptic drugs and medication education for the patients and their families.
引文
[1]中国抗癫痫协会.临床诊疗指南·癫痫病分册:2015修订版[M].北京:人民卫生出版社,2015:11,57.
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[3]刘砚韬,张伶俐,黄亮,等.新型抗癫痫药物治疗儿童癫痫的研究进展[J].中华妇幼临床医学杂志:电子版,2014,10(1):99-104.
[4]李苗霞,汪铁山,陈莉婧,等.2种抗癫痫药血药浓度监测1490例次结果分析[J].中南药学,2011,9(5):386-389.
[5]Spengler DC,Montouris GD,Hohler AD.Levetiracetam as a possible contributor to acute kidney injury[J].Clin Ther,2014,36(8):1303-1306.
[6]谢军平,林筱青,冯玲玲.4种抗癫痫药物血药浓度监测785例结果分析[J].中国医院药学杂志,2009,29(22):1936-1939.
[7]张峻,唐薇,季佳兴,等.抗癫痫药物中毒病例的血药浓度监测及分析[J].中国医院药学杂志,2003,23(3):31-32.
[8]黄志,陈琼,梁颖文.抗癫痫药物血药浓度监测的作用及价值[J].儿科药学杂志,2005,11(3):33-35.
[9]Milosheska D,Grabnar I,Vovk T.Dried blood spots for monitoring and individualization of antiepileptic drug treatment[J].Eur J Pharm Sci,2015,75:25-39.
[10]杨彤,何艳玲.1例婴儿痉挛症的药学监护实践[J].儿科药学杂志,2017,23(9):33-35.
[11]易爱玲,易博,周从辉.癫痫患儿联用抗癫痫药治疗致昏迷的药学监护[J].中国医院用药评价与分析,2016,16(5):704-707.
[12]陈木娟,卓倩.临床药师参与癫痫患儿药学监护的可行性分析[J].中国医学创新,2016,13(2):133-135.
[13]沙美娟.临床药师参与2例重症肺炎癫痫患儿的药学监护[J].儿科药学杂志,2014,20(12):35-37.
[14]盛晓燕,冯健全,吴晔,等.临床药师参与癫痫患儿的药学监护[J].中国临床药理学杂志,2014,30(5):458-459.
[15]曾智群,罗崇彬,李丽萍,等.症状性癫痫患者药学监护1例[J].今日药学,2013,23(4):249-251.
[16]曹洪富,邵欢,赵文艳,等.药学服务对癫痫患者用药依从性和疗效的影响[J].中国药房,2010,21(34):3246-3248.
[2]李雪华.癫痫的治疗方法研究进展[J].临床合理用药杂志,2012,5(6):155.
[3]刘砚韬,张伶俐,黄亮,等.新型抗癫痫药物治疗儿童癫痫的研究进展[J].中华妇幼临床医学杂志:电子版,2014,10(1):99-104.
[4]李苗霞,汪铁山,陈莉婧,等.2种抗癫痫药血药浓度监测1490例次结果分析[J].中南药学,2011,9(5):386-389.
[5]Spengler DC,Montouris GD,Hohler AD.Levetiracetam as a possible contributor to acute kidney injury[J].Clin Ther,2014,36(8):1303-1306.
[6]谢军平,林筱青,冯玲玲.4种抗癫痫药物血药浓度监测785例结果分析[J].中国医院药学杂志,2009,29(22):1936-1939.
[7]张峻,唐薇,季佳兴,等.抗癫痫药物中毒病例的血药浓度监测及分析[J].中国医院药学杂志,2003,23(3):31-32.
[8]黄志,陈琼,梁颖文.抗癫痫药物血药浓度监测的作用及价值[J].儿科药学杂志,2005,11(3):33-35.
[9]Milosheska D,Grabnar I,Vovk T.Dried blood spots for monitoring and individualization of antiepileptic drug treatment[J].Eur J Pharm Sci,2015,75:25-39.
[10]杨彤,何艳玲.1例婴儿痉挛症的药学监护实践[J].儿科药学杂志,2017,23(9):33-35.
[11]易爱玲,易博,周从辉.癫痫患儿联用抗癫痫药治疗致昏迷的药学监护[J].中国医院用药评价与分析,2016,16(5):704-707.
[12]陈木娟,卓倩.临床药师参与癫痫患儿药学监护的可行性分析[J].中国医学创新,2016,13(2):133-135.
[13]沙美娟.临床药师参与2例重症肺炎癫痫患儿的药学监护[J].儿科药学杂志,2014,20(12):35-37.
[14]盛晓燕,冯健全,吴晔,等.临床药师参与癫痫患儿的药学监护[J].中国临床药理学杂志,2014,30(5):458-459.
[15]曾智群,罗崇彬,李丽萍,等.症状性癫痫患者药学监护1例[J].今日药学,2013,23(4):249-251.
[16]曹洪富,邵欢,赵文艳,等.药学服务对癫痫患者用药依从性和疗效的影响[J].中国药房,2010,21(34):3246-3248.