Page 98 - 2020年2月第31卷第3期

2016－2018 年我院 856 例患者的丙戊酸钠血药浓度监测结果分

析 Δ

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刘春河 ，邓 莉 ，赵 瑛 ，谭 璐 ，朱芮芮 ，黄运林 ，黄伟青 ，陈文瑛 （1.武汉科技大学附属天佑医院药学
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1＊
部，武汉 430064；2.南方医科大学第三附属医院药学部，广州 510631；3.广州增城新塘医院急诊科，广州
511340；4.广州医科大学附属第一医院急诊科，广州 510000）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2020）03-0344-05
DOI 10.6039/j.issn.1001-0408.2020.03.18
摘 要 目的：为临床合理使用丙戊酸钠提供参考。方法：采用回顾性分析方法，收集2016年1月－2018年12月在武汉科技大学
附属天佑医院行丙戊酸钠治疗药物监测的856例患者的监测结果及相关病例资料，统计患者使用丙戊酸钠的剂型、治疗药物监测
次数、丙戊酸钠稳态血药浓度监测结果达标情况、给药剂量调整情况以及与卡马西平、氟康唑、碳青霉烯类药物的联用情况等。采
用Fisher精确检验分析影响丙戊酸钠稳态血药浓度达标的因素。结果：856例患者共行1 270例次丙戊酸钠治疗药物监测，其中男
性 407 例、女性 449 例，年龄（38.2±13.8）岁，体质量（52.3±10.0）kg。1 270 例次监测中，有 554 例次的丙戊酸钠稳态血药浓度在
50～100 µg/mL范围内，达标率为43.6％。多次监测的患者达标率高于单次监测患者，末次监测达标患者的给药剂量高于首次监
测达标患者的给药剂量。丙戊酸钠缓释片组患者的达标率高于丙戊酸钠普通片组，未合用卡马西平/氟康唑组患者的达标率高于
合用卡马西平组和合用氟康唑组，未合用碳青霉烯类药物组患者的达标率高于合用碳青霉烯类药物组（P均小于0.05）。结论：临
床药师应重视丙戊酸钠治疗药物监测，加强患者及其家属相关知识的宣教，尽量使用丙戊酸钠缓释片；当患者合用碳青霉烯类药
物或卡马西平、氟康唑时会降低丙戊酸钠的达标水平，需对丙戊酸钠剂量作相应调整。
关键词 丙戊酸钠；稳态血药浓度；治疗药物监测；合理用药；影响因素

Analysis of Blood Concentration Monitoring Results of Sodium Valproate in 856 Patients of Our Hospital
from 2016 to 2018
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LIU Chunhe ，DENG Li ，ZHAO Ying ，TAN Lu ，ZHU Ruirui ，HUANG Yunlin ，HUANG Weiqing ，CHEN
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Wenying （1.Dept. of Pharmacy， the Affiliated Tianyou Hospital of Wuhan University of Science and
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Technology，Wuhan 430064，China；2.Dept. of Pharmacy，the Third Affiliated Hospital of Southern Medical
University， Guangzhou 510631， China；3.Dept. of Emergency， Guangzhou Zengcheng Xintang Hospital，
Guangzhou 511340， China；4.Dept. of Emergency， the First Affiliated Hospital of Guangzhou Medical
University，Guangzhou 510000，China）
ABSTRACT OBJECTIVE：To reference for the rational use of sodium valproate in clinic. METHODS：By retrospective
analysis，blood concentration monitoring results of sodium valproate and medical record data in 856 patients were collected from
the Affiliated Tianyou Hospital of Wuhan University of Science and Technology during Jan. 2016-Dec. 2018. The dosage form of
sodium valproate，monitoring times of therapeutic drugs，monitoring results of steady-state blood concentration of sodium valproate
up to the standard，dosage adjustment and the combination with carbamazepin，fluconazol and carbapenem drugs were analyzed.
Fisher exact test was used to analyze the factors influencing the steady-state blood concentration of sodium valproate up to the
standard. RESULTS：A total of 1 270 cases of sodium valproate were monitored in 856 patients，involving 407 males and 449
females，with age of（38.2±13.8）years and body mass of（52.3±10.0）kg. Among 1 270 cases of monitoring，steady-state blood
concentration of sodium valproate in 554 cases were in the range of 50-100 µg/mL，and 43.6％ of which reached the standard. The
rate of reaching the standard in patients with multiple monitoring was higher than patients with single monitoring；the dosage of
patients with last monitoring reaching the standard was higher than that of patients with the first monitoring reaching the standard.
The rate of reaching the standard in Sodium valproate sustained-release tablet group was higher than general Sodium valproate tablet
group；the carbamazepin/fluconazol free group was higher than the carbamazepin combination group and fluconazol combination
group；the carbapenem free group was higher than the carbapenem combination group（all P＜0.05）. CONCLUSIONS：Clinical
pharmacists should pay attention to the monitoring of sodium
Δ 基金项目：广东省省级科技计划项目（No.2014A020212561）
valproate treatment drugs， strengthen the publicity and
＊主管药师。研究方向：药理学。电话：027-51228426。E-mail：
education of patients and their families，and try to use Sodium
3551851542@qq.com
# 通信作者：主任药师，博士。研究方向：临床药学。电话： valproate sustained-release tablets. When patients additionally
020-62784827。E-mail：chenwenying2016@163.com receive carbapenem drugs like carbamazepin or fluconazol，

·344 · China Pharmacy 2020 Vol. 31 No. 3 中国药房 2020年第31卷第3期