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目的 :探讨小儿抗癫药物 (AED)治疗过程中血药浓度的改变及其临床意义。方法 :采用HPLC法 ,测定 2 2 3例 6 44人次患儿单一AED治疗时的血药浓度 ,比较血药浓度与疗效及不良反应的关系。结果 :40 %以上监测浓度在有效血药浓度(治疗窗 )范围内 ;苯妥英钠 (PHT)血药浓度为 (13 6 8± 6 79)mg·L-1,卡马西平 (CBZ)为 (6 48± 2 6 6 )mg·L-1,苯巴比妥 (PB)为(2 4 0 5± 15 73)mg·L-1,丙戊酸钠 (VPA)为 (6 6 5 6± 2 1 2 0 )mg·L-1。调整剂量后癫发作控制率平均接近 70 % ,以VPA效果最佳 ,CBZ次之。虽然PHT血药浓度在治疗窗内时发作控制率优于治疗窗外 ,但差异并无显著性意义 (P >0 0 5 ) ,CBZ及VPA的监测浓度在治疗窗内时的疗效较优于非治疗窗者 (P <0 0 5 )。PB的组内控制率比较与PHT相似。EEG的改善与临床症状不一致 ,好转趋势以VPA最显著 ,其次为PB ,PHT最差。全部药物均有一定的不良反应 (12 5 0 % ) ,且大部分与血药浓度正相关。结论 :治疗小儿癫应监测AED血药浓度 ,尽可能单一药物治疗及剂量个体化投药
Objective: To investigate the changes of plasma concentration in pediatric antiepileptic drugs (AED) and its clinical significance. Methods: HPLC method was used to determine the blood concentration of 233 cases of 6 44 children with single AED treatment, comparing the relationship between plasma concentration and curative effect and adverse reactions. Results: More than 40% of the monitored concentrations were within the range of effective plasma concentration (therapeutic window); the plasma concentration of PHT was (13 6 8 ± 6 79) mg · L -1, CBZ was ( 6 48 ± 26 6) mg · L-1, phenobarbital (PB) was (2450 ± 1573) mg · L-1, and valproate (VPA) 2 1 2 0) mg · L-1. After adjusting for dosage, the control rate of epileptic seizures averaged nearly 70%, with VPA best, followed by CBZ. Although the control rate of PHT plasma concentration in the treatment window was better than that of the therapeutic window, the difference was not significant (P> 0.05). The therapeutic effect of CBZ and VPA in the treatment window was better than that of non-therapeutic window Treatment window (P <0 05). The control rate of PB in the group is similar to that of PHT. EEG improvement and clinical symptoms are inconsistent, the trend of improvement to the most significant VPA, followed by PB, PHT worst. All drugs have some adverse reactions (125.0%), and most of the plasma concentration is positively correlated. CONCLUSIONS: AED plasma concentrations should be monitored for the treatment of pediatric epilepsy, with individual medications and individual dose administration as possible