摘要
丙戊酸(VPA)是一种支链酸,该药被用于治疗部分或全身性癫痫发作和急性躁狂,并作为双相障碍和偏头痛的预防用药。有研究证实,丙戊酸钠不良反应大都是体内丙戊酸钠代谢产物积聚和氨含量持续升高的继发结果。通常地,当患者体内氨血清水平高达40mol/L时,即可诊断为高氨血症,故目前认为高氨血症为其代谢物丙酸引起,严重者可造成高氨血症脑病(VHE)。当将美罗培南、丙戊酸结合后,可以有效降低VPA血药浓度,有文献表明,在美罗培南应用前后,对比VPA的血药浓度,此果可以明确,美罗培南对VPA的血药浓度具有显著的影响。本文通过临床药师参与一VPA血药浓度持续降低,并血氨浓度持续升高的病例的原因查找,充分发挥药师在用药相互作用及不良反应干预的专长,为临床提供合理的用药方案及保障用药安全。
Valproic acid(VPA)is a kind of branched chain acid,for treatmnet of partial or systemic seizures and acute mania,and preventive drug for bipolar disorder and migraine.Studies have confirmed that its adverse reactions are mostly secondary results of accumulation of valproate metabolites and continuous increase of ammonia content in the body.Generally,when ammonia serum level of patients is up to 40mol/L,they can be diagnosed as hyperammonemia.Therefore,currently,it is considered that hyperammonemia is caused by its metabolite propionic acid,and severe cases can cause hyperammonemic encephalopathy(VHE).When meropenem and valproic acid is combined,it can reduce blood concentration of VPA effectively.Some literature shows that meropenem has significant effect on blood concentration of VPA based on comparing blood concentration of VPA before and after application of meropenem.In the paper,clinical pharmacists find reason of blood drug concentration decreasing of VPA and blood ammonia concentration increasing of one case,give full play to their expertise in drug interaction and adverse reaction intervention,to provide reasonable drug use scheme for clinic and ensure drug safety.
作者
张色华
ZHANG Sehua(Pharmacy Department,Foshan City Nanhai District Guicheng Hospital,Foshan Guangdong,528200)
出处
《智慧健康》
2022年第3期196-198,共3页
Smart Healthcare
关键词
丙戊酸钠
血药浓度
高氨血症
Sodium valproate
Blood drug concentration
Hyperammonemia
