摘要
目的探讨神经外科围术期使用丙戊酸盐(VPA)所致高氨血症对患者预后的影响及其相关因素分析。方法选取首都医科大学宣武医院神经外科自2021年3月至6月收治的颅内病变患者,围术期均使用VPA,收集患者的临床资料包括基本信息、VPA用量、时程、血药浓度及相关并发症。分析VPA导致高氨血症的相关影响因素及相关并发症。结果本组共纳入123例使用VPA的颅内病变患者,42例患者出现高氨血症,占34.15%,其中3例患者发生高氨性脑病(VHE),占总人数的2.44%。单因素和多因素Logistic回归分析结果显示,体质量指数(BMI)和类固醇激素使用是高氨血症发生的独立危险因素(P<0.05),其中高BMI患者、合并使用类固醇激素更容易发生高氨血症。而VPA使用的剂量、时程及血药浓度对高氨血症的发生无影响,差异无统计学意义(P>0.05)。高氨血症导致患者在ICU的治疗时间和总住院时间延长,会影响术后30 d的预后(P<0.05),但对术后90 d及1年的预后无影响(P>0.05)。高氨血症组和非高氨血症组术后均有并发症发生,但差异无统计学意义(P>0.05)。结论神经外科围术期使用VPA预防癫痫发作相对安全,但是要注意相关并发症,特别是高氨血症的发生。神经外科医生要注意术后并发症导致的意识障碍与VHE的鉴别,避免影响临床决策。
ObjectiveTo explore the factors related to hyperammonemia caused by perioperative valproate(VPA)use in neurosurgery and its effect on prognosis of patients.MethodsPatients with intracranial lesions who were admitted to Neurosurgery Department of Xuanwu Hospital,Capital Medical University from March to June 2021 were selected.VPA was used during the perioperative period.The clinical data of patients were collected,including basic information,VPA dosage,duration,blood concentration and related complications.Related factors and complications of hyperammonemia caused by VPA were analyzed.ResultsA total of 123 patients with intracranial lesions using VPA were included in this group,42 patients(34.15%)developed hyperammonemia,among which 3 patients(2.44%)developed hyperammonia-encephalopathy.Univariate and multivariate Logistic regression analysis showed that body mass index(BMI)and steroid hormone use were independent risk factors for the occurrence of hyperammonemia(P<0.05).Among them,patients with high BMI and combined use of steroid hormones were more likely to develop hyperammonemia.The dosage,duration and blood concentration of VPA were not related to hyperammonemia,and the difference was not statistically significant(P>0.05).Hyperammonemia prolonged the treatment time and total hospital stay in ICU,which would affect the prognosis 30 d after discharge(P<0.05),but had no effect on the prognosis 90 d and 1 year after operation(P>0.05).Postoperative complications occurred in both hyperammonemia group and non hyperammonemia group,but the difference was not statistically significant(P>0.05).ConclusionVPA is relatively safe to prevent epileptic seizures during perioperative period of neurosurgery,but attention should be paid on the related complications,especially hyperammonemia.Neurosurgeons should pay close attention to the differentiation of consciousness disturbance caused by operation and high ammonia encephalopathy to avoid influencing clinical decision making.
作者
赵浩
刘琛
曲鑫
徐跃峤
齐猛
陈文劲
程玮涛
尚峰
蒋丽丹
王宁
Zhao Hao;Liu Chen;Qu Xin;Xu Yueqiao;Qi Meng;Chen Wenjin;Cheng Weitao;Shang Feng;Jiang Lidan;Wang Ning(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华神经创伤外科电子杂志》
2022年第4期218-223,共6页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
基金
首都医科大学校培育基金(PYZ21037)
关键词
高氨血症
丙戊酸盐
并发症
围术期
神经外科
Hyperammonemia
Sodium valproate
Complications
Perioperative
Neurosurgery
