美罗培南降低丙戊酸钠稳态血药浓度的临床分析

美罗培南降低丙戊酸钠稳态血药浓度的临床分析

王金平,钱文璟

深圳市第二人民医院,深圳市第二人民医院

收稿日期:2016-11-14 修回日期:2017-02-08 出版日期:2017-02-25 发布日期:2017-01-25

Clinical Analysis of Reducting the Steady-state Plasma Concentration of

shenzhen second people''s hospital,

Received:2016-11-14 Revised:2017-02-08 Online:2017-02-25 Published:2017-01-25

摘要/Abstract

摘要： 目的：分析美罗培南降低丙戊酸钠（VPA）血药浓度的影响程度及变化规律，为临床合理用药提供借鉴和参考。方法：回顾性分析我院住院患者23例，记录患者的基本信息、用药信息，VPA血药浓度等，分析两药合用后VPA血药浓度下降的幅度和程度，及VPA血药浓度的变化规律；并依据两药合用前VPA的血药浓度，将患者分为3组，VPA血药浓度50~60 mg?L-1组（n=13例），VPA血药浓度60~70 mg?L-1组（n=6例），VPA血药浓度＞70 mg?L-1组（n=4例），探讨VPA血药浓度降低的程度和幅度是否呈浓度依赖性。结果：美罗培南与VPA合用24 h内，6例患者中有5例VPA血药浓度均降低到治疗浓度范围以下，合用24~48 h后所有患者VPA血药浓度均降到治疗浓度范围以下。未合用前VPA血药浓度越高，合用后VPA血药浓度下降幅度越大，VPA最低浓度波动5.9~15.7 mg?L-1之间，均降到了治疗浓度范围以下。停用美罗培南1~7 d后，7例患者中有2例VPA血药浓度恢复到了治疗浓度范围以上，7~14 d内13例患者VPA浓度均恢复到治疗浓度范围以上。结论：美罗培南降低VPA血药浓度主要发生在两药合用24 h内，个别病例会延迟到48 h。合用后VPA血药浓度下降幅度呈浓度依赖性，最低VPA血药浓度无浓度依赖性。停用美罗培南7~14 d后，VPA血药浓度基本都可恢复到治疗浓度范围以上。

Abstract: [Abstract]Objective： To analyze the onset and severity of the reductions in the concentration of VAP in patients with the coadminstration of meropenem， and promote rational drug use.Methods： Retrospective 23 patients who simultaneously received treatment with VPA and meropenem were included in this study， record basic information of patients， drug information， and VPA concentration.Based on the VPA concentration before combination of two drugs， the patients were divided into three groups VPA 50-60 mg?L-1 concentration group(n=13)， VPA 60-70 mg?L-1 concentration group(n=6)， VPA＞70 mg?L-1 concentration group(n=4)， analysis the variation of VPA concentration， discuss the decreasing range and extent of VPA concentration.Results：The VPA concentrations reduced and lowed to a therapeutic concentration range in 5 patients among 6 cases who detected the VPA concentrations within 24 h， within 24-48 h， all patient′s VPA concentrations were lowed to therapeutic concentrations.The higher levels of VAP concentration before combination of two drugs， the droper of VPA concentration decreases， minimum concentration of VAP fluctuated 5.9-15.7 mg?L-1， and below therapeutic concentrations range.After stopping the meropenem 1-7 d， VPA concentration were detected in7 patients， 2 patients VPA concentration back over the range of treatment， After7-14 d， VPA levels were detected in 13 patients， their VPA concentration were all back over the range of treatment.Conclusion： Meropenem reduced VPA concentrations occurred primarily within 24 h when two drugs were simultaneously used.Occasionally some cases would be delayed to 48h.After stopping meropenem 7-14 d， VPA concentration can be restored to the treatment concentration range.

王金平,钱文璟. 美罗培南降低丙戊酸钠稳态血药浓度的临床分析[J]. .