苯妥英钠在血药浓度监测下治疗癫痫大发作与部分性发作73例临床观察
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[摘要] 目的 通过对苯妥英钠血药浓度的监测，观察苯妥英钠治疗73例癫痫患者的临床疗效。 方法 随机将本院门诊和住院收治的癫痫患者219例分为苯妥英钠（PHT）治疗组（n = 73）、苯妥英钠（PHT）对照组（n = 73）、苯妥英钠和苯巴比妥（PHT+PB）双药组（n = 73），并对治疗组的患者进行治疗药物监测（TDM），双药组与对照组不进行TDM，观察其临床疗效。 结果 显示首次3组有效率差异无统计学意义（P ＞ 0.05），经调整DPH血药浓度后，3组疗效比较，治疗组与双药组、对照组有效率比较差异有统计学意义（P ＜ 0.05），双药组与对照组有效率比较差异无统计学意义（P ＞ 0.05）。 结论 表明控制癫痫大发作与部分性发作治疗组的个体化给药较双药组、对照组效果佳。
[关键词] 癫痫；苯妥英钠；血药浓度；监测
[中图分类号] R742.1 [文献标识码] A [文章编号] 1674-4721（2012）07（b）-0021-02
Clinical observation on 73 patients of the full and part break out of epilepsy with serum Phenytoin monitoring
QIAN Xujiang ZHANG Liwen YANG Yichao CHEN Anbin
Shenzhen Futian Traditional Chinese Medical Hospital Affiliated to Hunan Traditional Medical Therapy University, Guangdong Province, Shenzhen 518034, China
[Abstract] Objective To observe the clinical curative effect of Phenytoin sodium on 73 patients with epilepsy by monitoring of phenytoin sodium serum concentration. Methods Two hundred and nineteen patients were randomly divided into treated group (PHT, n = 73) and contrastive group (PHT, n = 73) and double medicines group (PHT+PB, n = 73) in our hospital outpatient service and be in hospital. The serum concentraction of therapeutic drug monitoring (TDM) were mesdured in treated grorp. It was no measured in double medicines group and contrastive group, the clinical curative effect were observed. Results The effective rate of each group showed the difference was no statistically significant (P > 0.05). After abjusting the serum concentration of PHT, the effective rate of treated group showed the difference was statistically significant with the other two groups (P < 0.05), but double medicine group and contrastive group showed the difference was no statistically significant (P > 0.05). Conclusion It show that the control the full and part break out of epilepsy for individualized administration, the treated group is better then the double medicine group and contrastive group.
[Key words] Epilepsy; Phenytoin; Serum concentration; Monitoring
苯妥英钠常用于治疗原发性、继发性全身强直-阵挛性发作，单纯复杂部分性发作及混合型发作[1]，由于该药治疗癫痫具有疗效肯定、副作用少和经济的特点，故临床应用较为广泛。但苯妥英钠常规偏低剂量无效时增加剂量时要非常小心，否则极易中毒，因此血药浓度监测很重要[2]。近年来，笔者采用苯妥英钠在血药浓度监测下的个体化给药，取得较好疗效，现将结果报道如下：
1 资料与方法
1.1 一般资料
选择2009年7月～2011年7月本院门诊和住院收治的癫痫患者219例，其中，癫痫大发作110例，部分性发作109例。将其随机分为苯妥英钠（PHT）治疗组、苯妥英钠和苯巴比妥（PHT+PB）双药组、苯妥英钠（PHT）对照组，每组73例。3组患者的一般资料比较，差异均无统计学意义（P ＞ 0.05），具有可比性。见表1。
1.2 诊断标准
依据《临床神经疾病诊断学》[3]拟订。（1）典型的发作形式以及2次以上的发作；（2）脑电图检查：发作期脑电图改变及发作间期脑电图改变。