陈振金;王可馨;彭世立;张庆玲;赵子薇;陈艳;王胜男;郑萍;刘世霆;李亦蕾;古春萍;
CHEN Zhenjin;WANG Kexin;PENG Shili;ZHANG Qingling;ZHAO Ziwei;CHEN Yan;WANG Shengnan;ZHENG Ping;LIU Shiting;LI Yilei;GU Chunping;Department of Pharmacy,Nanfang Hospital, Southern Medical University;School of Pharmaceutical Sciences, Southern Medical University;Department of Neurology, Nanfang Hospital, Southern Medical University;

• 1:南方医科大学南方医院药学部
• 2:南方医科大学药学院
• 3:南方医科大学南方医院神经内科

摘要(Abstract)：

目的探讨血浆置换治疗难治性癫痫持续状态对高剂量苯巴比妥血药浓度的影响。方法临床药师参与一例难治性癫痫持续状态患者的诊治过程,给予该患者负荷剂量苯巴比妥并行五次血浆置换,并采用气相色谱-质谱联用仪在置换前后分别检测血药浓度。结果患者行第2、3、4次置换前后,苯巴比妥的血浆浓度分别是131/139μg·mL~(-1)、98.3/102.2μg·mL~(-1)、95.6/96.3μg·mL~(-1)。结论血浆置换并未显著降低苯巴比妥血浆浓度,因此,置换后无须增加苯巴比妥剂量。
OBJECTIVE To explore the influence of therapeutic plasma exchange on plasma concentration of high-dose Phenobarbital(PB). METHODS A clinical pharmacist analyzed the treatment for one patient with refractory status epileptics. The patient was treated with load dose injection of PB as well as therapeutic plasma exchanges with five times. The plasma concentrations of PB were measured by gas chromatography-mass spectrometer before and after therapeutic plasma exchange. RESULTS The plasma concentrations of PB were 131/139 μg·mL~(-1), 98./102.2 μg·mL~(-1), 95.6/96.3 μg·mL~(-1) before and after the second, third, fourth therapeutic plasma exchange, respectively. CONCLUSION Therapeutic plasma exchange may not significantly affect the plasma concentration of PB. There was no need to increase PB dosage before and after therapeutic plasma exchange.

关键词(KeyWords)： 难治性癫痫持续状态;血浆置换;苯巴比妥;血药浓度
refractory status epileptics;plasma exchange;phenobarbital;plasma concentration

Abstract:

Keywords:

基金项目(Foundation): 广东省医院药学研究基金(2019A03)

作者(Author): 陈振金;王可馨;彭世立;张庆玲;赵子薇;陈艳;王胜男;郑萍;刘世霆;李亦蕾;古春萍;
CHEN Zhenjin;WANG Kexin;PENG Shili;ZHANG Qingling;ZHAO Ziwei;CHEN Yan;WANG Shengnan;ZHENG Ping;LIU Shiting;LI Yilei;GU Chunping;Department of Pharmacy,Nanfang Hospital, Southern Medical University;School of Pharmaceutical Sciences, Southern Medical University;Department of Neurology, Nanfang Hospital, Southern Medical University;

Email:

DOI:

参考文献(References)：

• [1]Trinka E,Cock H,Hesdorffer D,et al.A definition and classification of status epilepticus-Report of the ILAE Task Force on Classification of Status Epilepticus[J].Epilepsia,2015,56(10):1515-1523.
• [2]Rossetti A O,Reichhart M D,Schaller M D,et al.Propofol treatment of refractory status epilepticus:a study of 31 episodes[J].Epilepsia,2004,45(7):757-763.
• [3]Rossetti A A O,Milligan T A,Vulliémoz S,et al.A randomized trial for the treatment of refractory status epilepticus[J].Neurocrit Care,2011,14(1):4-10.
• [4]Holtkamp M,Othman J,Buchheim K,et al.Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit[J].J Neurol Neurosurg Psychiatry,2005,76(4):534-539.
• [5]李雄飞,陈劲松,刘琦,等.丙戊酸钠联合左乙拉西坦治疗癫痫的59例不良反应的案例分析[J].实用药物与临床,2019,22(3):317-320.
• [6]王晓玮,王文志,茹小娟.百年老药苯巴比妥治疗癫的临床应用进展[J].中国现代神经疾病杂志,2016,16(1):47-51.
• [7]Kwan P,Brodie M J.Phenobarbital for the treatment of epilepsy in the 21st Century:A Critical Review[J].Epilepsia,2004,45(9):1141-1149.
• [8]Tiamkao S,Mayurasakorn N,Suko P,et al.Very high dose phenobarbital for refractory status epilepticus[J].Journal of the Medical Association of Thailand,2007,90(12):2597-2600.
• [9]Shlomo S,Ravindra A,Thomas P B,et al.Evidence-based guideline:treatment of convulsive status epilepticus in children and adults:report of the guideline committee of the american epilepsy society[J].Epilepsy Currents,2016,16(1):48-61.
• [10]Dodson W E,Delorenzo R J,Pedley T A,et al.Treatment of convulsive status epilepticus.Recommendations of the epilepsy foundation of America’s working group on Status Epilepticus[J].JAMA,1993,270(7):854-859.
• [11]Crawford T O,Mitchell W G,Fishman L S,et al.Very-high-dose phenobarbital for refractory status epilepticus in children[J].Neurology,1988,38(7):1035-1040.
• [12]Sawanyawisuth K,Tiamkao S,Jitpimolmard S,et al.A case of Miller Fisher syndrome with anti GQ1b in Thailand[J].J Med Assoc Thai,2007,90(12):2597-2600.
• [13]Guan H Z,Ren H T,Cui L Y.Autoimmune encephalitis:an expanding frontier of neuroimmunology[J].Chin Med J,2016,129(9):1122-1127.
• [14]赵则燕,韩玮欣,李晓庆,等.自身免疫性脑炎的诊疗现状及进展[J].临床荟萃,2018,33(8):728-732.
• [15]邵龙,王威,郑娜,等.自身免疫性脑炎治疗进展[J].解放军医学杂志,2017,42(4):347-353.
• [16]李昕,林小茹,张鸿.癫痫与自身免疫的相关研究进展[J].医学综述,2017,23(24):4890-4894.
• [17]Cortese I,Chaudhry V,So Y T,et al.Evidence-based guideline update:Plasmapheresis in neurologic disorders:report of the therapeutics and technology assessment subcommittee of the american academy of neurology[J].Neurology,2011,76(3):294-300.
• [18]肖海兵,王洁,官静,等.抗神经元抗体阳性的自身免疫性脑炎12例临床研究[J].华中科技大学学报(医学版),2019,48(4):441-445.
• [19]毛晓薇,侯媌媌,王宗文,等.双重滤过血浆置换治疗重症抗N-甲基-D-天冬氨酸受体脑炎9例疗效分析[J].第二军医大学学报,2019,40(10):1148-1152.
• [20]Sagraves R,Bradberry J C.The effects of exchange transfusion on the pharmacokinetics of phenobarbital[J].Drug Intell Clin Pharm,1983,17(12):901-903.
• [21]Lai C W,Leppik I E,Jenkins D C,et al.Epilepsy,myasthenia gravis,and effect of plasmapheresis on antiepileptic drug concentrations[J].Arch Neurol,1990,47(1):66-68.