中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2013年
1期
33-36
,共4页
丙戊酸%脑疾病
丙戊痠%腦疾病
병무산%뇌질병
Valproic acid%Brain diseases
目的 分析老年患者丙戊酸钠(VPA)脑病的临床特点,提高对丙戊酸钠脑病的认识.方法 回顾性分析我院2003年4月至2011年4月诊治的10例老年VPA脑病患者的临床表现、生化、脑电图(EEG)变化及治疗结果,并结合文献进行总结. 结果 10例患者中男性8例,女性2例；年龄65～88岁,平均(75.4±10.3)岁；10例中7例单用丙戊酸钠(VPA),另3例合用其他抗癫痫药(AEDs)；10例病例的血清VPA水平62.1～122.7 mg/L,平均(92.3±30.1)mg/L；共同临床表现均为意识障碍、认知功能下降；血氨水平56.7～225.1μmol/L,平均(101.4±55.2) μmol/L；肝功能均在正常范围；EEG主要表现为弥漫性的慢波增多,以θ和δ波占优,1例有癫痫样放电增多,1例合并有三相波；所有病例在停用VPA 3～21 d后症状改善. 结论 VPA脑病在老年患者中并不罕见,突出表现是意识障碍、认知功能下降,多数VPA脑病预后良好,停药后可逐渐恢复正常.
目的 分析老年患者丙戊痠鈉(VPA)腦病的臨床特點,提高對丙戊痠鈉腦病的認識.方法 迴顧性分析我院2003年4月至2011年4月診治的10例老年VPA腦病患者的臨床錶現、生化、腦電圖(EEG)變化及治療結果,併結閤文獻進行總結. 結果 10例患者中男性8例,女性2例；年齡65～88歲,平均(75.4±10.3)歲；10例中7例單用丙戊痠鈉(VPA),另3例閤用其他抗癲癇藥(AEDs)；10例病例的血清VPA水平62.1～122.7 mg/L,平均(92.3±30.1)mg/L；共同臨床錶現均為意識障礙、認知功能下降；血氨水平56.7～225.1μmol/L,平均(101.4±55.2) μmol/L；肝功能均在正常範圍；EEG主要錶現為瀰漫性的慢波增多,以θ和δ波佔優,1例有癲癇樣放電增多,1例閤併有三相波；所有病例在停用VPA 3～21 d後癥狀改善. 結論 VPA腦病在老年患者中併不罕見,突齣錶現是意識障礙、認知功能下降,多數VPA腦病預後良好,停藥後可逐漸恢複正常.
목적 분석노년환자병무산납(VPA)뇌병적림상특점,제고대병무산납뇌병적인식.방법 회고성분석아원2003년4월지2011년4월진치적10례노년VPA뇌병환자적림상표현、생화、뇌전도(EEG)변화급치료결과,병결합문헌진행총결. 결과 10례환자중남성8례,녀성2례；년령65～88세,평균(75.4±10.3)세；10례중7례단용병무산납(VPA),령3례합용기타항전간약(AEDs)；10례병례적혈청VPA수평62.1～122.7 mg/L,평균(92.3±30.1)mg/L；공동림상표현균위의식장애、인지공능하강；혈안수평56.7～225.1μmol/L,평균(101.4±55.2) μmol/L；간공능균재정상범위；EEG주요표현위미만성적만파증다,이θ화δ파점우,1례유전간양방전증다,1례합병유삼상파；소유병례재정용VPA 3～21 d후증상개선. 결론 VPA뇌병재노년환자중병불한견,돌출표현시의식장애、인지공능하강,다수VPA뇌병예후량호,정약후가축점회복정상.
Objective To analysis the clinical features of valproate (VPA)-induced encephalopathy in elderly people in order to improve our cognition toward it.Methods From March 2003 to March 2011,a total of 10 cases with VPA-induced encephalopathy were retrospectively reviewed and summarized.The data collected included clinical manifestations,biochemistry,EEG and therapeutic effects.Results In the 10 cases,8 were males and 2 females.The age ranged from 65-88 years old (mean age 75.4±10.3 years).7 subjects were on treatment with VPA alone,and the other 3 in combination with other anti-epileptic drugs.The serum VPA level in this study ranged from 62.1-122.7 μg/ml with mean of (92.3 ± 30.1) mg/L (normal range 50-100 mg/L).All subjects presented with confusion and cognitive impairment.The serum ammonia level in this study ranged from 56.7-225.1 μmol/L with mean of (101.4±55.2) μmol/L (normal range 11-32 μmol/L).All cases were with normal liver function.Electroencephalography was characterized by signs of severe encephalopathy with continuous generalized slowing,a predominance of θ and δ activity,occasional bursts of epileptiform discharges and triphasic waves.All cases were improved 3-21 days after VPA withdrawal.Conclusions VPA-induced encephalopathy that manifested in confusion and cognitive impairment is not uncommon in elderly patients and it has a good prognosis and the early withdrawal of VPA lads to improvement in almost all cases.
