[1]邓其盼　宋　健　姚国杰　徐国政　马廉亭.丙戊酸钠相关性高血氨脑病1例报告并文献复习[J].中国临床神经外科杂志,2016,(01):30-33.[doi:10.13798/j.issn.1009-153X.2016.01.011]
　DENG Qi-pan,SONG Jian,YAO Guo-jie,et al.Valproate-induced hyperammonemic encephalopathy: case report and literatures review[J].,2016,(01):30-33.[doi:10.13798/j.issn.1009-153X.2016.01.011]
点击复制

丙戊酸钠相关性高血氨脑病1例报告并文献复习()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年01期
页码:
30-33
栏目:
论著
出版日期:
2016-01-25

文章信息/Info

Title:
Valproate-induced hyperammonemic encephalopathy: case report and literatures review
文章编号:
1009-153X（2016）01-0030-04
作者:
邓其盼　宋　健　姚国杰　徐国政　马廉亭
430070 武汉，广州军区武汉总医院神经外科
Author(s):
DENG Qi-pan;  SONG Jian;  YAO Guo-jie;  XU Guo-zhen;  MA Lian-ting.
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Command, PLA, Wuhan 430070, China
关键词:
颅脑术后; 高血氨脑病; 血丙戊酸钠浓度; 血氨浓度
Keywords:
Hyperammonemic encephalopathy;  Sodium valproate;  Blood ammonia;  Postoperative epilepsy
分类号:
R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2016.01.011
文献标志码:
A
摘要:
目的 报告1例罕见的丙戊酸钠相关性高血氨脑病患者，探讨颅脑术后患者血丙戊酸钠药物浓度监测的价值。方法 回顾性分析1例左侧颞叶肿瘤切除术后预防性应用丙戊酸钠致高血氨脑病患者的临床资料，包括临床表现、实验室检查、影像学检查，分析意识障碍原因。结果 患者为31岁女性，体重偏轻，以发作性四肢抽搐起病，行左侧颞叶肿瘤切除术后，患者1周内逐渐出现谵妄及意识障碍，并伴肢体抽动、肢体偏瘫，加量丙戊酸钠及脱水剂甘露醇不缓解，复查头颅CT及MRI 未见明显脑干病变、大面积脑梗死、脑内弥漫性病变及再出血，检测血氨及血丙戊酸钠浓度示轻中度增高，明确病因后，停用丙戊酸钠，患者意识逐渐恢复，肢体瘫痪逐渐恢复，预后良好。结论 对应用丙戊酸钠术后预防癫痫的病人，在用药过程中注意监测血丙戊酸钠与血氨浓度，减少不良反应发生。
Abstract:
Objective To discuss the value of monitoring serum concentrations of sodium valproate (SVP) to prevention and diagnosis of valproate-induced hyperammonemic encephalopathy (VIHAE) in the patient in whom SVP was used in order to prevent epilepsy after craniotomy. Methods The clinical data of a patient with VIHAE, who received intravenous infusion of SVP in order to prevent epilepsy after the removal of left temporal tumor, were analyzed retrospectively, including the clinical symptoms and signs, and data of laboratory examination and neurological imaging. The causes of disturbance of consciousness were analyzed. Results A 31 year old underweight woman with left temporal tumor was intravenously infused by SVP in order to prevent postoperative epilepsy immediately after the resection of the tumors. The mental symptoms, disturbance of consciousness, paroxysmal twitch, and hemiplegic paralysis gradually appeared 3 days after the surgery in the patient. The brainstern lessions and large area brain infarction or intracranial diffuse hemorrhage were not found by CT and MR reexaminations. The biochemical examination showed that blood ammonia and the serum concentration of SVP were moderately elevated, therefore VIHAE was definitely diagnosed as. The use of SVP was stopped immediately after the diagnosis was definitely made and then the above-mentioned symptoms gradually disappeared. Conclusion Monitoring the level of ammonia and serum concentrations of SVP should be recommended in the patients to whom SVP is administered for prevention of epilepsy after the craniotomy.

参考文献/References:

[1] Segura-Bruna N, Rodriguez-Campello A, Puente V, et al. Valproate-induced hyperammonemic encephalopathy [J]. Acta Neurol Scand, 2006, 114(1): 1-7.
[2] Rath A, Naryanan TJ, Chowdhary GV, et al. Valproate- induced hyperammonemic encephalopathy with normal liver function [J]. Neurol India, 2005, 53(2): 226-228.
[3] Wadzinski J, Franks R, Roane D, et al. Valproate-associ- ated hyperammonemic encephalopathy [J]. J Am Board Fam Med, 2007, 20(5): 499-502.
[4] Deutsch SI, Burket JA, Rosse RB. Valproate-induced hy- perammonemic encephalopathy and normal liver functions: possible synergism with topiramate [J]. Clin Neuropharma- col, 2009, 32(6): 350-352.
[5] Mehndiratta MM, Mehndiratta P, Phul P, et al. Valproate induced non hepatic hyperammonaemic encephalopathy (VNHE) l--a study from tertiary care referral university hospital, north India [J]. J Pak Med Assoc, 2008, 58(11): 627-631.
[6] Chopra A, Kolla BP, Mansukhani MP, et al. Valproate-in- duced hyperammonemic encephalopathy:an update on risk factors, clinical correlates and management [J]. Gen Hosp Psychiatry, 2012, 34(3): 290-298.
[7] 史克珊. 重视和规范继发性癫痫的治疗[J]. 中华神经外科 杂志，2006，22（5）：322-323.
[8] 史玉泉. 实用神经病学[M]. 第2版. 上海：科学技术出社， 1994. 789-803.
[9] 全国神经外科癫痫防治协助组. 神经外科围手术期和外 伤后癫痫的预防及治疗指南（草案）[J]. 中华神经医学 杂志，2006，15(12)：1189-1190.
[10] Carr RB, Sherws bury K. Hyperammonemia due to valproic acid in the psychiatric setting [J]. Am J Psychiatry, 2007, 164(7): 1020-1027.
[11] Bogdanovic MD, Kidd D, Boriddon A, et al. Late onset hete- rozygous ornithine transcarbamylase deficiency mimicking complex partialstatusepilepticus [J]. J Neurol Neurosug Psychiatry, 2000, 69: 813-815.
[12] Sousa C. Valproic acid-induced hyperammonemic encepha- lopathy--a potentially fatal adverse drug reaction [J]. SpringerPlus, 2013, 2: 13.
[13] 李金恒. 临床治疗药物检测的方法和应用[M]. 第1版. 北 京：人民卫生出版社，2003. 42.
[14] 徐叔云. 中华临床药物学[M]. 北京：人民卫生出版社， 2003. 597.

相似文献/References:

[1]杨俊丽.PICC在颅脑术后镇静镇痛病人中的应用及护理[J].中国临床神经外科杂志,2023,28(03):203.[doi:10.13798/j.issn.1009-153X.2023.03.020]

更新日期/Last Update: 2016-01-30