目的 探讨美罗培南对丙戊酸钠稳态血药浓度的影响,为临床合理用药提供参考.方法 选择新疆维吾尔自治区人民医院2015年1月至2017年9月联合应用美罗培南和丙戊酸钠并监测丙戊酸钠稳态血药浓度的27例住院患者,分析合用美罗培南前后丙戊酸钠血药浓度的变化及其变化幅度.结果 27例患者在合用美罗培南前丙戊酸钠血药浓度均达到治疗浓度(50～100 mg/L),合用美罗培南后其血药浓度为2 ～ 28 mg/L,均降到治疗浓度范围以下,下降幅度为(78±15)％,与合用美罗培南前比较明显降低[(15±10)mg/L比(71±18) mg/L],差异有统计学意义(t=15.408,P＜0.001).依据合用美罗培南前丙戊酸钠血药浓度将27例患者分为50～60 mg/L组(9例)、＞60～ 70 mg/L组(8例)、＞70 mg/L组(10例),3组患者合用美罗培南后丙戊酸钠血药浓度均低于合用前[(9 ±6) mg/L比(51±7)mg/L,(15 ±5) mg/L比(66±3)mg/L,(15±11)mg/L比(88±13) mg/L](均P＜0.05),但3组间下降幅度比较差异无统计学意义(P＞0.05).依据丙戊酸钠用法用量将27例患者分为0.25 g、3次/d组(6例),0.4g、3次/d组(13例),0.5g、2次/d组(8例),3组患者合用美罗培南后丙戊酸钠血药浓度均低于合用前[(7±6) mg/L比(64±20) mg/L,(16±12) mg/L比(74±20) mg/L,(15±9)mg/L比(71±16) mg/L](均P＜0.05),但3组间下降幅度比较差异无统计学意义(P＞0.05).结论 美罗培南与丙戊酸钠联合用药可使丙戊酸钠血药浓度显著降低,临床上应避免二者联用.%Objective To analyze the effect of meropenem on the steady state plasma concentration of sodium valproate.Methods Twenty-seven in-patients taking meropenem and sodium valproate in People's Hospital of Xinjing Uygur Autonomous Region were enrolled from January 2015 to September 2017.Steady state plasma-sodium valproate concentration was monitored;changes of the plasma-sodium valproate concentration after taking meropenem were analyzed.Results Steady state plasma-sodium valproate concentration in 27 patients was 50-100 mg/L before taking meropenem and it decreased to 2-28 mg/L after taking meropenem,which was below the therapeutic concentration range;the drop range was (78 ± 15)％;the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem[(15 ± 10)mg/L vs (71 ± 18)mg/L] (t =15.408,P ＜ 0.001).According to plasma-sodium valproate concentration before taking meropenem,27 patients were divided into 50-60 mg/L group (n =9),＞ 60-70 mg/L group (n =8) and ＞ 70 mg/L group (n =10);the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem in all 3 groups [(9 ± 6) mg/L vs (51 ± 7) mg/L,(15 ± 5) mg/L vs (66 ± 3) mg/L,(15 ± 11) mg/L vs (88 ± 13) mg/L] (P ＜ 0.05);the drop range showed no significant difference among groups(P ＞0.05).According to dosage of sodium valproate,27 patients were divided into 0.25 g,3 times/d group(n =6),0.4 g,3 times/d group (n =13) and 0.5 g,2 times/d group (n =8);the mean steady state plasma-sodium valproate concentration after taking meropenem was significantly lower than that before taking meropenem in all 3 groups[(7 ±6)mg/L vs (64 ±20) mg/L,(16 ± 12)mg/L vs (74 ±20)mg/L,(15 ±9) mg/L vs (71 ± 16) mg/L] (P ＜ 0.05);the drop range showed no significant difference among groups (P ＞ 0.05).Conclusion Steady state plasma concentration of sodium valproate can be lowered by meropenem;combined use of sodium valproate and meropenem should be avoided in clinical practice.
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