丙戊酸钠相关性高血氨脑病1例报告并文献复习

发布时间：2019-01-08 12:28

【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 report a rare case of high blood ammonia encephalopathy associated with sodium valproate and to explore the value of monitoring the concentration of valproate in patients after craniocerebral operation. Methods the clinical data of a patient with hyperglycemic encephalopathy caused by sodium valproate after resection of left temporal lobe tumor were analyzed retrospectively, including clinical manifestation, laboratory examination, imaging examination and analysis of the causes of disturbance of consciousness. Results the patient was a 31-year-old female with mild body weight. The patient suffered from paroxysmal limb convulsions. After resection of the left temporal lobe tumor, the patient gradually developed delirium and disturbance of consciousness within one week, accompanied by limb twitch and hemiplegia. The dosage of sodium valproate and dehydrating agent mannitol was not alleviated, no obvious brain stem lesion was found in CT and MRI, large area cerebral infarction, diffuse lesions and rebleeding in the brain, the concentration of blood ammonia and sodium valproate was increased slightly and moderately, and the etiology was determined. When valproate was stopped, the consciousness and paralysis of the patients were gradually restored and the prognosis was good. Conclusion for the patients with epilepsy after operation of valproate sodium valproate and ammonia concentration should be monitored to reduce the adverse reaction.
【作者单位】：广州军区武汉总医院神经外科;
【分类号】：R739.41

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