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首页> 外文期刊>The neurologist. >Hyperammonemia in Patients With Status Epilepticus Treated With or Without Valproic Acid
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Hyperammonemia in Patients With Status Epilepticus Treated With or Without Valproic Acid

机译：患有病态癫痫病患者的高血肿性癫痫病毒治疗或不含丙戊酸

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Background: Hyperammonemia is a common side effect of valproic acid (VPA) and can occur after generalized seizures, but the clinical significance is unclear. The aim of this study was to better understand the clinical practice and utility of ammonia testing in status epilepticus (SE) treated with or without VPA. Methods: Charts of adult patients with SE from St. Mary’s Hospital Intensive Care Units (ICUs) (Mayo Clinic, Rochester, MN) from 2011 to 2016 were reviewed. Clinical factors were compared between patients who had ammonia checked versus those who did not, and those with normal ammonia versus hyperammonemia (>50?μg/dL). Charts were reviewed to determine if hyperammonemia changed clinical management and if it was felt to be symptomatic. Results: There were 304 patients identified: 94 received VPA, 142 had ammonia checked and receiving VPA was associated with ammonia testing ( P <0.001). Hyperammonemia was identified in 32 and associated with younger age, being in a non-neurological intensive care unit, and liver disease, but was not statistically associated with VPA. Only one patient had valproate-induced hyperammonemic encephalopathy; however, many patients received treatment for hyperammonemia such as lactulose, levocarnitine, or VPA dose reductions. Conclusions: This study demonstrated variability in ammonia testing and management changes in SE but does not support the routine monitoring of ammonia levels and showed that hyperammonemic encephalopathy was rare in this clinical setting.
机译：背景：高氨血症是丙戊酸钠（VPA）的常见副作用，可在全身性癫痫发作后发生，但其临床意义尚不清楚。本研究的目的是更好地了解氨试验在癫痫持续状态（SE）治疗中的临床实践和效用。方法：回顾2011年至2016年圣玛丽医院重症监护病房（ICU）（明尼苏达州罗彻斯特梅奥诊所）成人SE患者的图表。比较氨检查组和未检查组的临床因素，以及氨正常组和高氨血症组（>50μg/dL）的临床因素。对图表进行审查，以确定高氨血症是否改变了临床管理，以及是否有症状。结果：共确定304例患者：94例接受VPA，142例接受氨检查，接受VPA与氨检测相关（P<0.001）。在32名患者中发现了高氨血症，并与年龄较小、在非神经重症监护病房和肝病有关，但与VPA无统计学相关性。只有一名患者患有丙戊酸钠诱发的高氨血症性脑病；然而，许多患者接受了高氨血症治疗，如乳果糖、左旋卡尼汀或VPA剂量减少。结论：本研究证明了SE中氨检测和管理变化的可变性，但不支持氨水平的常规监测，并表明在这种临床环境下，高氨血症性脑病是罕见的。

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