| Objective:By using CMIA to determine the blood drug concentration of patients,analyze the changes of sodium valproate(VPA)concentration after combined olanzapine treatment,and the influence of age and gender on this change.At the same time,explore the clinical efficacy and safety of olanzapine combined with VPA in treatment of bipolar I disorder.Methods:A total of 160 patients with bipolar I disorder(BD-I)admitted to a special psychiatric hospital in Jining City were selected as subjects.All patients were divided into a control group(80 cases)and an observation group(80 cases)using a random number table method.Control group: Treatment with VPA sustained-release tablets alone.Observation group: Combined use of olanzapine and VPA sustained-release tablets for treatment.On the morning of the second,fourth and eighth weekends after treatment,fasting blood was collected and CMIA was used to determine the plasma concentration of sodium valproate in patients with BD-I.The Bech-Rafaelsen Mania Scale was used to evaluate the patient’s condition before treatment and after the second,fourth,and eighth weekends after treatment.The clinical efficacy of the patient was evaluated at the end of the eighth week.Blood tests,blood biochemistry,urine routine hematuria,electrocardiogram,and body weight were routinely performed on all patients before and after treatment,and side-reaction scales were used to evaluate the safety of the treatment.Results:(1)The study found that the concentration of VPA in the observation group was lower than that in the control group at different time points(P<0.05).(2)Except for no difference between 29-40 years old and 41-48 age groups,the average valproate concentration difference between the other age groups was statistically significant(P<0.05),and with age increase,more and less after the first dose.(3)The mean concentration of sodium valproate in female patients(80.4μg/ml)was higher than that in male patients,and the difference was significant(P<0.05).(4)Before treatment,the BRMS scores of the observation group and the control group were(39.6±6.5)points and(39.1±6.8)points respectively,and the difference between the two groups was not significant(P>0.05).After 2 weeks of treatment,the BRMS scores of the observation group and the control group were(28.9±4.7)points and(32.7 ± 5.2)points,the difference was significant(P<0.05).After 4 weeks of treatment,the BRMS scores of the observation group and the control group were(17.3±3.7)points and(21.4±4.3)points,the difference was significant(P<0.05).After 8 weeks of treatment,the BRMS scores of the observation group and the control group were(12.2±2.0)points and(15.6±2.5)points respectively,the BRMS scores of the observation group were significantly lower than those of the controlgroup,with significant differences(P<0.05).(5)After 8 weeks of treatment,among the 80 patients in the observation group,51 patients(63.7%)were judged to be cured,15(18.8%)were markedly effective,and 8(10.0%)were improved.In 6 patients(7.5%),the total effective rate was 92.5%;in the 80 patients in the control group,42cases(52.5%)were cured,13 cases(16.2%)were markedly effective,and 10 cases were improved.(12.5%),ineffective in 15 cases(18.8%),the total effective rate of treatment was 81.2%;the effective rate of the two groups was c 2=4.440,v=1,P=0.035 <0.05,and the difference was statistically significant.The clinical efficacy of the group was better than that of the control group.(6)During the 8 weeks of treatment,the two groups showed abnormal liver function,dry mouth,constipation,dizziness,and ECG abnormalities.However,the patients in the observation group had akathisia,weight gain,and lethargy.The probability was significantly higher than that of the control group,whereas the abnormal blood and nausea and vomiting were higher in the control group than in the observation group.Conclusions:VPA combined with olanzapine can reduce the dose of VPA when it is used in the treatment of BD-I.Age and gender have an effect on the concentration of VPA.It is effective in the treatment of BD-I,and can be quickly activated,with high safety and low incidence of adverse reactions. |
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