| Objective: To study the differences in curative effects of classic mood stabilizers lithium salt and valproate combined with second-generation antipsychotics quetiapine and olanzapine in the treatment of bipolar manic episodes,so as to provide guidance for choosing the appropriate treatment plan for patients with bipolar manic episodes;Establishing the precision drug treatment path of mood stabilizers and exploring the effective,accurate and simple detection method of blood drug concentration of first-line treatment drugs for bipolar disorder(lithium and valproate),and use SPSS Modeler18.0to establish a preliminary prediction model of rational drug use of lithium carbonate.Methods:1.Efficacy analysis of lithium carbonate,sodium valproate combined with quetiapine and olanzapine in the treatment of bipolar manic episodesThe case information of patients with bipolar mania who were admitted to a tertiary hospital from January 2015 to July 2022 was retrospectively collected,grouped according to the treatment plan.Before treatment,after 2 weeks in hospital,and at discharge,the Baker-Ravenson Mania Scale(BRMS)was used to evaluate the manic symptoms of the patients,and the clinical efficacy(BRMS score reduction rate)and the incidence of adverse reactions were compared among the groups,and the factors affecting the remission rate of manic symptoms after two weeks were analyzed.2.Establishment of a precise drug therapy pathway for mood stabilizers and a predictive model for rational use of lithium carbonateEstablish a precision drug treatment decision-making group composed of physicians,pharmacists,and nurses,conduct a comprehensive analysis of previous diagnosis and treatment plans for patients with bipolar disorder,and combine relevant literature and books to establish a precise drug treatment path for mood stabilizers;Searching for literature and exploring the methodology for detecting lithium salt and valproate blood drug concentrations by using automatic biochemistry analyser.(TBA-120FR),and verifies it in terms of accuracy,precision,linearity,and anti-interference performance;The lithium carbonate blood concentration monitoring data,height,weight,gender,liver and kidney function,combined drug use and other 17 related indicators of bipolar disorder patients treated based on the established mood stabilizer precision drug treatment path were collected.SPSS Modeler18.0 was used to construct the lithium carbonate rational drug use prediction model.Results:1.Efficacy analysis of lithium carbonate,sodium valproate combined with quetiapine and olanzapine in the treatment of bipolar manic episodesA total of 120 patients with bipolar manic episodes were collected and divided into four groups according to the treatment plan,lithium carbonate combined with quetiapine group(21 cases),lithium carbonate combined with olanzapine group(21cases),valproic acid Sodium combined with quetiapine group(50 cases),sodium valproate combined with olanzapine group(28 cases).There were statistically significant differences in BRMS scores at admission,BRMS scores two weeks later,and BRMS scores at discharge of the four combined regimens(P<0.001);the remission rate after two weeks in the lithium carbonate combined with quetiapine group was better than that of lithium carbonate combined with olanzapine group,the difference was statistically significant(P=0.006);multivariate Logistic regression analysis found that family history,adverse reactions,treatment options,age of onset were associated with the remission rate of manic symptoms after two weeks of treatment.2.Establishment of a precise drug therapy pathway for mood stabilizers and a predictive model for rational use of lithium carbonateA precise drug treatment path for mood stabilizers has been established;The accuracy,precision and anti-interference performance of phosphase assay to detect blood lithium concentration and immunoturbidimetric assay to detect blood valproic acid concentration were all in line with the guidelines for the verification of biological sample analysis methods;A prediction model for the rational use of lithium carbonate was preliminarily established,among which,the accuracy of the prediction model for blood drug concentration was 77.3%,and the accuracy of the prediction model for daily dose was 78.2%.Conclusion:1.All four combined regimens can effectively improve manic symptoms in patients with manic episodes of bipolar disorder;among the four combined regimens,the efficacy of lithium carbonate combined with quetiapine in the treatment of bipolar mania is comparable to that of sodium valproate combined with quetiapine,but the incidence of adverse reactions of the former is higher than that of the latter,while sodium valproate combined with quetiapine has good curative effect and low incidence of adverse reactions in the treatment of bipolar mania,1.therefore,when treating bipolar manic patients,it is recommended to choose the following drug treatment options:sodium valproate combined with quetiapine,lithium carbonate combined with quetiapine,sodium valproate combined with olanzapine,and lithium carbonate combined with olanzapine;The remission rate of manic symptoms after two weeks of treatment was related to family history,occurrence of adverse drug reactions,drug treatment program,and age of onset.2.The established precise drug treatment path of mood stabilizers can provide precise and homogeneous treatment for patients with bipolar disorder.3.It is feasible to use neural network to establish a prediction model for the rational use of lithium carbonate,which can be used in the study of individualized administration of lithium carbonate. |
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