透析患者头孢类抗生素引起药物性脑病的临床分析  

Clinical study on cephalosprin encephalopathy in dialysis patients

作　　者：俞勇[1] 邬碧波[1] 唐琦[1] 贺云岚[1] 郝晓萍[1] 张黎明[1] 

机构地区：[1]上海市闸北区中心医院肾内科,上海200070

出　　处：《医学信息（中旬刊）》2011年第7期3213-3214,共2页Medical Information Operations Sciences Fascicule

基　　金：上海市闸北区中心医院"789攀登计划"基金资助项目

摘　　要：目的:观察慢性肾衰竭维持性透析(血液透析、腹膜透析)患者使用头孢类抗生素后出现精神神经症状的临床特点,探讨头孢类抗生素在透析患者中的合理应用方法。方法:对36例慢性肾衰竭接受透析治疗患者,在使用常规剂量头孢类抗生素后出现的神经精神症状的特点及发病后的治疗进行回顾性分析。结果:①头孢菌素脑病的精神神经症状表现多样,症状轻重不等,部分患者精神神经障碍时出现双上肢、头部不自主震颤,继之烦躁,谵妄,部分患者有幻觉,迫害妄想或抑郁、偏执、嗜睡等症状,严重者出现昏迷。所有发病患者均无神经系统定位体征。②所有出现精神神经障碍的患者均行头部CT检查,12例表现为腔隙性脑梗死,但均为陈旧性梗死灶,4例表现为脑萎缩,其余20例未见异常。所有发病均无急性脑血管病变。③发病后治疗,所有36例患者均立即停用头孢类抗生素。10例患者停药后经对症处理于24～48h内缓解;18例患者行加强血液透析治疗,16例透析后缓解,其中4例透析后未能立即缓解,予对症处理,症状又持续16～48h后完全缓解;8例出现严重症状的患者,行血液灌流+透析治疗,连续行3次血液灌流,症状在48～96h后缓解。所有患者治疗后症状完全消失,均未复发。结论:慢性肾衰竭透析患者使用常规剂量的头孢类抗生素可引起药物性脑病,推测与药物半衰期延长、透析清除率较低、体内药物积蓄浓度过高有关。因此,使用时应注意药物选择及剂量调整,一旦出现症状及时停药及加强透析等治疗。Objective：To investigate the encephal opathy and clinical characteristics of utilization of cephalosporins in patients with choric renal failure on hemodialysis and peritoneal dialysis. Methods：We retrospectively analysed the clinical characteristics of 30 patients on hemodialysis and 6 patients on peritoneal dialysis,who developed encephalopathic syndrome while being treated with cephalosporins. Results：The encephal opathie syndrome include ：mental confusion, dizzy,lethargy, hyperexcitabmty, hallucination, disorientation, dysmnesia, barylalia, dystaxia and seizure. Physical examination did not showed signs of cerebral focal injury. Computed tomography of the brain in all patients did not showed acute lesions. The states of neurotoxixity were completely recovered after withdrawn of cephalosporins with hemodialysis or hemoperfusion. Conclusion： Cephalosporins used in conventional doses can cause temporary encephal opathy in patients with chorie renal failure on hemodialysis and peritoneal dialysis, which might due to prolongation of drug half life. The cephalosporin should be withdrawn if patients show unexplained encephalopathy.

关 键 词：肾功能衰竭 慢性 透析 头孢菌素 脑病 

分 类 号：R978.11[医药卫生—药品]