慢性肾脏病并发抗生素脑病的危险因素及防治  

Risk factors and treatment of antibiotic encephalopathy in chronic kidney disease

作　　者：张佩殷 黄新忠[2] 范亚平[2] 施辉[2] 陈晓岚[2] 钱桐荪[2] 

机构地区：[1]江苏省如东人民医院肾内科,江苏如东226400 [2]江苏省南通大学附属医院肾内科,江苏南通226001

出　　处：《中国现代医学杂志》2014年第15期90-93,共4页China Journal of Modern Medicine

摘　　要：目的探讨慢性肾脏病(CKD)患者应用头孢他啶所致抗生素脑病的危险因素及防治效果。方法选择应用头孢他啶且eGFR<60 mL/(min/1.73 m2)的CKD患者,分为抗生素脑病组与非抗生素脑病组,并根据CKD不同分期分析抗生素脑病发生的相关危险因素及其防治。结果共入选符合标准的患者464例,其中抗生素脑病组36例,非抗生素脑病组428例。单因素分析结果显示,年龄、血钙、CO2-CP、血红蛋白、白蛋白、血肌酐、血液透析、抗生素使用时间与剂量是CKD患者发生抗生素脑病的危险因素,经停用头孢他啶及血液透析滤过联合血液灌流治疗后症状缓解,仅有1例死亡。结论头孢他啶是CKD患者发生抗生素脑病的常见原因,血液透析滤过联合血液灌流治疗可以有效缓解抗生素脑病,值得临床推广应用。[ Objectives ] To explore the risk factors and treatment of antibiotic encephalopathy induced by Ceftazidime in chronic kidney disease. [Methods] A random cohort of chronic kidney disease patients who were re-ceived intravenous Ceftazidime and eGFR less than 60 mL/（min/1.73 m2） was studied. We subdivided the CKD patients into antibiotic encephalopathy group and non-antibiotic encephalopathy group, and analyzed the risk factorsand treatment of Ceftazidime-induced encephalopathy according to K/DOQI staging criteria. [ Results ] A total of se-lected 464 patients were enrolled in the study, including 36 patients in antibiotic encephalopathy group and 428 pa-tients without encephalopathy. Univariate analysis revealed that age, blood calcium, CO2-CP, hemoglobin, albumin,serum creatinine, hemodialysis, antibiotic time and dose were significantly associated to antibiotic encephalopathy inpatients with chronic kidney disease. In addition to one patient died, other patients were effectively alleviated afterwithdrawal Ceftazidime and treatment of hemodiafiltration joint hemoperfusion. [ Conclusions ] Ceftazidime-inducedencephalopathy is a common cause in chronic kidney disease patients. The treatment of hemodiafiltration jointhemoperfusion could effectively alleviate encephalopathy.

关 键 词：头孢他啶 慢性肾脏病 抗生素脑病 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]