慢性肾功能衰竭患者使用第三代头孢菌素致中枢神经系统不良反应病例分析  

Case analysis of adverse reactions of central nervous system induced by the third generation cephalosporins in the treatment of chronic renal failure

作　　者：刘艳波[1] 周龙洋[1] 吕礼安[1] 

机构地区：[1]湖北医药学院附属襄阳医院药学部,湖北襄阳441000

出　　处：《实用药物与临床》2015年第2期202-205,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的分析第3代头孢菌素对慢性肾功能衰竭患者的中枢神经系统造成的不良反应情况,并研究其相应的临床防治对策。方法在我院内科住院患者中,随机选取接受过第3代头孢菌素治疗的慢性肾功能衰竭患者79例,统计其中枢神经系统的不良反应情况,以及相应的对症治疗措施,分析、评价患者的临床治疗效果。结果 77例患者在服药约1周时,出现不同程度的注意力减退、容易疲劳、嗜睡、记忆力下降、呆滞、妄想、幻听、幻视、烦躁不安、意识障碍、认知能力异常等中枢神经系统一般不良反应;4例患者在服药约1~2周时,表现出中枢神经系统肾性脑病的严重不良反应。经过及时抢救和对症治疗后,其临床症状均明显减退或痊愈。结论第3代头孢菌素能够引起慢性肾功能衰竭患者中枢神经系统的不良反应,因此,在治疗期间需严格控制药量,不可长期大剂量应用,在发现不良反应症状后应立即停止用药,并给予相应的对症治疗。对于用药时间过长而引起的严重中枢性肾性脑病患者应积极抢救,必要时行血液透析治疗以确保患者的生命安全。Objective To analyze the adverse effects on central nervous system induced by the third generation cephalosporins in patients with chronic renal failure,in order to find relevant clinical prevention strategies. Methods Seventy-nine inpatients with chronic renal failure in the internal medicine department received the third generation cephalosporins were randomly chose,and the adverse effects on central nervous system and the relevant therapeutic strategies were collected and analyzed. Finally,the clinical therapeutic effects were evaluated and statistical analysis was performed. Results After one-week medication,general adverse effects of different degrees on central nervous system were found in 77 patients which presented as attention loss,fatigue,drowsiness,memory loss,sluggishness,paranoia,auditory hallucinations,visual hallucinations,irritability,impaired consciousness,cognitive deficit,and so on; serious adverse effects on central nervous system raised in 4 patients as renal encephalopathy after 1 ~ 2 week treatment. After giving timely rescues and symptomatic therapies,the adverse symptoms were evidently relieved or vanished. Conclusion The third generation cephalosporins can lead to adverse effects on central nervous system in patients with chronic renal failure. Therefore,the doses should be strictly controlled and such drugs can never be given at high doses for longterm treatment. The application of drugs should be ceased immediately once the adverse reactions were monitored,and meanwhile the relevant symptomatic therapies should be applied. In case of renal encephalopathy caused by relative long-term drug application,effective measures for emergency rescue,and hemodialysis if necessary,should be applied to ensure the safety of patients.

关 键 词：慢性肾功能衰竭 第3代头孢菌素 中枢神经系统 不良反应 

分 类 号：R692.5[医药卫生—泌尿科学]