维持性腹膜透析患者抗生素脑病10例分析  

Clinical analysis of antibiotic encephalopathy in continuous ambulatory peritoneal dialysis patients(report of 10 cases)

作　　者：姜美华[1] 徐友平[1] 韩志武[1] 姚国乾[1] 谭红梅[1] 沈俊[1] 李靖[1] 杨芳[1] 

机构地区：[1]中国人民解放军第一六一医院肾内科

出　　处：《临床肾脏病杂志》2015年第5期277-280,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨维持性腹膜透析（continuous ambulatory peritoneal dialysis，CAPD）患者发生抗生素脑病的临床特点和防治措施。方法回顾性分析我院自2008年1月至2014年1月使用抗生素的维持性腹膜透析患者64例的资料，其中10例确诊为抗生素脑病的患者设为观察组，从另外54例中随机选取15例作为对照组，用t检验和X2检验比较2组患者资料的差异性。结果抗生素脑病的发病率为15．6％。2组患者的性别、血浆蛋白，电解质，血肌酐水平无统计学差异（P〉0．05）。与对照组相比，观察组多为高龄、合并脑血管疾病、透析时间长、由血液透析转为腹膜透析的患者，同时低残余肾功能，低腹膜清除率的比例更高，抗生素多选择β内酰胺类，使用时间超过3d。经积极对症处理，调整抗生素，更改透析处方后多数患者预后良好。结论应高度重视高龄合并脑血管疾病透析患者的管理，避免使用易通过血脑屏障和单通道排泄的抗生素。根据患者残余肾功能、腹膜清除率和药代动力学特点合理选用抗生素，监测患者使用抗生素期间的不良反应和血药浓度。一旦确诊为抗生素脑病，应积极对症处理，及时调整用药及腹膜透析处方。必要时选择杂合式透析，重症患者可行血液灌流联合血液透析滤过治疗。Objective To explore the clinical features and prevention of antibiotic encephalopathy in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods Sixty-four CAPD patients using antibiotics were retrospectively studied from January 2008 to January 2014. Ten cases diagnosed as antibiotic encephalopathy served as observation group, and 15 cases out of the rest 54 non- antibiotic encephalopathy were randomly selected as control group. Significance was compared with t- test and X2 test between two groups. Results The incidence of antibiotic encephalopathy was 15.6%. There was no significant difference in gender, plasma protein, electrolytes, and blood creatinine level between two groups （P〈0. 05）. The patients were older, had more instances of cerebrovascular disease, and longer duration of dialysis and history of hemodialysis in observation group than in control group. The residual renal function was worse and peritoneal clearance was significantly lower in observation group than in control group. Beta-lactam was mainly used and the use time was over 3 days in observation group. Majority had good prognosis through complication prevention, and active treatment including adjustment of antibiotics and peritoneal dialysis prescription. Conclusions We should pay close attention to the management of older patients with cerebrovascular disease and avoid using the kind of antibiotics which easily entered blood-brain barrier and egested via the single channel. We should reasonably choose antibiotics based on residual renal function and detect adverse reaction, blood drug level, peritoneal clearance and pharmacokinetics feature. Patients once diagnosed as antibiotic encephalopathy were actively treated including adjustement of drug and peritoneal dialysis prescription. Hybrid renal replacement therapy was done if single dialysis was unsatisfactory. Hemoperfusion and hemodiafiltration were needed if the state of patients was severe.

关 键 词：腹膜透析 抗生素脑病 残余肾功能 腹膜清除率 

分 类 号：R692[医药卫生—泌尿科学] R459.5[医药卫生—外科学]