慢性肾衰竭并发抗生素脑病46例临床分析  

作　　者：黄海燕[1] 向少伟[1] 庞学丰[1] 

机构地区：[1]广西中医药大学附属瑞康医院肾内科,广西南宁530011

出　　处：《中国药业》2015年第B12期364-366,共3页China Pharmaceuticals

摘　　要：目的探讨慢性肾衰竭（CRF）患者并发抗生素脑病的临床特点、预防及处理措施。方法回顾性分析我院2008年至2013年收治的46例CRF应用抗生素并发脑病患者的临床资料，分析使用抗生素种类、并发抗生素脑病的临床表现、治疗与临床转归、预防和处理。结果抗生素种类：46例CRF患者应用的抗生素包括头孢菌素类和喹诺酮类，其中头孢哌酮他唑巴坦26例；头孢哌酮舒巴坦13例；左氧氟沙星7例。临床表现：从开始使用抗生素到出现神经症状的时间为4～16d．表现为头昏、反应迟钝、幻觉、谵妄、嗜睡、抽搐等，部分患者出现面肌抽动、肢体不自主抖动、癫痫样发作。治疗与转归：46例患者均停用或更改抗生素，32例经镇静、低流量吸氧等对症处理，症状于3-6d内缓解：14例症状较重者经血液透析或血液透析串联血液灌流治疗2—4次，最终症状全部得到缓解。结论CRF患者易并发各种感染，3代头孢对CRF患者相对安全，临床广为应用，有时不可避免需使用喹诺酮类药。由于肾功能衰竭患者的药代动力学与正常人有很大差异，常因药物蓄积导致抗生素脑病。早期诊断、及时停药和对症处理，必要时采取不同方式的血液净化治疗．可改善抗生素脑病患者的预后。Objective To investigate the clinical features, preventions and treatment of patients with chronic renal failure （CRF） complicated by antibiotics encephalopathia.Methods Clinical data of 46 patients complicated by antibiotics encephalopathia who admitted to our hospital from 2008 to 2013 were retrospectively analyzed, including types of antibiotics,Alinical？manifestation, treatment and outcome,prevention and process and so on.Results Aantibiotics：all 46 patients with CRF were treated with antibiotics including cephalosporins and quinoloues of which 26 cases with Cefoperazone azole his temple, 13 cases with Cefoperazone shu tan,7 cases with Levofioxacin.Alinical manifestation： The patients all suffered from psychiatric symptoms after being treated with cephalosporins for 4 to 16 days, Clinical symptoms including dizziness, unresponsive, hallucinations, delirium, lethargy, seizures and so on. Some patients had the Clinical symptoms of facialtic, imbinvoluntary shaking,or epileptic seizures.Treatment and outcome ：all patients stopped using or changed to use other antibiotics. Symptoms of 32 cases were relieved owing to sedation or low flow oxygen inhalation treatment in 3 to 6 days,14much sever patients were treated with hemodiafihration or hemodialysis plus hemoperfusion 2 to 4 times and the symptoms were finally relieved.Conclusion Three generation cephalosporins are relatively safe for the CRF patients and used widely on clinical,because of being prone to be infected. Sometimes the use of quinolones are inevitably required.The sharp pharmacokinetic difference between CRF patients and normal people often lead to antibiotic encephalopathy by drug accumulation. Therefore early diagnosis,drug withdrawal and treatment in time were needed to improve the prognosis of antibiotics encepbalopathia. If necessary,different types of blood purification treatment should be used.

关 键 词：慢性肾衰竭 抗生素脑痛 血液透析 血液灌流 

分 类 号：R969.3[医药卫生—药理学] R978.11[医药卫生—药学]