美罗培南相关中枢神经系统不良反应临床病例分析  

Analysis of the clinical characteristic of adverse drug reactions in central nervous system induced by meropenem

作　　者：邓美玉 于旭红 张令晖 陈玲 Deng Meiyu;Yu Xuhong;Zhang Linghui;Chen Ling(Department of Respiratory,the 305 Hospital of the People′s Liberation Army,Beijing 100017,China;Department of Pharmacy,the 305 Hospital of the People′s Liberation Army,Beijing 100017,China)

机构地区：[1]解放军第三〇五医院呼吸内科,北京100017 [2]解放军第三〇五医院药局,北京100017

出　　处：《药物不良反应杂志》2022年第12期641-646,共6页Adverse Drug Reactions Journal

摘　　要：目的了解美罗培南相关中枢神经系统(CNS)不良反应的发生情况及其临床特征。方法利用医院信息系统收集2016年1月至2021年12月在解放军第三〇五医院呼吸内科住院且应用过美罗培南患者的电子病历,从中筛选出用药后出现CNS症状患者的病历进行回顾性分析。从病历中提取的数据主要包括患者性别、年龄、感染性疾病、基础疾病、入院时肾功能[血清肌酐、内生肌酐清除率(Ccr)]、美罗培南应用情况(给药剂量、是否按Ccr调整剂量)、美罗培南相关CNS不良反应发生情况(发生时间、主要临床表现等)以及不良反应的治疗和转归。计算美罗培南相关CNS不良反应发生率,对美罗培南相关CNS不良反应的临床特征进行描述性统计分析。结果设定时段内使用过美罗培南的患者共636例,其中17例发生美罗培南相关CNS不良反应,发生率为2.7%。17例患者中,男性10例,女性7例;年龄74~94岁,中位年龄86岁;肺部感染13例(其中1例合并泌尿系感染),慢性阻塞性肺疾病急性加重4例(其中2例合并Ⅱ型呼吸衰竭);合并肾功能不全者14例(其中10例Ccr<50 ml/min),脑梗死后遗症5例。Ccr<50 ml/min的10例患者中有3例未按Ccr调整美罗培南剂量致剂量过大。17例患者出现CNS症状的时间为开始应用美罗培南后1~7 d,中位时间为3 d;12例主要表现为精神障碍(包括谵妄、躁动、亢奋、幻觉、精神错乱和睡眠颠倒等),5例表现为肢体或口舌抽搐。出现CNS症状后17例患者均停用美罗培南,其中5例给予对症治疗,1~7 d后CNS症状均缓解,中位缓解时间为3 d。结论美罗培南的CNS不良反应在高龄、肾功能不全、呼吸衰竭以及有CNS疾病史的患者中较常见,主要表现为精神障碍和抽搐,多发生在用药1周内,及时停用美罗培南,酌情给予对症治疗,预后较好。Objective To understand the occurrence and the clinical characteristics of meropenem-related central nervous system(CNS)adverse reactions.Methods Using the hospital information system,the electronic medical records of patients who were hospitalized in the Department of Respiratory,the 305 Hospital of the People′s Liberation Army from January 2016 to December 2021 and received meropenem were collected.Medical records of patients who developed CNS symptoms after meropenem administration were screened and analyzed retrospectively.The data extracted from the medical records mainly included gender,age,infectious diseases,underlying diseases,renal function at admission[serum creatinine,endogenous creatinine clearance(Ccr)]in the patient,the application of meropenem(dose,whether dose was adjusted according to Ccr),and the occurrence(occurrence time,main clinical manifestations,etc.),treatment,and outcome of meropenem-related CNS adverse reaction.The incidence of meropenem-related CNS adverse reactions was calculated,and their clinical characteristics was descriptively analyzed.Results A total of 636 patients used meropenem during the set period and 17 of them developed meropenem-related CNS adverse reactions,with an incidence of 2.7%.Among 17 patients,10 were male and 7 were female,aged from 74 to 94 years with a median age of 86 years.Thirteen patients had pulmonary infection(one with urinary system infection)and 4 had acute exacerbation of chronic obstructive pulmonary disease(2 with typeⅡrespiratory failure);14 patients had combined renal insufficiency(10 of them had a Ccr<50-ml/min)and 5 had sequelae of cerebral infarction.Ten patients were with Ccr<50-ml/min and 3 of them did not adjust the dose of meropenem according to Ccr,resulting in excessive dosage.The time to onset of CNS symptoms in 17 patients ranged from 1 to 7 days after starting meropenem,with a median time of 3 days.Twelve patients presented mainly with psychiatric disorders(including delirium,agitation,hyperarousal,hallucinations,confusion and sle

关 键 词：美罗培南 中枢神经系统疾病 药物相关副作用和不良反应 老年人 肾功能不全 

分 类 号：R741[医药卫生—神经病学与精神病学]