摘要
目的探讨终末期肾病维持血液透析患者使用头孢菌素导致抗生素脑病的临床表现及预防、治疗方法 ,指导合理用药。方法我院2005年7月~2016年7月16例终末期肾病维持血液透析患者使用头孢菌素后出现抗生素脑病,回顾性总结分析上述患者的临床资料。结果 16例维持性血液透析患者因感染住院治疗,使用头孢菌素后出现抗生素脑病,患者平均年龄(69.3±13.7)岁,发病前后无神经系统定位体征,查血常规、肝肾功能、血糖、电解质等指标无明显变化(P>0.05),头颅CT检查未见急性脑梗死或脑出血病变。患者临床表现多种多样:嗜睡、昏睡、头痛、幻觉、定向力障碍、癫痫样发作等。经停药、对症治疗及加强血液透析、联合血液滤过、CRRT、血液灌流后患者症状消失。结论尿毒症血液透析患者,特别是老年患者,使用头孢菌素可能会导致抗生素脑病。减小剂量或延长给药间隔是防范发生脑病的关键。一旦发现需及时停药,并加强血液净化,患者大多预后良好。
Objective To investigate the clinical manifestation, prevention and treatment of antibiotic encephalopathy caused by cephalosporin in hemodialysis patients with end-stage renal disease, and to guide the rational use of drugs. Methods 16 hemodialysis patients of end-stage renal disease in our hospital from July 2005 to July 2016 had antibiotic encephalopathy after the use of cephalosporin, and their clinical data were retrospectively analyzed. Results 16 patients with maintained hemodialysis were hospitalized for infection, and hadantibiotic encephalopathy after the use of cephalosporin. The average age of patients was（69.3±13.7）years old. The patients had no neurological signs before and after the onset. The blood routine, liver and kidney function, blood glucose, electrolyte and other indicators had no significant change （P〉0.05）. And head CT examination showed no acute cerebral infarction or cerebral hemorrhage lesions. Patients had a variety of clinical manifestations such as lethargy, drowsiness, headache, hallucinations, orientation disorders, epileptic seizures and so on. The symptoms disappeared after withdrawing the drugs, symptomatic treatment and strengthening hemodialysis, combined with blood filtration, CRRT, blood perfusion. Conclusion The use of cephalosporins for uremic hemodialysis patients, especially the elderly, may lead to antibiotic encephalopathy. Reducing the dose or extending the interval is the key to prevent the occurrence of encephalopathy. Once antibiotic encephalopathy is found, the drugs should be timely withdrawn, and the blood purification must be strengthened, and most of the prognosis is good.
出处
《中国现代医生》
2017年第13期26-29,共4页
China Modern Doctor
关键词
尿毒症
血液透析
头孢菌素
抗生素脑病
Uremia
Hemodialysis
Cephalosporin
Antibiotic encephalopathy
