血透患者应用第三代和第四代头孢菌素发生抗生素脑病17例临床分析.docVIP

血透患者应用第三代和第四代头孢菌素发生抗生素脑病17例临床分析 　　[摘要] 目的 探讨血透患者并发抗生素脑病的原因、机制及防治。 方法 对2006年10月～2010年10月在我院住院时应用第三、四代头孢菌素出现神经精神症状的17例血透患者回顾性分析其临床资料及治疗转归情况。 结果 17例血透患者于应用第三代或第四代头胞菌素常规剂量2～14 d后，出现神经精神症状，其中头孢他啶8例，头胞曲松5例，头孢哌酮-舒巴坦3例，头孢吡肟1例，所有患者均无神经系统定位体征，行头颅CT、脑电图等检查无急性病变，经停药及血液透析、血液灌流治疗后症状迅速消失。 结论 血透患者使用常规剂量第三、四代头孢菌素容易蓄积中毒，导致抗生素脑病发生；选用时需根据血肌酐清除率或药代动力学调整剂量，并密切观察，一旦出现及时停药，加强透析，可有效迅速缓解，预后较好。 　　[关键词] 血液透析；头孢菌素；抗生素脑病 　　[中图分类号] R459.5 [文献标识码] B [文章编号] 1673-9701（2012）04-0151-03 　　 　　Hemodialysis patients with application of the third generation and fourth generation cephalosporin antibiotic encephalopathy occurred clinical analysis of 17 cases 　　PAN Meng1 JIANG Luming2 　　1.Department of Nephrology, Lianyuan Peoples Hospital in Hunan Province, Lianyuan 417100, China; 2.Department of Laboratory, Lianyuan City Peoples Hospital in Hunan Province, Lianyuan 417100, China 　　[Abstract] Objective To investigate the hemodialysis patients complicated with antibiotic encephalopathy causes, mechanism and prevention. Methods From 2006 October to 2010 October in our hospital in the useing of third, four generation cephalosporins neuropsychic symptom in 17 cases of hemodialysis patients ： a retrospective analysis of the clinical data and treatment prognosis. Results All of 17 cases of hemodialysis patients in the application of third or fourth generation head cell in conventional doses of 2 to 14 days after emergence, neuropsychiatric symptoms, including ceftazidime in 8 cases, 5 cases of head cell ceftriaxone, cefoperazone, Shu Batan in 3 cases, cefepime in 1 cases, all patients had no nervous system positioning signs, line head CT, EEG examination without acute lesions, after drug withdrawal and hemodialysis, hemoperfusion symptoms quickly disappeared after treatment. Conclusion Hemodialysis patients using conventional doses of third, four generation cephalosporins easy poisoning, leading to antibiotic encephalopathy occurred, when used according to serum creatinine clearance rate or pharmacokineti