頭孢菌素致血液透析患者抗生素腦病臨床分析

玄先法　李瑩　王玉新　張以勤　呂天羽　葉婧　周麗娜　顏建華　許麗蘋　武挺

[摘要] 目的 探討終末期腎病維持血液透析患者使用頭孢菌素導致抗生素腦病的臨床表現及預防、治療方法，指導合理用藥。 方法 我院2005年7月～2016年 7月16例終末期腎病維持血液透析患者使用頭孢菌素后出現抗生素腦病，回顧性總結分析上述患者的臨床資料。 結果 16例維持性血液透析患者因感染住院治療，使用頭孢菌素后出現抗生素腦病，患者平均年齡（69.3±13.7）歲，發病前后無神經系統定位體征，查血常規、肝腎功能、血糖、電解質等指標無明顯變化（P>0.05），頭顱CT檢查未見急性腦梗死或腦出血病變。患者臨床表現多種多樣：嗜睡、昏睡、頭痛、幻覺、定向力障礙、癲癇樣發作等。經停藥、對癥治療及加強血液透析、聯合血液濾過、CRRT、血液灌流后患者癥狀消失。 結論 尿毒癥血液透析患者，特別是老年患者，使用頭孢菌素可能會導致抗生素腦病。減小劑量或延長給藥間隔是防范發生腦病的關鍵。一旦發現需及時停藥，并加強血液凈化，患者大多預后良好。

[關鍵詞] 尿毒癥；血液透析；頭孢菌素；抗生素腦病

[中圖分類號] R692 [文獻標識碼] A [文章編號] 1673-9701（2017）13-0026-04

[Abstract] 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 Once antibiotic encephalopathy is found，the drugs should be timely withdrawn， and the blood purification must be strengthened， and most of the prognosis is good.

[Key words] Uremia； Hemodialysis； Cephalosporin； Antibiotic encephalopathy

終末期腎病（end-stage renal disease，ESRD）維持血液透析（maintenance hemodialysis，MHD）患者大多免疫力低下，是感染的高發人群[1]。頭孢菌素相對廣譜強效，不良反應較少，廣泛應用于治療終末期腎病血液透析患者的細菌感染。但該類患者，尤其是老年尿毒癥患者，其藥代動力學與正常人相比有顯著變化，主要表現為降低了藥物的清除排泄，容易造成體內抗生素蓄積，有可能引起抗生素腦病等不良后果。為……