β-内酰胺类抗生素致血液透析患者神经系统不良反应

The nervous system adverse effect induced by β-lactam antibiotics in patients on hemodialysis.

目的探讨β-内酰胺类抗生素在肾功能衰竭血液透析中的合理应用。方法回顾性分析我院13例肾功能衰竭血液透析的患者应用β-内酰胺类抗生素时引起的神经精神症状及相关临床资料。结果患者于开始透析后或维持透析期间均出现神经精神症状，神经精神症状表现多样：神志恍惚，兴奋多语或语无伦次，嗜睡，其中2例伴有肌肉震颤。均无神经定位症状，其中7例经头颅CT检查，均未发现急性颅脑病变。所有患者停药后继续血液透析或血液透析滤过治疗后症状消失。结论肾功能衰竭血液透析患者使用常规剂量的β-内酰胺类抗生素可引起一过性的脑病，与药物半衰期延长有关。

Objective To discuss the reasonable utilization of β-lactam antibiotics in patients with renal failure on hemodialysis. Methods The clinical characteristics of patients with renal failure on hemodylysis,who developed the adverse effect of nervous system and psychiatric symptom while being treated with β-laetam antibiotics, were retrospectively analyzed. Results The adverse effect of nervous system and psychiatric symptom showed during and after hemodialysis,including ： mental confusion, hyperexcitabiliy, incoherent speech, lethargy and amyostasia in two cases. Physical examination did not show signs of cerebral focal injury in all cases. Computed tomography of brain in 7 patients did not show acute lesions. The symptoms completely disappeared after withdrawal of β-laetam antibiotics but hemodialysis or hemodiafihration continued. Conclusion β-lactam antibiotics used in conventional dose could cause temporary adverse effect of nervous system in patients with renal failure on hemodialysis, which is related to prolongation of drug half life.