头孢他啶致慢性肾衰竭维持性透析患者中枢神经系统损害

Neurotoxicity induced by Ceftazidime treatment in chronic renal failure patients on maintenance hemodialysis.

目的了解头孢他啶导致慢性肾衰竭维持性透析患者中枢神经系统不良反应,以及不同血液净化治疗模式对其影响。方法收集广东省人民医院1999年至2008年维持性透析使用头孢他啶、且伴有精神症状的病例,收集患者透析前后的血液,检测头孢他啶的血药浓度,分析不同血液净化治疗方式对其浓度及临床表现的影响。结果广东省人民医院1999年至2008年慢性肾衰竭维持性透析患者,出现头孢他啶相关的神经系统症状21例,平均(69.1±6.4)岁,以老年患者为多见。中枢神经系统反应以认知和定向力障碍、抽搐、谵妄及精神异常等为主要临床表现,其中认知和定向力障碍17例(81%)、抽搐13例(62%)、精神异常11例(52%)。13例患者检测血液净化前后血液头孢他啶浓度,其中血液透析(hemodialysis)组有5例,在线血液透析滤过(On-line hemodiafitration on-line,HDF)组有8例,在线血液透析滤过比血液透析清除头孢他啶效率更高,这与临床表现一致。结论对于老年慢性肾衰竭维持性透析患者,在使用头孢他啶时应调整剂量,以免出现神经毒性,一旦出现神经毒性后,需及时停药,并行在线血液透析滤过处理。

Objective Ceftazidime-induced neurotoxicity is often underestimated or misinterpreted by clinicians. To understand this ailment, we described 21 hemodialysis cases with ceftazidime-related neurotoxicity, and compared the effect of ceftazidime clearance by different blood purification methods. Methods We recruited the maintenance hemodialysis （MHD） patients complicated with psychiatric symptoms after ceftazidime treatment in Guangdong General Hospital from 1999 to 2008. Their neurotoxic symptoms induced by ceftazidime, and blood ceftazidime concentrations before and after hemodialysis were observed. Their clinical symptoms were then analyzed along with the efficiency of ceftazidime clearance by different blood purification methods. Results The involvement of central nervous system induced by ceftazidime treatment was found in 21 chronic renal failure patients on MHD. Their average age was 69.1±6.4 years old, indicating the higher incidence in older patients. The frequent findings included confusion and spatial disorientation （81% patients）, myoclonus （62%）, and psychiatric disturbances （52%）. The average Glassgow score increased, and recovery from neurotoxicity began after blood purification in all these patients. Neurotoxocity improved in less than 24 hours after blood purification. Blood ceftazidim concentrations before and after blood purification were measured in 13 cases, of which 5 cases were treated with hemodialysis, and 8 cases with on-line hemodiafiltration. The ceftazidime clearance was more efficient by hemodiafiltration than by hemodialysis, in accordance with the differences of symptom improvement by the two blood purification methods. Conclusions Ceftazidime can induce neurotoxicity in MHD patients. For elderly MHD patients, ceftazidime dose should be adjusted to avoid neurotoxicity. Awareness of the potential nervous system complications following ceftazidime administration should be emphasized.