美罗培南对神经外科患者癫痫发作的影响

The effect of meropenen on seizures attacks in the patients after neurosurgery

目的探讨神经外科患者应用美罗培南治疗重症感染包括颅内感染的临床安全性,明确其对癫痫发作的影响。方法由医院计算机系统筛选出2009年9月以前应用美罗培南(商品名美平,住友制药)的神经外科患者,回顾调查患者的一般资料、用药信息、用药期间和非用药期间癫痫发生率和疾病转归等情况。结果共92例患者纳入研究,男51例,女41例;平均年龄(39.7±17.6)岁;其中胶质细胞瘤22例,神经鞘瘤20例,脑膜瘤13例,其余37例,均于术后并发重症颅内感染。入院格拉斯哥评分(Glasgow Coma Scale,GCS)为(14.3±2.6)分,出院格拉斯哥预后评分(Glasgow Outcome Scale,GOS)为(4.6±0.9)分,总病死率为2.1%。癫痫发作发生率为6.5%(6/92),6例中2例发生在用药疗程期间,其余4例均发生在用药之前,患者用药期间癫痫发生率为3.4/1000患者-住院日,非用药期间癫痫发生率为2.0/1000患者-住院日,两者相比无显著性差异。结论神经外科患者的癫痫发作存在多种因素,在适合的剂量范围内,美罗培南用于神经外科患者并不增加癫痫的发生率。

Objective To evaluate the safety of Meropenen in the treatment of infections in neurosurgical patients,and to determine the drug-induced risk of seizures.Methods Charts of all patients in the hospital who received Meropenen before September 2009 were reviewed for dosage and duration of the drug use,occurrence of seizures,and mortality.Attention was paid to demographic features,pattern of seizure occurrence during,before and after the drug use.Results Nighty two charts were reviewed.22 cases of the patients were Giiomas,20 cases were neurilemmoma,13 cases were meningioma,37 cases were the others.The Glasgow Coma Scale and Glasgow Outcome Scale and other index showed that patients condition were severe.The incidence of seizures was 2.0/1000 patient-days after the drug,withdrawal and 3.4/1000 patient-days druing the durg use.We found six patients had seizures,two was during the fist day of the drug use,and the other four had seizures before using Meropenen.Conclusions Many reasons may increase the risk of seizures in neurosurgical patients,but if we choose the appropriate dosage based on patient＇s body mass,correct the dosage in the presence of renal failure,we could reduce the risk of seizures during Meropenen treatment.