头孢吡肟致神经毒性反应78例中外文献分析

Literature Analysis of 78 Cases of Neurotoxicity Induced by Cefepime

目的:探讨头孢吡肟致神经毒性反应的特点与规律,为临床合理用药提供参考。方法:检索中国医院数字图书馆(1994-2009)、万方医学网(1998-2009)、中文科技期刊全文数据库(1989-2009)和PubMed数据库,查阅有关文献全文,对获得的病例资料进行归纳、分析。结果:共获得78例头孢吡肟致神经毒性反应的病例资料。头孢吡肟致神经毒性反应在老年人、肾功能不良患者中发生率高,剂量大、与肾毒性药物合用发生率高。临床表现主要有意识障碍(如意识混乱、昏迷、反应迟钝、神情淡漠等)和神经兴奋性增高(烦躁不安、言语错乱、抽搐、癫痫样发作等)。发生神经毒性反应后早停药、注射氯硝西泮及血液透析或血液透析加血液灌流等是有效的治疗措施。患者原发疾病较重、治疗措施不当或治疗不及时可导致患者死亡。结论:头孢吡肟所致的神经毒性反应可造成严重不良后果,临床医师应高度重视这种严重的毒性反应。

OBJECTIVE： To investigate the characteristics and regularity of cefepime-inducing neurotoxicity, and to provide reference for rational use of drugs in the clinic. METHODS： Retrieved from CHKD （1994--2009）, Wanfang database （1998--2009） and Chinese periodical full-text databases （1989- 2009） and PubMed, related literatures were collected and analyzed statistically. RESULTS： A total of 78 neurotoxicity cases induced by cefepime were obtained. Most of neurotoxicity induced by cefepime oc- curred in the elderly and patients with renal dysfunction. High dosage of cefepime and combined with renal toxicity drugs induced neurotoxicity mostly. The main clinical manifestations were disorder of consciousness （such as confusion, coma, obtundation, ex- pression of indifference, etc.） and excitability increasing （irritability, paraphasia, convulsion, epilepsy, etc.）. The early withdraw- al, injection of clonazepam, hemodialysis, or hemodialysis plus hemoperfusion after neurotoxicity occurred were the effective mea- sures. Serious primary disease, inappropriate measures or not timely treatments could lead to death. CONCLUSION： The neurotoxicity induced by cefepime can cause serious consequences and the clinicians must have a heightened awareness of serious neurotoxicity effect of eefepime.