慢性肾脏病并发抗生素脑病的防治分析

Analysis of Prevention and Treatment of Encephalopathy Induced by Antibiotics in Patients with Chronic Kidney Disease

目的探讨慢性肾脏病并发抗生素脑病的防治措施。方法分析我院收治的5例和国内文献中的378例慢性肾脏病患者并发抗生素脑病的临床资料。结果 383例患者中,男202例,女181例。引起脑病的抗生素依次为头孢他啶、头孢曲松、头孢吡肟、头孢哌酮舒巴坦钠。有13例为无指征用药,分别有60例、12例、111例使用了常规剂量、超常规剂量、减量的抗生素。该病缺乏特异性临床表现。多数患者出现脑病症状的时间为用药后3～4 d。经治疗后,372例恢复良好,无后遗症;11例因诊治不及时死亡。结论加强各科医师对抗生素脑病的认识,严格掌握使用抗生素的使用指征、种类和剂量是预防的关键;有效的治疗措施为及时停药和充分透析。

Objective To explore the prevention and treatment strategies of encephalopathy induced by antibiotics in patients with chronic renal disease.Methods The clinical data of 5 cases of encephalopathy induced by antibiotics in our hospital and 378 cases in literatures were retrospectively analyzed.Results Of these 383 patients,there were 202 males and 181 females.Encephalopathy was most frequently induced by ceftazidime,ceftriaxone,cefepime,cefoperazone,and sulbactam.Thirteen patients received antibiotics treatment without specific indication.Sixty,12,and 111 patients received routine,hyper-routine,and hypo-routine dosages of antibiotics,respectively.No specific clinical manifestation was identified.In most patients,the symptoms emerged three or four days after antibiotics usage.After treatment,372 patients were cured without sequelae,while 11 patients died because of delayed diagnosis and improper treatment.Conclusion Physicians shall grasp the knowledge of encephalopathy induced by antibiotics.The indications,type,and quantity of antibiotics should be strictly controlled.Prompt withdrawal of drug and sufficient dialysis may be helpful to manage this disease.