22例尿毒症患者抗菌药物引起的脑病临床分析

Antibiotic encephalopathy in 22 patients with uremia

目的探讨尿毒症血液透析患者精神神经症状与抗菌药物使用的关系。方法对22例维持性血液透析尿毒症合并感染应用抗菌药物后出现精神神经症状患者进行尿素氮(BUN)、肌酐(Cr)、血糖(BS)、血钠(Na)、血钙(Ca)、血气分析以及头颅CT/MRI等检查,并对其临床资料进行分析总结,同时给予停药、透析以及血液灌流治疗,观察其治疗效果。结果 22例尿毒症血液透析患者BS、Na、Ca、血气分析以及头颅CT/MRI等检查结果均正常,BUN、Cr与发病前比较无明显差异,排除了高血糖、低血糖、低钠血症、低钙血症及严重酸碱平衡紊乱、尿毒症脑病、病毒性脑炎等所致的精神神经症状。抗菌药物使用当中常规剂量头孢他啶、头孢吡肟、亚胺培南、左氧氟沙星发生精神神经症状较其他抗菌药物多见。及时诊断、停药、透析以及血液灌流治疗,预后良好。结论尿毒症血液透析患者精神神经症状与不恰当使用抗菌药物有关,根据药物的清除速率调整抗菌药物用量以及恰当选择抗菌药物类型是预防血液透析患者抗菌药物脑病的关键。

Objective To investigate the relationship between neuropsychological symptoms and antibiotic use in patients with uremia who received hemodialysis.Methods Blood glucose,sodium and calcium levels were measured,and blood gas analysis and head CT/MRI were performed in 22 patients with uremia who received hemodialysis and had secondary infection and neuropsychological symptoms.After the occurrence of neuropsychological symptoms,withdrawal of antibiotics,hemodialysis and hemoperfusion treatment were performed on these patients.Results Blood glucose,sodium and calcium levels,blood gas results,and head CT/MRI results were normal in the 22 patients.Blood BUN and Cr levels were not significantly different before and after the occurrence of neuropsychological symptoms.Hyperglycemia,hypoglycemia,hyponatremia,hypocalcemia,acid-base disturbance,uremic encephalopathy and viral encephalitis were not responsible for the development of neuropsychological symptoms.Regular doses of ceftazidime,cefepime,imipenem and levofloxacin resulted in higher frequencies of neuropsychological symptoms than other antibiotics.The patients had good outcome by prompt diagnosis,withdrawal of antibiotics,hemodialysis and hemoperfusion treatment.Conclusion The occurrence of neuropsychological symptoms may be associated with the inappropriate use of antibiotics.It is important to adjust the antibiotics dose based on drug clearance rate and choose appropriate antibiotics to prevent antibiotic encephalopathy in hemodialysis patients.