慢性肾衰竭并发抗生素脑病诊治分析

Diagnosis and Treatment of Chronic Renal Failure Complicated by Antibiotics Encephalopathia

目的探讨慢性肾衰竭(CRF)患者并发抗生素脑病的临床特点、机制、预防及处理措施。方法回顾性分析我院2007—2009年收治的25例CRF应用抗生素并发脑病患者的临床资料。结果 25例患者均有CRF,应用抗生素均为头孢菌素类,从开始使用抗生素到出现神经精神症状的时间为3～14 d,症状轻重不等。患者均停用抗生素,其中18例经镇静、止抽、降颅压等对症处理,症状于3～5 d内缓解,7例较重患者(包括5例抽搐患者)行血液透析滤过或血液透析+灌流(HP)治疗,最终全部缓解。结论 CRF患者免疫力低下,易并发感染,应用抗生素时应根据肾功能减退程度调整药物剂量,并注意观察,警惕抗生素脑病的发生,早期诊断、及时停药对症处理,必要时采取不同方式的血液净化治疗,可改善抗生素脑病患者的预后。

Objective To investigate the clinical features,mechanisms,preventions and treatment of patients with chronic renal failure（CRF） complicated by antibiotics encephalopathia.Methods Clinical data of 25 patients complicated by antibiotics encephalopathia who admitted to our hospital from 2007 to 2009 were retrospectively analyzed.Results All 25 patients had CRF.The patients all suffered from psychiatric symptoms after being treated with cephalosporins for 3 to 14 days with varied degrees of symptoms.Treatment and outcome：all patients stopped using antibiotics.Symptoms of 18 patients were relieved owing to expectant treatment in 3 to 5 days.7 much severer patients（including 5 patients with convulsion）were given hemodiafiltration or hemodialysis plus hemoperfusion and the symptoms were finally relieved.Conclusion Medicine dose should be regulated according to the kidney function and antibiotics encephalopathia should be paid attention to when antibiotics were used for CRF patients who had low immunity and were prone to be infected.If antibiotics encephalopathia appeared,early diagnosis,drug withdrawal and treatment in time were needed.If necessary,different types of blood purification treatment should be used to improve the prognosis of antibiotics encephalopathia patients.