头孢吡肟致尿毒症维持性血液透析患者抗生素脑病的临床分析

Clinical analysis of antibiotics encephalopathy induced by cefepime in uraemic patients with maintenance hemodialysis

目的分析不同剂量头孢吡肟对尿毒症维持性血液透析患者引起抗生素脑病的发生率并探讨可能的作用机制。方法对103例尿毒症并行维持性血液透析治疗患者在使用头孢吡肟治疗时出现的神经精神异常的情况进行分析，探讨其与头孢吡肟剂量的关系及可能的发生机制。将103例患者按照头孢吡肟使用剂量分为3组，A组31例，剂量为每次0．5g，每天2次；B组37例，剂量为每次1．0g，每天2次；C组35例，剂量为每次2．0g，每天2次。其引起抗生素脑病的发生率分别为3．26％、18．92％和40．00％，总发生率为21．36％。结果3组抗生素脑病的发生率随抗生素使用剂量的增加而增加，3组间发生率比较差异有统计学意义（P〈0．05）。总发生率明显高于正常人群，差异具有统计学意义（P〈0．01）。结论头孢吡肟对尿毒症患者有着高于一般人群的致抗生素脑病危险性，其发生率随着使用剂量的增加而增加。

Objective To analyze the incidence rate of antibiotics encephalopathy induced by cefepime in uraemic patients who received maintennance hemodialysis and explore the potential mechanism of action. Methods To retrospectively analyze 103 uraemic patients with cefepime- related neurotoxicity,discuss its association with the dose of cefepime and explore the potential mechanism of action. The patients were divided into group A（31 cases,0.5 g Bid）, group B（37 cases, 1.0 g Bid） and group C （35 cases, 2.0 g Bid ）. The incidence rate of antibiotics encephalopathy induced by cefepime were 3.26%, 18.92% and 40.00% espectively,the total incidence rate was 21.36%. Results The incidence rate of antibiotics encephalopathy increased with the augmentation dose of cefepime in these 3 groups. The differences were significant（ P 〈 0.05 ）, total incidence rate was significant higher than the normal people （ P 〈 0.01 ）. Conclusions Cefepime probably results in higher incidence rate of antibiotics encephalopathy in uraemic patients than normal people, and it increases with the augmentation dose of cefepime.