头孢菌素类药物致尿毒症患者脑病的文献分析

Literature Analysis of Cephalosporin-induced Encephalopathy in Uremic Patients

目的:总结头孢菌素类药物致尿毒症患者脑病的抗生素种类、用药至发生脑病的时间及脑病的临床处理方法,为临床合理用药提供参考。方法:检索中国医院知识总库(CHKD)全文数据库,对2010-2012年报道的头孢菌素类药物所致的尿毒症患者脑病病例进行统计、分析。结果:纳入涉及头孢菌素类药物所致尿毒症患者脑病的文献9篇,报道例数177例。头孢菌素所致尿毒症患者脑病在第1、2、3、4代头孢菌素应用中均有发生;脑病出现的时间均集中在用药2周以内,多数出现在1周之内,约占70%以上;39.54%的患者只需停药及对症处理,另一部分需调整血液净化方式治疗,预后均较好。结论:加强对头孢菌素类药物引起尿毒症患者脑病的监测,根据头孢菌素的药动学特点选择处理方法,并加强临床合理用药。

OBJECTIVE： To summarize the kinds of antibiotics of cephalosporin-induced encephalopathy in uremic patients, the time from the beginning of drug use to encephalopathy attack and clinical treatment methods of encephalopathy, and to provide refer- ence for rational drug use in the clinic. METHODS： Related literatures of cephalosporin-induced encephalopathy in uremic patients were collected from CHKD full-text database during 2010--2012, and then included literatures were analyzed statistically. RESULTS： A total of 9 references relating to cephalosporin-induced encephalopathy in uremic patients were collected, and 177 cases were reported. Cephalosporin-induced encephalopathy in uremic patients had occurred in 1, 2, 3, 4 generation cephalosporins; encephalopathy mainly appeared within 2 weeks of medication; most of them appeared within 1 week, accounting for 70% above. 39.54% only needed drug withdrawal and symptomatic treatment, and the others needed to adjust the blood purification treatment with good prognosis. CONCLU- SIONS： Great importance should be attached to the understanding of cephalosporin-induced encephalopathy in uremic patients and clini- cal rational drug use. The processing methods should be chosen according to the pharmacokinetic characteristics of cephalosporin.