慢性肾衰竭患者头孢菌素脑病28例分析

Clinical analysis of cephalosporin encephalopathy in 28 patients with chronic renal failure

目的探讨慢性肾衰竭患者头孢菌素脑病的发病机制、临床特点、治疗方法及转归。方法回顾性分析使用头孢菌素类药物后出现脑病的28例慢性肾衰竭患者,分析与头孢菌素脑病发生的相关因素。结果 28例慢性肾衰竭患者引起头孢菌素脑病发生的抗菌药物包括:头孢硫咪、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶和头孢替安,所有患者均无神经定位体征,CT扫描检查无病理性改变,慢性肾衰竭患者发生头孢菌素脑病较未发生头孢菌素脑病患者的年龄明显增加,接受透析的患者头孢菌素脑病发生率明显低于未透析者,头孢菌素脑病的发生与抗菌药物的剂量有明显关系,停用头孢类药物或减量后症状消失。结论头孢菌素脑病的发病机制考虑与慢性肾衰竭致排泄率降低有关,且增龄是其危险因素,透析可减少其发生,如能及早发现,及早进行对症治疗,绝大多数患者预后良好。

Objective To explore the pathogenesis,clinical characteristics,treatment and prognosis of cephalosporin encephalopathy in patients with chronic renal failure （CRF）.Methods The neuropsychiatric symptoms and treatment strategies of cephalosporin encepha-lopathy in 28 patients with CRF who were treated with cephalosporin drugs during January 2008 and June 2013 were retrospectively analyzed, and the influential factors of cephalosporin encephalopathy were analyzed as well.Results All the patients had no neurological signs and po-sitioning.CT showed no pathological changes,among CRF,those with cephalosporin encephalopathy were older than those without,incidence of cephalosporin encephalopathy in which did not receive dialysis was significantly higher than those already had,and the symptoms disap-peared after withdrawal.Conventional dose of these antibiotics was correlated with the occurrent of cephalosporin encephalopathy.Conclusion The pathogenesis of encephalosporin encephalopathy in patients with CRF is related to the low excretion rates resulting from renal insuffi-ciency,and aging was a risk factor.Better prognosis can be achieved with early diagnosis and treatment such as enhanced dialysis.