血液灌流联合血液透析治疗维持性血液透析患者β内酰胺抗生素脑病的临床研究

Clinic study of the treatment of hemodialysis combined with hemoperfusion in hemodialysis patients with beta-lactam antibiotics encephalopathy

目的探讨血液灌流联合血液透析对维持性血液透析（maintenance hemodialysis，MHD）患者B内酰胺类抗生素脑病的治疗效果。方法回顾性分析2003年10月至2012年1月本院MHD患者并发β内酰胺类抗生素脑病的一般状况、原发病情况、相关感染性疾病、临床常规用药及抗生素应用情况、临床表现、辅助检查结果、对症治疗和血液净化治疗情况以及预后。结果共9例MHD患者在应用抗生素治疗过程中出现β内酰胺类抗生素脑病，平均年龄（73．1±9．8）岁，透析时间（23．6±23．5）个月；其中7例致病抗生素为头孢类药物，其余2例为青霉素类药物；感染性疾病以肺部感染为主，患者临床症状多样，表现为感觉异常、意识障碍、精神异常及抽搐等，重症患者出现癫痫及昏迷，所有患者均无神经系统定位体征；血红蛋白、血肌酐、血尿素氮、血丙氨酸氨基转移酶、血天冬氨酸氨基转移酶、血糖、血钾、血钙、血钠、血酸碱度等在抗生素脑病发作前后无统计学差异；头颅CT或核磁共振检查未见急性脑梗塞或出血等病变，1例患者脑电图检查提示为发作性慢波。8例患者经停用抗生素、对症治疗、血液透析联合血液灌流治疗后症状完全消失，1例症状改善后因呼吸衰竭死亡。结论MHD患者出现β内酰胺类抗生素脑病后，血液灌流联合血液透析治疗有效。

Objective To investigate the effect of hemoperfusion combined with hemodialysis in the maintenance hemodialysis patients who were diagnosed as having encephalopathy induced by beta-lactam antibiotics. Methods The clinical manifestation, treatment and prognosis of patients subject to maintenance hemodialysis who were treated with β-lactam antibiotics and had neurotoxic effects were retrospectively reviewed from October 2003 to January 2012 in our hospital. Results Nine patients subject to maintenance hemodialysis developed neuropsychiatric symptoms induced by β-lactam antibiotics, their average age was （73. 1 ± 9.8）year old, age of dialysis was （23.6 ± 23.5） months;Pathogenic antibiotics of seven cases were cephalosporin, pathogenic antibiotics of the rest 2 cases were penicillin; Patients with infectious diseases is given priority to with lung infection, clinical symptom diversity. Patients had a vailety of clinical manifestations such as abnormal sensation, disturbance of , mental disorder, tic and so on, and in severe cases had seizures and coma; All patients had no neurological signs of localization, the results is no statistical difference before and after the onset of encephalopathy, which were hemoglobin, serum creatinine, blood urea nitrogen, blood alt aspertate aminotransferase, blood aspertate aminotransferase, blood sugar, blood potassium, blood calcium, blood sodium, blood pH-value of all patients. Patients had no acute cerebral infarction or hemorrhage lesions from head CT or mil examination, and ruled out the other disease. One case of patients had paroxysmal slow wave from eeg examination clew. After discontinuation of antibiotics and blood perfusion, β patients recovered and 1 patient died due to respiratory failure after symptoms improve. Conclusions In maintermnce hemodialysis patients, β- lactam antibiotics can cause neuropsychiatric symptoms, and the treatment of hemodialysis combined with hemoperfusion is effective.