组合式血液净化治疗尿毒症抗生素脑病疗效观察

Clinical observation of combined blood purification for antibiotic encephalopathy with uremia

目的探讨组合式血液净化治疗头孢菌素致尿毒症抗生素脑病患者的临床疗效。方法回顾性分析贵州省人民医院2009年10月至2014年10月收治并采用组合式血液净化治疗的44例头孢菌素致尿毒症抗生素脑病的临床资料。其中接受血液透析(HD)治疗13例,血液透析联合血液灌流组(HD+HP)治疗15例,血液透析联合血液透析滤过组(HD+HDF)治疗16例;疗程均为4周。观察3组患者治疗前后炎症因子[C反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)]、生化指标[尿素氮(BUN)、血肌酐(Scr)]的变化,检测血清头孢他啶的药物浓度变化,进行格拉斯哥(GSC)评分分析。结果治疗前HD、HP+HD和HDF+HD组CRP、IL-6、PCT、BUN、Scr、头孢他啶浓度及GCS评分各指标差异均无统计学意义(P>0.05)。治疗后HD、HP+HD及HDF+HD组CRP、IL-6、PCT、头孢他啶浓度、GCS评分差异均有统计学意义(P<0.05)。Bun、Scr差异无统计学意义(P>0.05)。HD+HP组治疗有效率达93%,且治疗时间明显缩短,差异有统计学意义(P<0.05)。结论 HD+HP能更有效清除血液中头孢他啶及中大分子的炎症物质,缓解抗生素脑病临床症状,临床值得应用推广。

Objectives To explore the efficacy of combined blood purification for antibiotic encephalopathy leaded by cephalosporin with uremia. Methods： Forty-four patients with antibiotic encephalopathy leaded by cephalosporin and uremia were recruited from our hospital between October 2009 and October 2014 .They were randomly divided into three groups： group A （13cases） treated with the hemodialysis（HD） group B （15 cases） treated with the hemodialysis combined with blood perfusion （HD＋HP） and group C （16 cases） treated with hemodialysis combined with hemodialysis filtration （HD＋HDF）, 4 weeks treatment. Before and after treatment,Inflammatory factor, sush as c-reactive protein （CILP）, interleukin 6 （IL-6）, Calcitonin original （PCT）, biochemical indicator （Bun and Scr）, concentration of ceftazidime and Glasgow score were recorded. Results Compare with group A and B ,the levels of CRP, IL-6, PCT, concentration of ceftazidim decreased significantly and the levels of Glasgow scorewere increased in group B after treatment（all V 〈0.05 ）. Compare with group B and C, the levels of Bun decreased obviously after treatment.（all P〉0.05 ）. The recovery of patient conditions was much more rapid in group B than in group C. Conclusion The HD＋HP may be more effective in the clearance of inflammatory mediators and improved the recovery of patient conditions with antibiotic encephalopathy leaded by cephalosporin, which can be popularized in clinic.