尿毒症血液透析患者发生抗生素相关性脑病的临床分析

Clinical Analysis of Antibiotic Related Encephalopathy in Hemodialysis Patients with Uremia

目的:探讨尿毒症血液透析患者应用抗生素治疗后并发抗生素相关性脑病的临床特点、预防和治疗方法。方法:回顾性分析2013年1月~2020年1月收治的16例发生抗生素相关性脑病尿毒症血液透析患者的原发病、治疗情况,抗生素脑病临床表现及临床处理,以分析尿毒症血液透析患者发生抗生素相关性脑病的临床特点、相关因素及应对策略。结果:16例维持性血液透析患者因各种感染原因住院治疗,其中肺部感染8例,尿路感染1例,肾积脓1例,慢性支气管炎肺气肿急性发作3例,导管相关性感染1例,内瘘感染1例,急性阑尾炎1例。使用的抗生素主要有头孢哌酮舒巴坦、头孢哌酮他唑巴坦、头孢米诺、头孢他啶、左氧氟沙星、莫西沙星。使用抗生素后发生抗生素相关性脑病,经停药给予苯巴比妥及血液透析滤过后,精神异常、抽搐等症状消失。结论:尿毒症血液透析患者使用头孢菌素或喹诺酮抗生素后易发生抗生素相关性脑病,抗生素的使用剂量和时间与患者癫痫等脑病症状发生有一定的相关性,明确诊断后应及时对症处理,可以考虑血液透析滤过及血液灌流治疗。

Objective:To investigate the clinical characteristics,prevention and treatment of antibiotic related encephalopathy in hemodialysis patients with uremia after antibiotic treatment.Methods:The primary disease and its treatment of antibiotic related encephalopathy in 16 hemodialysis patients with uremia in our hospital admitted from January 2013 to January 2020 were analyzed retrospectively,as well as the clinical manifestations and treatment of antibiotic related encephalopathy,were used to analyze clinical characteristics,related factors and coping strategies of antibiotic related encephalopathy in hemodialysis patients.Results:16 Patients with maintenance hemodialysis were hospitalized for various infection reasons,including 8 patients with pulmonary infection,1 case of urinary tract infection,1 case of renal empyema,3 cases of acute exacerbation of chronic bronchitis and emphysema,1 case of catheter-related infection,1 case of internal fistula infection,1 case of acute appendicitis.The main antibiotics used were cefoperazone sulbactam,cefoperazone tazobactam,cefminox,ceftazidime,levofloxacin and moxifloxacin.Antibiotic related encephalopathy occurred after the use of antibiotics.After the withdrawal of antibiotics,used phenobarbital and hemodialysis,symptoms such as mental abnormality and convulsions disappeared.Conclusion:The use of cephalosporin or quinolone antibiotics in hemodialysis patients with uremia was prone to antibiotic related encephalopathy,the dosage and time of antibiotic were related to the occurrence of epilepsy and other encephalopathy symptoms.Symptomatic treatment should be timely after definite diagnosis,and hemodialysis and hemoperfusion therapy can be considered.