肾功能不全头孢菌素脑病16例临床分析

目的总结肾功能不全头孢菌素脑病的诊治经验,指导肾功不全患者的抗感染治疗。方法回顾性分析我科16例肾功能不全患者应用头孢类抗生素时引起的神经精神症状及相关临床资料。结果使用头孢菌素到出现神经精神症状时间间隔（4.26±1.85）天（2～6天）,临床表现为神志恍惚、谵妄、幻觉、嗜睡、口齿不清、记忆力障碍、肌肉震颤、抽搐等。所有患者停药并血液净化治疗后好转。结论 肾功能不全患者使用常规剂量的头孢菌素可造成神经毒性,因此应根据肌酐清除率调整剂量,一旦出现症状需立即停药。

Clinical analysis of 16 cases of encephalopathy induced by cephalosporin in patients with renal inadequacy

Objective To discuss the reasonable utilization of cephalosporin in renal failure patients to guide the anti-infective therapy for patients with renal inadequacy.Methods Neuropsychiatric symptoms caused by cephalosporin for patients with renal inadequacy and correlated clinical characteristics were retrospectively analyzed.Results The period between start of treatment and onset of neuropsychiatric symptoms was（4.26±1.85） days（1~6 days）.The clinical manifestation were staring spells,delirium,hallucination,lethargy,lisp,memory disorders,amyostasia and convulsion etc.The symptoms completely disappeared after withdrawal of cephalosporin and blood purification.Conclusions Cephalosporin used in conventional dose could cause adverse effect of nervous system in renal failure patients.Therefore,we should adjust the dosage of cephalosporin based on creatinine clearance rate,and discontinue the drugs once encephalopathy appears.