血液灌流联合血液透析在慢性肾衰竭患者药物性脑病中的应用

目的 探讨血液灌流(HP)联合血液透析(HD)在慢性肾衰竭患者药物性(头孢菌素)脑病中的临床疗效,以进一步指导临床治疗.方法 收集2004年9月-2011年11月收治的24例头孢菌素脑病患者,进行血液透析和(或)联合血液灌流治疗,观察两组脑病的缓解率,评定其临床效果.结果 发生头孢菌素脑病的慢性肾衰竭患者24例,12例应用HP+HD治疗,12例单纯应用HD治疗,HP+HD组完全缓解和部分缓解率分别为41.7％和58.3％,较单纯HD组缓解率高(P＜0.05),且临床症状明显改善；β2-微球蛋白(β2-MG)HP+HD组明显降低(P＜0.05),HD组降低不明显(P＞0.05).结论 在慢性肾衰竭患者中头孢菌素脑病一旦诊断应及时停药,并选择合适的血液净化方式,其中HP+HD治疗,对于分子量大或(和)蛋白结合的抗菌药物是一种较好的治疗方法.

Application of hemoperfusion combined hemodialysis in treatment of cephalosporin encephalopathy in chronic renal failure patients

OBJECTIVE To investigate the clinical effects of hemoperfusion combined hemodialysison on the treatment of cephalosporin encephalopathy in the patients with chronic renal failure(CRF) so as to instruct clinical therapy.METHODS From Sep 2004 to Nov 2011,24 patients diagnosed cephalosporin encephalopathy were collected,and those patients underwent hemodialysis and/or hemoperfusion,the remission rates of the two groups were observed,and the clinical efficacy was evaluated.RESULTS Of 24 CRF patients with cephalosporin encephalopathy,12 cases were treated with hemoperfusion combined hemodialysis(HP+HD),while 12 cases were treated with hemodialysis only(HD),the complete remission rate was 41.7% and the part remission rate was 58.3% in the HP+HD group,both of which were higher than the HD group(P<0.05),the clinical symptoms have been improved significantly;the β 2-MG level decreased significantly in the HP+HD group(P<0.05),while there was not a significant decrease in the HD group(P>0.05).CONCLUSION The CRF patients should stop using antibiotics and select appropriate approach for blood purification once the ephalosporin encephalopathy is diagnosed;and hemoperfusion combined hemodialysison is an effective treatment for macro-molecular weight and/or protein binding cephalosporin drugs.