慢性肾功能衰竭患者使用头孢菌素致中枢神经系统不良反应病例分析

目的了解头孢菌素应用于慢性肾功能衰竭患者导致精神症状的临床特点,探讨其防治措施。方法对2010年5月至2013年8月本院收治的慢性肾衰竭患者使用头孢菌素治疗中出现神经精神症状的病例进行临床特点和用药情况分析。结果共9例患者,使用常规剂量的头孢菌素3¹2 d出现神经精神症状,颅脑CT检查排除急性病变,经停药、对症治疗和加速药物排出后,9例患者症状均得到缓解。结论慢性肾功能衰竭患者使用头孢菌素类药物可导致药物在中枢神经系统内蓄积,出现中枢神经系统不良反应,故根据患者的肌酐清除率及药物的动力学特点制定个体化给药方案是预防的关键,有效的治疗措施为及时停药和充分透析。

Adverse reaction of central nervous system induced by cephalosporin in patients with chronic renal failure

Objective To investigate clinical characteristics of cephalosporin encephalopathy-induced in patients with chronic renal failure and to explore the prevention and treatment. Methods Patients with chronic renal failure treated with cephalosporins, from May 2010 to August 2013, were retrospectively analysed in our hospital. Results Nine patients were involved. After receiving conventional dose of cephalosporins for 3 - 12 d, the patients presented neuropsychiatric symptoms. Acute lesions were excluded by craniocerbral CT examination. After withdrawal of cephalosporins, symptomatic treatment and accelerating drug excretion, the symptoms disappeared. Conclusion Cephalosporins can accumulate in the central nervous system and cause central nervous system adverse reactions. To formulate individualized dosage regimen is the key to prevention, accoring to creatinine clearance of patients and the characteristics of pharmaco- kinetics of drugs, Prompt withdrawal of drugs and sufficient dialysis may be helpful.