慢性肾功能衰竭合并抗生素脑病29例分析

目的通过研究慢性肾功能衰竭(CRF)患者抗生素脑病的发病机制和临床特点,探讨头孢菌素在CRF患者中的合理应用。方法29例CRF患者在使用常规剂量或减量使用头孢菌素后出现神经精神症状,诊断为抗生素脑病,将其临床资料进行回顾性分析。结果神经精神症状表现多样:(1)精神异常4例,表现为胡言乱语、烦躁不安、睡眠倒错;(2)意识障碍2例,表现为嗜睡、昏睡、神志不清;(3)癫痫样抽搐23例,表现为肌阵挛、全身抽搐、癫痫样发作;部分患者同时出现几组症状。所有患者均无神经系统定位体征,行颅脑CT检查无急性病变。所有患者经停药及继续透析治疗后症状完全消失。结论常规剂量或减量使用头孢菌素可引起一过性的脑病,推测与药物的半衰期延长有关。

A clinical study of chronic renal failure with cephalosporin encephalopathy

Objective To explore the reasonable utilization of cephalosporins in chronic renal failure(CRF)patients with cephalosporin encephalopathy.Method We retrospectively analyzed the clinical characteristics of 29 CRF patients,who developed encephalopathic syndrome and was treated with cephalosporin.Results The encepha1opathic syndrome include(1)mental confusion in 4 cases;(2)unconsciousness in 2 cases;(3)seizure in 23 cases.Physical examination did not show signs of cerebral focal injury.Computed tomography of the brain in 29 patients did not show acute lesions.The state of neurotoxicity was completely recovered after discontinuation of cephalosporins.Conclusion Cephalosporins used in conventional doses or reduced doses can cause temporary encephalopathy in patients with CRFwhich might due to prolongation of drug half life.So in patients with CRF,admitted dosage should be lowered and monitor the blood level of cephalosporins if possible.The cephalosporin should be discontinued if patients showed unexplained encephalopathy.