头孢菌素致肾衰竭患者脑病的临床分析

目的探讨头孢菌素在肾功能衰竭患者中的合理应用。方法回顾性分析30例肾衰竭患者在使用头孢菌素（头孢菌素用量2～3g／d）过程中出现的神经精神症状及脑电图表现，探讨其可行的治疗方案。结果所有患者均停用头孢类抗生素，22例行血液透析治疗，2例行腹膜透析治疗，5例应用抗癫痫药物，2～5天后29例患者症状缓解，1例患者死亡；27例患者行脑电图检查，23例脑电图显示背景为广泛慢波伴有中到高波幅尖波或者尖慢波。结论肾衰竭患者使用常规剂量的头孢菌素可引起神经毒性，推测与患者血脑屏障的改变、药物的清除率降低以及游离药物浓度增高有关。肾衰竭患者在应用头孢菌素时需根据内生肌酐清除率调整剂量，一旦出现症状需及时停药。

Clinical analysis of cephalosporins induced encephalopathy in renal failure patients

Objective To discuss the appropriate administration of cephalosporins in renal failure patients. Methods We retrospectively analyzed 30 renal failure patients developing encephalopathic syndrome and electro- encephalogram changes during the cephalosporins treatment （daily dose of 2-3g）. Results In the 30 patients, 29 completely recovered from encephalopathy syndrome after discontinuing of the drug for 2-5 days, and one patient died. Twenty-two patients were treated with hemodialysis, 2 with peritoneal dialysis, and 5 patients used antiepileptic drugs. Electroencephalogram showed background of generalized slow waves with continuous bursts of moderate to high amplitude, or sharp and slow wave activity in 23 of the 27 patients. Conclusions Regular dose of cephalosporins treatment may have neurotoxicity in renal failure patients, probably resulting from blood-brain barrier change, low drug clearance and higher blood drug concentration. Therefore, we should adjust the dosage of cephalosporins based on creatinine clearance rate, and discontinue the drugs once unexplained encephalopathy appears.