尿毒症血液透析患者发生抗生素相关脑病的临床分析

目的 探讨尿毒症血液透析患者应用抗生素治疗后并发抗生素相关脑病的临床特点，以及预防和治疗的分析。方法 回顾性分析我院2013年1月至2020年1月期间16例尿毒症血液透析患者发生抗生素相关性脑病的临床特点，分析其发生抗生素脑病的相关因素及应对策略。结果 16例维持性血液透析患者因各种感染原因住院治疗，其中肺部感染8例；尿路感染1例；肾积脓1例；慢性支气管炎肺气肿急性发作3例；导管相关性感染1例；内瘘感染1例；急性阑尾炎1例。使用的抗生素主要有头孢哌酮舒巴坦、头孢哌酮他唑巴坦、头孢米诺、头孢他啶、左氧氟沙星、莫西沙星。使用抗生素后发生抗生素相关脑病，经停药给于苯巴比妥及血液透析滤过后，精神异常、抽搐等症状消失。结论 尿毒症血液透析患者，使用头孢菌素或喹诺酮抗生素后易发生抗生素脑病，抗生素的使用剂量和时间与患者癫痫等脑病症状发生有一定的相关性，明确诊断后应及时对症处理，可以考虑血液透析滤过及血液灌流治疗。

Clinical analysis of antibiotic related encephalopathy in uremic hemodialysis patients

Objective To investigate the clinical characteristics, prevention and treatment of antibiotic related encephalopathy after antibiotic treatment in hemodialysis patients with uremia. Methods The clinical characteristics of antibiotic related encephalopathy in 16 uremic hemodialysis patients in our hospital from January 2013 to January 2020 were analyzed retrospectively,and the related factors and coping strategies were analyzed.Results 16 patients with maintenance hemodialysis were hospitalized for various infection reasons,including 8 patients with pulmonary infection.Urinary tract infection:1 case;1case of pyonephrosis;3 cases of acute exacerbation of chronic bronchitis and emphysema;Catheter-related infection:1case;1case of internal fistula infection;1 case of acute appendicitis.The antibiotics used are mainly cefoperazone sulbactam,cefoperazone tazobactam,cefminox,ceftazidime,levofloxacin and moxifloxacin.Antibiotic related encephalopathy occurs after the use of antibiotics. After the withdrawal of phenobarbital and hemodialysis ,the symptoms such as mental abnormality and convulsions disappeared.Conclusion The use of cephalosporin or quinolone antibiotics in uremic hemodialysis patients is prone to antibiotic encephalopathy,and the dose and time of antibiotic use are correlated with the occurrence of epilepsy and other encephalopathy symptoms in patients.Symptomatic treatment should be timely after definite diagnosis ,and hemodialysis and hemoperfusion therapy can be considered.