尿毒症患者使用抗生素后引起尿毒症脑病的临床观察(1)
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【摘要】 目的 探讨尿毒症患者使用抗生素后引起尿毒症脑病的抗生素种类和临床特点，以指导抗生素在肾衰竭血液透析患者中的合理应用，为临床上的透析患者抗生素的使用提供建议和对策，为临床抗生素合理用药提供参考。方法 回顾性分析2008年12月至2009年12月在抗生素治疗过程中出现神经精神症状的20例慢性肾衰竭透析治疗患者，并对其进行临床症状和用药情况的分析和统计。结果 20例患者均在5~12 d出现神经精神症状，症状表现多样，所有患者均无神经系统定位体征，经颅脑CT检查无急性病变。所有患者经停药、改变剂量及继续透析治疗后症状完全消失。结论 慢性肾功能衰竭血液透析患者使用抗生素可引起中毒性脑病，由于肾脏的排泄功能下降，故用药前应根据肾功能减退程度调整药物剂量，有条件者可进行血药浓度监测，用药过程中应密切观察，一旦出现症状及时停药及处理。
【关键词】尿毒症;脑疾病;抗生素;血液透析
Clinical observation of encephalopathy in uremic patients after the use of antibiotics
PENG Chang-lu,LIU Yu-ming.China Aerospase Science and Industry Corporation 731 hospital,Beijing 100074,China
【Abstract】 Objective In order to explore the type and the character of the antibiotics which caused encephalopathy in uremia patient after using the antibiotic, it can provide suggestions and the measurements for the usage of the antibiotic in renal failure hemodialysis patient. Methods By retrospective analysis of 20 patients behaving neuropsychiatric symptoms he in the treatment of antibiotic from December 2008 to December 2009,we can make a statistical analysis of the symptoms and antibiotics of the dialysis patients with chronic renal failure. Results Neuropsychiatric symptoms occurred in 5 to 12 days of the 20 patients. The clinical features were different. All patients had no signs of nervous system orientation, no acute lesions by brain CT examination. The symptom would relieve after suspending antibiotics therapy or change the dose of the antibiotics. Conclusion The hemodialysis patient with chronic renal function failure uses the antibiotic supposed to be possible to cause the encephalopathy, owing to the decrease of kidney’s excretory function, therefore before applying antibiotics, medicine dosage should be adjusted according to the kidney function. The medicine density in the blood should be monitored. Once symptom occurs, the measurement should be taken immediately.
【Key words】 Uremia；Encephalopathy；Antibiotic；Hemodialysis
随着抗生素新药的不断研制、开发及应用，药物不良反应也相继出现，有的药物甚至可以引起溶血、胃肠道、皮肤、中枢神经和心脏毒性，尤其是存在严重的肾功能不全时，抗生素药代动力学与正常人相比有显著变化，药物的代谢比较差，大量的药物潴留在体内，会产生严重的不良反应[1]。在临床治疗过程中，常因忽视肾功能衰竭对抗生素代谢的影响，引起不良后果。尿毒症是一种炎性反应状态，需要长期进行透析治疗，尿毒症患者机体免疫力低下 ......
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