玄先法　李莹　王玉新　张以勤　吕天羽　叶婧　周丽娜　颜建华　许丽苹　武挺

[摘要] 目的 探讨终末期肾病维持血液透析患者使用头孢菌素导致抗生素脑病的临床表现及预防、治疗方法，指导合理用药。 方法 我院2005年7月～2016年 7月16例终末期肾病维持血液透析患者使用头孢菌素后出现抗生素脑病，回顾性总结分析上述患者的临床资料。 结果 16例维持性血液透析患者因感染住院治疗，使用头孢菌素后出现抗生素脑病，患者平均年龄（69.3±13.7）岁，发病前后无神经系统定位体征，查血常规、肝肾功能、血糖、电解质等指标无明显变化（P>0.05），头颅CT检查未见急性脑梗死或脑出血病变。患者临床表现多种多样：嗜睡、昏睡、头痛、幻觉、定向力障碍、癫痫样发作等。经停药、对症治疗及加强血液透析、联合血液滤过、CRRT、血液灌流后患者症状消失。 结论 尿毒症血液透析患者，特别是老年患者，使用头孢菌素可能会导致抗生素脑病。减小剂量或延长给药间隔是防范发生脑病的关键。一旦发现需及时停药，并加强血液净化，患者大多预后良好。

[关键词] 尿毒症；血液透析；头孢菌素；抗生素脑病

[中图分类号] R692 [文献标识码] A [文章编号] 1673-9701（2017）13-0026-04

[Abstract] Objective To investigate the clinical manifestation， prevention and treatment of antibiotic encephalopathy caused by cephalosporin in hemodialysis patients with end-stage renal disease， and to guide the rational use of drugs. Methods 16 hemodialysis patients of end-stage renal disease in our hospital from July 2005 to July 2016 had antibiotic encephalopathy after the use of cephalosporin， and their clinical data were retrospectively analyzed. Results 16 patients with maintained hemodialysis were hospitalized for infection， and hadantibiotic encephalopathy after the use of cephalosporin. The average age of patients was（69.3 ±13.7）years old. The patients had no neurological signs before and after the onset. The blood routine， liver and kidney function， blood glucose， electrolyte and other indicators had no significant change （P>0.05）. And head CT examination showed no acute cerebral infarction or cerebral hemorrhage lesions. Patients had a variety of clinical manifestations such as lethargy， drowsiness， headache， hallucinations， orientation disorders， epileptic seizures and so on. The symptoms disappeared after withdrawing the drugs， symptomatic treatment and strengthening hemodialysis， combined with blood filtration， CRRT， blood perfusion. Conclusion The use of cephalosporins for uremic hemodialysis patients， especially the elderly， may lead to antibiotic encephalopathy. Reducing the dose or extending the interval is the key to prevent the occurrence of encephalopathy. Once antibiotic encephalopathy is found，the drugs should be timely withdrawn， and the blood purification must be strengthened， and most of the prognosis is good.

[Key words] Uremia； Hemodialysis； Cephalosporin； Antibiotic encephalopathy

終末期肾病（end-stage renal disease，ESRD）维持血液透析（maintenance hemodialysis，MHD）患者大多免疫力低下，是感染的高发人群[1]。头孢菌素相对广谱强效，不良反应较少，广泛应用于治疗终末期肾病血液透析患者的细菌感染。但该类患者，尤其是老年尿毒症患者，其药代动力学与正常人相比有显著变化，主要表现为降低了药物的清除排泄，容易造成体内抗生素蓄积，有可能引起抗生素脑病等不良后果。为……