论文部分内容阅读
目的探讨慢性肾衰竭(CRF)患者并发抗生素脑病的临床特点、预防及处理措施。方法回顾性分析46例CRF应用抗生素并发脑病患者的临床资料,分析使用抗生素种类、并发抗生素脑病的临床表现、治疗与临床转归、预防和处理。结果 (1)抗生素种类:46例CRF患者应用的抗生素包括头孢菌素类和喹诺酮类,其中头孢哌酮他唑巴坦26例;头孢哌酮舒巴坦13例;左氧氟沙星7例。(2)临床表现:从开始使用抗生素到出现神经症状的时间为4~16 d,表现为头昏、反应迟钝、幻觉、谵妄、嗜睡、抽搐等,部分患者出现面肌抽动、肢体不自主抖动、癫痫样发作。(3)治疗与转归:46例患者均停用或更改抗生素,32例经镇静、低流量吸氧等对症处理,症状于3~6 d内缓解;14例症状较重者经血液透析或血液透析串联血液灌流治疗2~4次,最终症状全部得到缓解。结论 CRF患者易并发各种感染,三代头孢对CRF患者相对安全,临床上广为应用,有时不可避免需使用喹诺酮类药;早期诊断、及时停药和对症处理,必要时采取不同方式的血液净化治疗,可改善抗生素脑病患者的预后。
Objective To investigate the clinical features, prevention and treatment of patients with chronic renal failure (CRF) complicated by antibiotic encephalopathy. Methods The clinical data of 46 cases of patients with CRF complicated with encephalopathy were retrospectively analyzed. The clinical manifestation, treatment and clinical outcome of antibiotics and antibiotic encephalopathy were analyzed. Results (1) Antibiotics: The antibiotics used in 46 patients with CRF included cephalosporins and quinolones, of which 26 were cefoperazone tazobactam, 13 were cefoperazone sulbactam and 7 were levofloxacin. (2) clinical manifestations: from the beginning of the use of antibiotics to appear neurological symptoms time is 4 ~ 16 d, manifested as dizziness, unresponsiveness, hallucinations, delirium, drowsiness, convulsions, etc., some patients with facial muscle twitching, limb involuntary jitter Epilepsy. (3) Treatment and outcome: 46 patients discontinued or changed their antibiotics, and 32 patients were symptomatically treated with sedative and low-flow oxygen inhalation. The symptoms were relieved within 3 ~ 6 days. Among the 14 patients with severe symptoms, hemodialysis or Hemodialysis hemoperfusion in series 2 to 4 times, the final symptoms were all alleviated. Conclusions CRF patients are complicated with various infections. The third generation cephalosporins are relatively safe to CRF patients and are widely used clinically. Sometimes it is inevitable to use quinolones; early diagnosis, timely withdrawal and symptomatic treatment, if necessary, take different ways of blood purification Treatment can improve the prognosis of patients with antibiotic encephalopathy.