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目的:分析头孢替安致尿毒症患者诱发头孢菌素类脑病的临床表现和机制,为合理选用头孢菌素类药物提供参考。方法:分析1例尿毒症患者使用头孢替安诱发脑病的临床表现,查阅国内外相关文献,探讨头孢菌素类脑病的发生机制,并根据头孢菌素类药物的结构推测不同头孢菌素类药物对脑病的影响程度。结果:调查发现头孢菌素类药物的化学结构在3-头孢环-4-羧酸的3位或7位被杂环或四唑环基取代是致脑病(癫痫)的必备条件,杂环和四唑环基的数量和位置不同,其致脑病作用的程度也不同;3位和7位均有杂环的化合物比只有一个部位被取代的化合物的致脑病作用强;3位比7位杂环取代药物的致脑病作用强;当取代3位和7位的杂环是四唑环基时,其致脑病作用程度相反,即母核7位比3位四唑环基取代的头孢菌素类药物致脑病作用更强。结论:正常剂量的不同头孢菌素类药物所致脑病的程度各异,合理选用头孢菌素类药物能有效地降低患者尤其是尿毒症患者头孢菌素类脑病的发生率。
Objective: To analyze the clinical manifestations and mechanism of cephalosporin encephalopathy induced by cefotiam in patients with uremia, and to provide a reference for rational selection of cephalosporins. Methods: To analyze the clinical manifestations of cephalothine-induced encephalopathy in one case of uremia patients, consult domestic and foreign literatures and explore the mechanism of cephalosporin-like encephalopathy. According to the structure of cephalosporins, we speculated that different cephalosporins The extent of the impact on brain disease. Results: The survey found that the chemical structure of cephalosporins in the 3-position or 3-cephalosporin-4-carboxylic acid heterocyclic or tetrazolyl substituted is a necessary condition for encephalopathy (epilepsy), heterocyclic And tetrazole ring group number and location of different encephalopathy caused by the degree of effect is also different; 3 and 7 are heterocyclic compounds than only one site substituted compounds encephalopathy role; 3 than 7 Heterocyclic substitution drugs cause encephalopathy role; when the substitution of the three and seven heterocyclic ring is tetrazolyl, the degree of encephalopathy caused by the opposite degree, that is, the mother of the nucleus 7 than the three azole-substituted cephalosporins Class drugs cause encephalopathy stronger. Conclusion: Different levels of encephalopathy caused by different doses of cephalosporins are different, and rational use of cephalosporins can effectively reduce the incidence of cephalosporin encephalopathy in patients, especially uremia patients.