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目的探讨尿毒症血液透析患者精神神经症状与抗菌药物使用的关系。方法对22例维持性血液透析尿毒症合并感染应用抗菌药物后出现精神神经症状患者进行尿素氮(BUN)、肌酐(Cr)、血糖(BS)、血钠(Na)、血钙(Ca)、血气分析以及头颅CT/MRI等检查,并对其临床资料进行分析总结,同时给予停药、透析以及血液灌流治疗,观察其治疗效果。结果 22例尿毒症血液透析患者BS、Na、Ca、血气分析以及头颅CT/MRI等检查结果均正常,BUN、Cr与发病前比较无明显差异,排除了高血糖、低血糖、低钠血症、低钙血症及严重酸碱平衡紊乱、尿毒症脑病、病毒性脑炎等所致的精神神经症状。抗菌药物使用当中常规剂量头孢他啶、头孢吡肟、亚胺培南、左氧氟沙星发生精神神经症状较其他抗菌药物多见。及时诊断、停药、透析以及血液灌流治疗,预后良好。结论尿毒症血液透析患者精神神经症状与不恰当使用抗菌药物有关,根据药物的清除速率调整抗菌药物用量以及恰当选择抗菌药物类型是预防血液透析患者抗菌药物脑病的关键。
Objective To investigate the relationship between neuropsychiatric symptoms and the use of antibiotics in hemodialysis patients with uremia. Methods BUN, BS, Na, Ca, Ca and B were determined in 22 patients with maintenance psychiatric hemodialysis and uremia with antibiotics. Blood gas analysis and head CT / MRI examination, and its clinical data were analyzed and summarized, at the same time give withdrawal, dialysis and hemoperfusion treatment to observe the therapeutic effect. Results 22, uremia hemodialysis patients BS, Na, Ca, blood gas analysis and head CT / MRI examination results were normal, BUN, Cr and before onset no significant difference, excluding high blood sugar, hypoglycemia, hyponatremia , Hypocalcemia and severe acid-base balance disorders, uremic encephalopathy, viral encephalitis caused by neuropsychiatric symptoms. Antibacterial drugs used in conventional doses of ceftazidime, cefepime, imipenem, levofloxacin neuropsychiatric symptoms more common than other antibacterials. Timely diagnosis, withdrawal, dialysis and hemoperfusion treatment, the prognosis is good. Conclusion The neuropsychiatric symptoms of hemodialysis patients with uremia are related to the improper use of antimicrobial agents. Adjusting the dosage of antimicrobial agents according to the drug clearance rate and proper selection of antimicrobial agents are the key factors to prevent the antimicrobial encephalopathy in hemodialysis patients.