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碳青霉烯类是一类具有广谱抗菌作用的β-内酰胺类抗生素。其常用药物包括亚胺培南、美罗培南、厄他培南、法罗培南、帕尼培南和多尼培南等。此类药物可诱发神经毒性,发生率约为0.01%～3%。神经毒性主要临床表现为头痛、惊厥、癫痫、肌阵挛、意识障碍等。神经毒性的发生机制为碳青霉烯类抗生素阻止γ-氨基丁酸(γ-GABA)与受体的结合,从而干扰γ-GABA的神经抑制作用,导致癫痫等神经毒性发生。神经毒性反应的危险因素包括患者肾功能减退、中枢神经系统病变、合并用药等。防治措施:根据不同种类碳青霉烯类抗生素与癫痫的相关性合理选择药物;应谨慎调整肾衰竭患者的使用剂量;避免与高剂量茶碱、非甾体抗炎药及丙磺舒等合用;儿童及老年患者用药过程中应进行监测;一旦出现癫痫发作应立即停药,必要时可选用地西泮或丙戊酸钠治疗;癫痫无法控制者可用血液透析治疗。
Carbapenems are a family of β-lactam antibiotics with broad-spectrum antibacterial activity. The commonly used drugs include imipenem, meropenem, ertapenem, faropenem, panipenem and doripenem. Such drugs can induce neurotoxicity, the incidence of about 0.01% to 3%. Neurological toxicity of the main clinical manifestations of headache, convulsions, epilepsy, myoclonus, disturbance of consciousness. The mechanism of neurotoxicity is the carbapenem antibiotics to prevent γ-aminobutyric acid (γ-GABA) binding to the receptor, thus interfering with the nerve inhibition of γ-GABA, resulting in epilepsy and other neurotoxicity. Risk factors for neurotoxic reactions include renal dysfunction, CNS disorders, and combination therapy. Prevention and treatment measures: According to the different types of carbapenems and epilepsy related to the rational choice of drugs; caution should be used to adjust the dosage of renal failure patients; avoid with high doses of theophylline, non-steroidal anti-inflammatory drugs and probenecid combined ; Children and elderly patients should be monitored during medication; in the event of seizures should be discontinued immediately, if necessary, the choice of diazepam or sodium valproate treatment; epilepsy can not be controlled hemodialysis treatment.