中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2011年
6期
479-481
,共3页
毛永辉%陈献广%赵班%王海涛
毛永輝%陳獻廣%趙班%王海濤
모영휘%진헌엄%조반%왕해도
β内酰胺类%肾功能不全%肾小管%呼吸道感染
β內酰胺類%腎功能不全%腎小管%呼吸道感染
β내선알류%신공능불전%신소관%호흡도감염
β-lactams%Renal insufficiency%Kidney tubules%Respiratory tract infections
目的 了解应用β内酰胺类抗生素抗感染治疗对高龄老年患者肾小管功能的影响,为老年患者临床应用抗生素提供参考意见.方法 对肺部感染住院的高龄老年患者应用β内酰胺类抗生素治疗,药物剂量为正常剂量50%~70%;用药3 d、14 d及停药后7 d检测患者反映肾小管功能的指标尿α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)、尿蛋白/肌酐(pro/Cre)、尿N-乙酰-β-氨基葡萄糖苷酶/肌酐(NAG/Cre)及反映肾小球功能指标血肌酐(Cre)、Cystatin C、肾小球滤过率(eGFR).结果 34例患者治疗后感染均明显好转;用药前患者肾小管功能的指标均异常,尿pro/Cre(489.3±399.8)mg·g-1·Cre-1、NAG/Cre(30.8±17.6)U·g-1·Cre-1、β2-MG(0.27±0.33)μg/L、α1-MG(3.29±2.2)μg/L,用药3 d、14 d上述指标明显升高(均为P＜0.05),停药7 d后恢复到基础水平;用药前及用药14 d后,血肌酐分别为(89.0±26.0) μmol/L和(76.4±21.5)μmol/L,eGFR分别为(26.39±8.17)ml/min和(29.8±9.5)ml/min,停药7 d后恢复到用药前水平,血肌酐(81.5±21.9)μmol/L,eGFR(28.8±8.6)ml/min;用药前血Cystatin C高于正常,用药过程中无明显变化.结论 在高龄患者呼吸道感染治疗中,肾功能保护非常重要,掌握好抗生素剂量及疗程是保护肾功能的关键环节.
目的 瞭解應用β內酰胺類抗生素抗感染治療對高齡老年患者腎小管功能的影響,為老年患者臨床應用抗生素提供參攷意見.方法 對肺部感染住院的高齡老年患者應用β內酰胺類抗生素治療,藥物劑量為正常劑量50%~70%;用藥3 d、14 d及停藥後7 d檢測患者反映腎小管功能的指標尿α1-微毬蛋白(α1-MG)、β2-微毬蛋白(β2-MG)、尿蛋白/肌酐(pro/Cre)、尿N-乙酰-β-氨基葡萄糖苷酶/肌酐(NAG/Cre)及反映腎小毬功能指標血肌酐(Cre)、Cystatin C、腎小毬濾過率(eGFR).結果 34例患者治療後感染均明顯好轉;用藥前患者腎小管功能的指標均異常,尿pro/Cre(489.3±399.8)mg·g-1·Cre-1、NAG/Cre(30.8±17.6)U·g-1·Cre-1、β2-MG(0.27±0.33)μg/L、α1-MG(3.29±2.2)μg/L,用藥3 d、14 d上述指標明顯升高(均為P＜0.05),停藥7 d後恢複到基礎水平;用藥前及用藥14 d後,血肌酐分彆為(89.0±26.0) μmol/L和(76.4±21.5)μmol/L,eGFR分彆為(26.39±8.17)ml/min和(29.8±9.5)ml/min,停藥7 d後恢複到用藥前水平,血肌酐(81.5±21.9)μmol/L,eGFR(28.8±8.6)ml/min;用藥前血Cystatin C高于正常,用藥過程中無明顯變化.結論 在高齡患者呼吸道感染治療中,腎功能保護非常重要,掌握好抗生素劑量及療程是保護腎功能的關鍵環節.
목적 료해응용β내선알류항생소항감염치료대고령노년환자신소관공능적영향,위노년환자림상응용항생소제공삼고의견.방법 대폐부감염주원적고령노년환자응용β내선알류항생소치료,약물제량위정상제량50%~70%;용약3 d、14 d급정약후7 d검측환자반영신소관공능적지표뇨α1-미구단백(α1-MG)、β2-미구단백(β2-MG)、뇨단백/기항(pro/Cre)、뇨N-을선-β-안기포도당감매/기항(NAG/Cre)급반영신소구공능지표혈기항(Cre)、Cystatin C、신소구려과솔(eGFR).결과 34례환자치료후감염균명현호전;용약전환자신소관공능적지표균이상,뇨pro/Cre(489.3±399.8)mg·g-1·Cre-1、NAG/Cre(30.8±17.6)U·g-1·Cre-1、β2-MG(0.27±0.33)μg/L、α1-MG(3.29±2.2)μg/L,용약3 d、14 d상술지표명현승고(균위P＜0.05),정약7 d후회복도기출수평;용약전급용약14 d후,혈기항분별위(89.0±26.0) μmol/L화(76.4±21.5)μmol/L,eGFR분별위(26.39±8.17)ml/min화(29.8±9.5)ml/min,정약7 d후회복도용약전수평,혈기항(81.5±21.9)μmol/L,eGFR(28.8±8.6)ml/min;용약전혈Cystatin C고우정상,용약과정중무명현변화.결론 재고령환자호흡도감염치료중,신공능보호비상중요,장악호항생소제량급료정시보호신공능적관건배절.
Objective To investigate the change of renal tubular function in elderly patients after use of β lactam antibiotic. Methods The elderly patients with pulmonary infection were treated with β lactam antibiotic,the dosage was 50%-70% of normal use. The renal tubular function indicated by urine α1-MG, β2-MG, pro/Cre, NAG/Cre and glomerulus function marked by eGFR, serum creatinine (Cre)), cystatin C were detected during drugs treatment and 7 days after stopping medications. Results The infection was controlled well in 3-7 days after treatment. Urine α1-MG, β2-MG, pro/Cre and NAG/Cre were abnormal before treatment, were elevated in 3, 14 days after using antibiotic, and came down to the level before treatment on 7 days after stopping treatment. The level of Cre and eGFR was (89.0±25.97) μmol/L and (26.39±8.17) ml/min before treatment, then elevated and decreased in 14 days after treatment, respectively, and down to the level before treatment on 7 days after stopping of antibiotic. Cystatin c was abnormal before treatment and did not change significantly after treatment and after stopping antibiotic. Conclusions It is important to protect renal tubular function and to adjust antibiotic dosage according to eGFR during using antibiotic in elderly patients to control infection.
