CAJ | 학술논문

目的：探讨慢性肾衰竭患者头孢菌素脑病的发病机制、临床特点、治疗方法及转归。方法回顾性分析使用头孢菌素类药物后出现脑病的28例慢性肾衰竭患者，分析与头孢菌素脑病发生的相关因素。结果28例慢性肾衰竭患者引起头孢菌素脑病发生的抗菌药物包括：头孢硫咪、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶和头孢替安，所有患者均无神经定位体征，CT扫描检查无病理性改变，慢性肾衰竭患者发生头孢菌素脑病较未发生头孢菌素脑病患者的年龄明显增加，接受透析的患者头孢菌素脑病发生率明显低于未透析者，头孢菌素脑病的发生与抗菌药物的剂量有明显关系，停用头孢类药物或减量后症状消失。结论头孢菌素脑病的发病机制考虑与慢性肾衰竭致排泄率降低有关，且增龄是其危险因素，透析可减少其发生，如能及早发现，及早进行对症治疗，绝大多数患者预后良好。
목적：탐토만성신쇠갈환자두포균소뇌병적발병궤제、림상특점、치료방법급전귀。방법회고성분석사용두포균소류약물후출현뇌병적28례만성신쇠갈환자，분석여두포균소뇌병발생적상관인소。결과28례만성신쇠갈환자인기두포균소뇌병발생적항균약물포괄：두포류미、두포필우、두포고동/서파탄、두포타정화두포체안，소유환자균무신경정위체정，CT소묘검사무병이성개변，만성신쇠갈환자발생두포균소뇌병교미발생두포균소뇌병환자적년령명현증가，접수투석적환자두포균소뇌병발생솔명현저우미투석자，두포균소뇌병적발생여항균약물적제량유명현관계，정용두포류약물혹감량후증상소실。결론두포균소뇌병적발병궤제고필여만성신쇠갈치배설솔강저유관，차증령시기위험인소，투석가감소기발생，여능급조발현，급조진행대증치료，절대다수환자예후량호。
Objective To explore the pathogenesis,clinical characteristics,treatment and prognosis of cephalosporin encephalopathy in patients with chronic renal failure (CRF).Methods The neuropsychiatric symptoms and treatment strategies of cephalosporin encepha-lopathy in 28 patients with CRF who were treated with cephalosporin drugs during January 2008 and June 2013 were retrospectively analyzed, and the influential factors of cephalosporin encephalopathy were analyzed as well.Results All the patients had no neurological signs and po-sitioning.CT showed no pathological changes,among CRF,those with cephalosporin encephalopathy were older than those without,incidence of cephalosporin encephalopathy in which did not receive dialysis was significantly higher than those already had,and the symptoms disap-peared after withdrawal.Conventional dose of these antibiotics was correlated with the occurrent of cephalosporin encephalopathy.Conclusion The pathogenesis of encephalosporin encephalopathy in patients with CRF is related to the low excretion rates resulting from renal insuffi-ciency,and aging was a risk factor.Better prognosis can be achieved with early diagnosis and treatment such as enhanced dialysis.