中国药物应用与监测
中國藥物應用與鑑測
중국약물응용여감측
CHINESE JOURNAL OF DRUG APPLICATION AND MONITORING
2013年
3期
150-153
,共4页
头孢吡肟%神经损害%药品不良反应%文献分析
頭孢吡肟%神經損害%藥品不良反應%文獻分析
두포필우%신경손해%약품불량반응%문헌분석
Cefepime%Neurotoxicity%Adverse drug reaction%Literature analysis
目的：调查头孢吡肟致中枢神经系统损害的临床特征和发生原因，为临床合理用药提供参考。方法：以“头孢吡肟”、“神经”、“脑病”、“精神”、“共济失调”、“癫痫”为主题词，检索中国期刊全文数据库及维普中文科技期刊文献数据库，收集2008–2012年国内文献报道的与头孢吡肟相关的中枢神经系统不良反应，对患者的一般情况、用药情况、中枢神经系统损害的主要临床表现、肾功能异常与中枢神经系统损害的关系、用药关联性评价、治疗与转归进行分析。结果：共65例头孢吡肟致中枢神经系统损害，其中，男29例，女36例，中枢神经系统损害多发生于71～80岁年龄组，65例患者中枢神经系统损害发生时间最长6 d，多数发生于1～5 d，临床表现主要有意识障碍（如意识混乱、昏迷、反应迟钝、神情淡漠等）和神经兴奋性增高（烦躁不安、言语错乱、抽搐、癫痫样发作等）。经过治疗后，4例患者痊愈，59例患者好转，2例死亡。结论：头孢吡肟引起的中枢神经系统损害，可能与血脑屏障通透性改变、年龄和肾功能密切相关，因此，临床使用时应根据患者的肌酐清除率来调整头孢吡肟的剂量，如出现不明原因的中枢神经损害应立即停药。
目的：調查頭孢吡肟緻中樞神經繫統損害的臨床特徵和髮生原因，為臨床閤理用藥提供參攷。方法：以“頭孢吡肟”、“神經”、“腦病”、“精神”、“共濟失調”、“癲癇”為主題詞，檢索中國期刊全文數據庫及維普中文科技期刊文獻數據庫，收集2008–2012年國內文獻報道的與頭孢吡肟相關的中樞神經繫統不良反應，對患者的一般情況、用藥情況、中樞神經繫統損害的主要臨床錶現、腎功能異常與中樞神經繫統損害的關繫、用藥關聯性評價、治療與轉歸進行分析。結果：共65例頭孢吡肟緻中樞神經繫統損害，其中，男29例，女36例，中樞神經繫統損害多髮生于71～80歲年齡組，65例患者中樞神經繫統損害髮生時間最長6 d，多數髮生于1～5 d，臨床錶現主要有意識障礙（如意識混亂、昏迷、反應遲鈍、神情淡漠等）和神經興奮性增高（煩躁不安、言語錯亂、抽搐、癲癇樣髮作等）。經過治療後，4例患者痊愈，59例患者好轉，2例死亡。結論：頭孢吡肟引起的中樞神經繫統損害，可能與血腦屏障通透性改變、年齡和腎功能密切相關，因此，臨床使用時應根據患者的肌酐清除率來調整頭孢吡肟的劑量，如齣現不明原因的中樞神經損害應立即停藥。
목적：조사두포필우치중추신경계통손해적림상특정화발생원인，위림상합리용약제공삼고。방법：이“두포필우”、“신경”、“뇌병”、“정신”、“공제실조”、“전간”위주제사，검색중국기간전문수거고급유보중문과기기간문헌수거고，수집2008–2012년국내문헌보도적여두포필우상관적중추신경계통불량반응，대환자적일반정황、용약정황、중추신경계통손해적주요림상표현、신공능이상여중추신경계통손해적관계、용약관련성평개、치료여전귀진행분석。결과：공65례두포필우치중추신경계통손해，기중，남29례，녀36례，중추신경계통손해다발생우71～80세년령조，65례환자중추신경계통손해발생시간최장6 d，다수발생우1～5 d，림상표현주요유의식장애（여의식혼란、혼미、반응지둔、신정담막등）화신경흥강성증고（번조불안、언어착란、추휵、전간양발작등）。경과치료후，4례환자전유，59례환자호전，2례사망。결론：두포필우인기적중추신경계통손해，가능여혈뇌병장통투성개변、년령화신공능밀절상관，인차，림상사용시응근거환자적기항청제솔래조정두포필우적제량，여출현불명원인적중추신경손해응립즉정약。
Objective:To investigate the clinical characteristics and occurrence reasons of cefepime-inducing central nervous system damage, and provide reference for rational use of drugs in clinic. Methods:With the key words of cefepime, nerve, encephalopathy, mind, dystaxia and epilepsy, we searched Chinese Journal Full-text Database (CNKI database) and Chinese Science and Technology Periodical Database (VIP information). And the case reports of cefepime-inducing central nervous system adverse reaction published in domestic literatures from 2008 to 2012 were collected and analyzed in respect of the basic characteristics of the patients, the usage of drugs, clinical manifestations of central neurotoxicity, the relationship between the abnormal renal function and neurotoxicity, the relevance evaluation of drug use, treatment and prognosis. Results: There were 65 patients (29 men and 36 women) with central nervous system damage induced by cefepime. The central neurotoxicity mostly occurred in patients with the age of 71–80 years. The longest incubation period of neurotoxicity was 6 days, and mostly in the range of 1–5 days. The main clinical manifestations were disorder of consciousness (such as confusion, coma, lags in response, expression of indifference, etc) and neuronal excitability (irritability, paraphasia, convulsion, epilepsy, etc). Of the 65 patients, 4 were cured, 59 improved and 2 died after the treatment. Conclusion:Cefepime-inducing central nervous system damage may be relevant to the change of blood-brain barrier permeability, ages and renal functions. Therefore, the dosage of cefepime should be adjusted based on creatinine clearance rate of the patient, and cefepime should be discontinued immediately when unexplained central nervous system damage appears.
