抗生素相关脑病：发生机制及处置

抗生素相关脑病：发生机制及处置摘要抗生素相关脑病(antibiotic-associatedencephalopathy,AAE)是在抗生素治疗过程中发生的一系列神经精神症状，包括头晕、嗜睡、抽搐、昏迷，甚至癫痫或精神病发作等。AAE 的发生机制是抗生素直接作用于中枢神经系统，干扰抑制性突触传导，造成中枢兴奋毒性。抗生素也可通过影响抗癫痫药和抗精神病药的吸收、分布、代谢和排泄，干扰治疗效果，诱导癫痫或精神病发作。临床上一旦怀疑 AAE,首先要停止抗生素治疗。头颅影像学检查及生化检查有助于排除脑血管意外、低糖血症或电解质紊乱。肝肾功能检查有利于 AAE 的诊断。对于症状比较严重的患者,除对症治疗外,给予利尿剂或进行血液透析或置换,可有效缓解 AAE症状。ABSTRACTAntibiotic-associatedencephalopathy(AAE)isaseriesofneuropsychiatricsymptomsincludingdizzyness,drowsy,lethargy,convulsion,comaandonsetofepilepsyorpsychosisinthetreatmentofantibiotics.ThemechanismofAAEisthattheantibioticsdirectlyeffectonthecentralnervoussystem,interfereininhibitorysynaptictransmissionandinducecentralexcitatorytoxicity.Antibioticscanalsodisturbtheefficacyduringthetreatmentbyinterferingintheabsorption,distribution,metabolismandexcretionofantiepilepticorantipsychoticsdrugstoinduceonsetofepilepticorpsychotics.OnceAAEsuspectedclinically,theimmediateterminationofantibiotictherapyshouldbetheinitialtreattoAAE.Theheadimagingandbiochemicalexaminationcanhelptoexcludetheincidenceofcerebrovascularaccident,hypoglycemiaorelectrolytedisturbance.TheexaminationofliverandrenalfunctionisbeneficialtothediagnosisofAAE.Besidessymptomatictreatment,diureticsadministrationorhemodialysisorbloodreplacementcaneffectivelyalleviatesymptomsofAAEforpatientswithseriousconditions.KEYWORDSantibiotic-associatedencephalopathy；mechanism；treatment抗生素相關脑病(antibiotic-associatedencephalopathy，AAE)是抗生素使用过程中由于抗生素的直接神经毒性或与其他药物相互作用诱发的一系列神经精神功能障碍［1］，临床表现为头晕、反应迟钝、兴奋多语、幻觉等，重者有躁狂、肢体震颤、腱反射亢进、抽搐、昏迷、嗜睡等，甚至诱导癫痫或精神病发作［2］。AAE 广泛发生于卩-内酰胺类、喹诺酮类、大环内酯类、硝基咪唑类等抗...