亚胺培南/西司他丁致成人危重症患者中枢神经系统不良反应发生情况及其危险因素分析
|
摘要
目的:初步考察成人危重症患者应用亚胺培南/西司他丁发生中枢神经系统不良反应的发生率及其危险因素。方法:采用回顾性研究的方法,收集2017年1月1日–12月31日我院使用亚胺培南/西司他丁的成人危重症患者信息,并应用Naranjo评分量表评价亚胺培南/西司他丁与中枢神经系统不良反应的相关性。使用SPSS 22.0软件对患者的人口学资料、既往病史、现病史、合并用药等情况进行统计分析,考察影响不良反应发生的因素。结果:73例危重症患者中,13例(17.81%)患者的中枢神经系统症状可能与亚胺培南/西司他丁相关。统计结果显示,接受肾替代治疗(P=0.032)是导致中枢神经系统不良反应的危险因素。结论:对于接受肾替代治疗的危重症患者在应用亚胺培南/西司他丁时,应严密监护中枢神经系统不良反应。
Objective: To investigate the occurrence and risk factors of adverse drug reactions(ADRs) of central nervous system(CNS) induced by imipenem/cilastatin in adult critically ill patients. Methods: A retrospective study was performed in adult critically ill patients treated with imipenem/cilastatin from January to December in 2017. The Naranjo scale was used to evaluate the relativity between imipenem/cilastatin and ADRs of CNS. Patients' characteristics including demographic information, past and current medical history, combined medication were analyzed by SPSS 22.0 to explore the possible risk factors of imipenem/cilastatin-related CNS ADRs. Results: A total of 73 cases were enrolled in this study. 13 cases(17.81%) were identified to have CNS symptoms associated with imipenem/cilastatin. Renal replacement therapy(P = 0.032) was a risk factor of imipenem/cilastatinrelated CNS ADRs. Conclusion: Critically ill patients, especially those with renal replacement therapy, should be closely monitored to advoid CNS ADRs during imipenem/cilastatin therapy.
Objective: To investigate the occurrence and risk factors of adverse drug reactions(ADRs) of central nervous system(CNS) induced by imipenem/cilastatin in adult critically ill patients. Methods: A retrospective study was performed in adult critically ill patients treated with imipenem/cilastatin from January to December in 2017. The Naranjo scale was used to evaluate the relativity between imipenem/cilastatin and ADRs of CNS. Patients' characteristics including demographic information, past and current medical history, combined medication were analyzed by SPSS 22.0 to explore the possible risk factors of imipenem/cilastatin-related CNS ADRs. Results: A total of 73 cases were enrolled in this study. 13 cases(17.81%) were identified to have CNS symptoms associated with imipenem/cilastatin. Renal replacement therapy(P = 0.032) was a risk factor of imipenem/cilastatinrelated CNS ADRs. Conclusion: Critically ill patients, especially those with renal replacement therapy, should be closely monitored to advoid CNS ADRs during imipenem/cilastatin therapy.
引文
[1]Shafiekhani M, Mirjalili M, Vazin A. Psychotropic drug therapy in patients in the intensive care unit-usage, adverse effects, and drug interactions:a review[J]. Ther Clin Risk Manag, 2018, 14:1799-1812.
[2]Vanham D, Spinewine A, Hantson P, et al. Drug-drug interactions in the intensive care unit:do they really matter?[J]. J Crit Care,2017, 38:97-103.
[3]操银针,祝亚文.抗感染药物致中枢神经系统不良反应503例国内文献分析[J].药物流行病学杂志,2018,27(5):345-349.
[4]周璇,李艳玲.某院药物致住院患者中枢神经系统不良反应168例的回顾性调查[J].实用医药杂志,2017,34(5):447-448.
[5]Sutter R, Ruegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs:a systematic review[J]. Neurology, 2015,85(15):1332-1341.
[6]BreilhD,Texier-MaugeinJ, AllaouchicheB,etal.Carbapenems[J]. J Chemother, 2013, 25(1):1-17.
[7]马莉莉,张健.碳青霉烯类抗生素的神经毒性[J].药物不良反应杂志,2010,12(3):178-182.
[8]Cannon JP, Lee TA, Clark NM, et al. The risk of seizures among the carbapenems:a meta-analysis[J]. J Antimicrob Chemother,2014, 69(8):2043-2055.
[9]刘晓东,菅凌燕,曾聪慧.亚胺培南/西司他丁的神经系统不良反应评价分析[J].中国新药杂志,2011,20(24):2479-2482.
[10]王玮,余淑珍.注射用亚胺培南西司他丁钠的临床不良反应分析[J].中国医药指南,2018,16(27):95-96.
[11]Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions[J]. Clin Pharmacol Ther,1981, 30(2):239-245.
[12]许卫华,温泽淮,赖世隆.两种药物不良反应因果关系判断方法的比较与分析[J].中药新药与临床药理,2000,11(4):248-250,257.
[13]Miller AD, Ball AM, Bookstaver PB, et al. Epileptogenic potential of carbapenem agents:mechanism of action, seizure rates, and clinical considerations[J]. Pharmacotherapy, 2011,31(4):408-423.
[14]Matsumoto K, Kurihara Y, Kuroda Y, et al. Pharmacokinetics and brain penetration of carbapenems in mice[J]. J Infect Chemother,2016, 22(5):346-349.
[15]李琦恒,倪鸿昌.亚胺培南/西司他丁不良反应回顾性调查分析[J].中国药物应用与监测,2010,7(4):223-225.
[16]潘利飞,章仲恒,叶向红,等.ICU患者谵妄的危险因素分析[J].解放军护理杂志,2014,31(1):46-48.
[17]张存海,蔡洪流,方强.亚胺培南在无尿CVVH治疗患者的药代动力学研究[J].中国实用医药,2008,3(1):5-7.
[18]陈亚媚.81例亚胺培南/西司他丁(泰能)不良反应分析[J].海峡药学,2007,19(5):92-94.
[19]袁进,赵树进.亚胺培南/西司他丁诱发癫痫28例文献分析[J].药物流行病学杂志,2007,16(3):165-167.
[20]李琦恒,倪鸿昌.亚胺培南/西司他丁不良反应回顾性调查分析[J].中国药物应用与监测,2010,7(4):223-225.
[21]Hoffman J, Trimble J, Brophy GM. Safety of imipenem/cilastatin in neurocritical care patients[J]. Neurocrit Care, 2009, 10(3):403-407.
[2]Vanham D, Spinewine A, Hantson P, et al. Drug-drug interactions in the intensive care unit:do they really matter?[J]. J Crit Care,2017, 38:97-103.
[3]操银针,祝亚文.抗感染药物致中枢神经系统不良反应503例国内文献分析[J].药物流行病学杂志,2018,27(5):345-349.
[4]周璇,李艳玲.某院药物致住院患者中枢神经系统不良反应168例的回顾性调查[J].实用医药杂志,2017,34(5):447-448.
[5]Sutter R, Ruegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs:a systematic review[J]. Neurology, 2015,85(15):1332-1341.
[6]BreilhD,Texier-MaugeinJ, AllaouchicheB,etal.Carbapenems[J]. J Chemother, 2013, 25(1):1-17.
[7]马莉莉,张健.碳青霉烯类抗生素的神经毒性[J].药物不良反应杂志,2010,12(3):178-182.
[8]Cannon JP, Lee TA, Clark NM, et al. The risk of seizures among the carbapenems:a meta-analysis[J]. J Antimicrob Chemother,2014, 69(8):2043-2055.
[9]刘晓东,菅凌燕,曾聪慧.亚胺培南/西司他丁的神经系统不良反应评价分析[J].中国新药杂志,2011,20(24):2479-2482.
[10]王玮,余淑珍.注射用亚胺培南西司他丁钠的临床不良反应分析[J].中国医药指南,2018,16(27):95-96.
[11]Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions[J]. Clin Pharmacol Ther,1981, 30(2):239-245.
[12]许卫华,温泽淮,赖世隆.两种药物不良反应因果关系判断方法的比较与分析[J].中药新药与临床药理,2000,11(4):248-250,257.
[13]Miller AD, Ball AM, Bookstaver PB, et al. Epileptogenic potential of carbapenem agents:mechanism of action, seizure rates, and clinical considerations[J]. Pharmacotherapy, 2011,31(4):408-423.
[14]Matsumoto K, Kurihara Y, Kuroda Y, et al. Pharmacokinetics and brain penetration of carbapenems in mice[J]. J Infect Chemother,2016, 22(5):346-349.
[15]李琦恒,倪鸿昌.亚胺培南/西司他丁不良反应回顾性调查分析[J].中国药物应用与监测,2010,7(4):223-225.
[16]潘利飞,章仲恒,叶向红,等.ICU患者谵妄的危险因素分析[J].解放军护理杂志,2014,31(1):46-48.
[17]张存海,蔡洪流,方强.亚胺培南在无尿CVVH治疗患者的药代动力学研究[J].中国实用医药,2008,3(1):5-7.
[18]陈亚媚.81例亚胺培南/西司他丁(泰能)不良反应分析[J].海峡药学,2007,19(5):92-94.
[19]袁进,赵树进.亚胺培南/西司他丁诱发癫痫28例文献分析[J].药物流行病学杂志,2007,16(3):165-167.
[20]李琦恒,倪鸿昌.亚胺培南/西司他丁不良反应回顾性调查分析[J].中国药物应用与监测,2010,7(4):223-225.
[21]Hoffman J, Trimble J, Brophy GM. Safety of imipenem/cilastatin in neurocritical care patients[J]. Neurocrit Care, 2009, 10(3):403-407.