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慢性肾衰病人常合并感染,感染又可加重肾损害,因而抗感染治疗极为重要.临床常用的抗生素为青霉素类、头胞菌素类和喹诺酮类.有些药物主要经肾排出,对肾脏有一定毒性,所以必须根据药物排泄速度、肾脏毒性对其剂量和给药时间进行适当调整,使其达到有效浓度而又避免毒性.为提高基层医务人员对此问题的高度重视,特做如下讨论.1 β-内酰胺类抗生素1.1 青霉素 系β-内酰胺类抗生素,于细菌繁殖期起杀菌作用,对G~+和G~-球菌的抗菌作用较强,对G~-杆菌(大肠杆菌、绿脓杆菌)无效.它的t_(1/2)约0.5小时,大部分以原形从肾脏排出,其中90%自肾小管分泌.丙磺舒可竞争性阻断该分泌通道,使血清中青霉素浓度成倍增加,t_(1/2)延长,虽然青霉素相对无肾毒性,但大剂量(2000万u/日以上)应用一般在用药8天后可致少尿、无尿、蛋白尿以致引起BUN升高,发生间质性肾炎,导致肾小管坏死.1.2 氨苄青霉素 它是广谱半合成青霉素,临床上主
Chronic renal failure patients often co-infection, infection can aggravate renal damage, and thus anti-infective treatment is extremely important clinical commonly used antibiotics for penicillins, cephalosporins and quinolones.Many drugs are mainly excreted by the kidneys, there is a certain Therefore, it is necessary to adjust the dosage and administration time according to the drug excretion rate and renal toxicity so as to reach the effective concentration and avoid the toxicity. To improve the grass-roots medical staff’s attention to this issue, the following discussion is made. β-lactam antibiotics 1.1 Penicillin β-lactam antibiotics, the bactericidal effect in the bacterial growth stage, the strong antibacterial effect on G ~ + and G ~ - cocci, G ~ - bacilli (E. coli, pus Bacilli) .T_ (1/2) about 0.5 hours, the majority of the prototype from the kidneys, of which 90% from the tubular secretion. Progesterone can competitively block the secretion of the channel, the serum concentration of penicillin into Fold increase, t_ (1/2) prolongation, although penicillin relative nephrotoxicity, but high-dose (20 million u / day or more) application generally can cause oliguria, anuria, proteinuria after 8 days of treatment can cause elevated BUN , Interstitial nephritis, resulting in tubules Necrosis .1.2 Ampicillin It is a broad-spectrum semi-synthetic penicillin, the main clinical