Davenport A, Goel S, Mackenzie J C
Department of Renal Medicine, Southmead Hospital, Westbury-on-Trym, Bristol, England.
Am J Kidney Dis. 1992 Dec;20(6):647-9. doi: 10.1016/s0272-6386(12)70234-2.
We report two cases of herpes-zoster in which the administration of acyclovir to patients with end-stage renal failure treated by continuous ambulatory peritoneal dialysis (CAPD) resulted in acyclovir neurotoxicity, even though the doses administered were within those recommended by the manufacturer's data sheet for patients with renal failure. Acyclovir removal was negligible with peritoneal dialysis and one patient died. The other patient was successfully treated with hemodialysis, which effectively reduced plasma concentrations, resulting in an improvement in conscious state. Acyclovir neurotoxicity should be considered in patients with renal failure who have been treated for viral infections, in whom the conscious state has deteriorated despite normal brain computed tomography (CT) scan and lumbar puncture investigations. Hemodialysis is the preferred treatment for the rapid removal of acyclovir.
我们报告了两例带状疱疹病例，在这两例病例中，接受持续非卧床腹膜透析（CAPD）治疗的终末期肾衰竭患者使用阿昔洛韦后出现了阿昔洛韦神经毒性，尽管给药剂量在制造商数据手册为肾衰竭患者推荐的剂量范围内。腹膜透析对阿昔洛韦的清除可忽略不计，其中一名患者死亡。另一名患者通过血液透析成功治疗，血液透析有效降低了血浆浓度，使意识状态得到改善。对于接受病毒感染治疗的肾衰竭患者，若尽管脑部计算机断层扫描（CT）和腰椎穿刺检查结果正常但意识状态恶化，应考虑阿昔洛韦神经毒性。血液透析是快速清除阿昔洛韦的首选治疗方法。
