Sierra R R, Torres A M, Rodriguez R B, Albelo I M
Urol Nefrol (Mosk). 1989 Mar-Apr(2):50-3.
The use of aminoglycosides and cephalosporins is fairly often complicated by acute renal failure (ARF), particularly so if overdoses are used and baseline renal function is impaired. The course of ARF and outcome of treatment have been analyzed in 51 patients. ARF was caused by a nephrotoxic effect of aminoglycosides, cephalosporins or a combination thereof (ARF, type A) in 30 (58.8%) patients, and a combination with other factors (hypotension, arterial hypertension, sepsis) in 21 (41.2%) patients (ARF, type B). Nephrotoxic effect was more commonly produced by a ceporin-gentamicin combination (in 34 (66%) of 51 cases). Nineteen (55.8%) of the 34 patients died, in spite of extracorporeal detoxication treatment (peritoneal dialysis, hemodialysis), which way be attributed to a severe original condition (mostly, due to severe sepsis, original functional renal insufficiency, etc.) rather than the nephrotoxic effect of antibiotics. Hyperazotemia without marked oliguria is a specific feature of ARF, induced by nephrotoxic action of antibiotics. Preventive principles are proposed.
氨基糖苷类药物和头孢菌素类药物的使用常常会并发急性肾衰竭(ARF),如果用药过量且患者基线肾功能受损,则更是如此。我们对51例急性肾衰竭患者的病程及治疗结果进行了分析。在30例(58.8%)患者中,急性肾衰竭是由氨基糖苷类、头孢菌素类药物或二者联用的肾毒性作用所致(A型急性肾衰竭),在21例(41.2%)患者中,急性肾衰竭是由这些药物与其他因素(低血压、动脉高血压、脓毒症)共同作用所致(B型急性肾衰竭)。肾毒性作用更常见于头孢菌素-庆大霉素联用(51例中有34例,占66%)。尽管进行了体外解毒治疗(腹膜透析、血液透析),但这34例患者中有19例(55.8%)死亡,这可能是由于患者原有病情严重(主要是由于严重脓毒症、原有功能性肾功能不全等),而非抗生素的肾毒性作用所致。无明显少尿的高氮血症是抗生素肾毒性作用所致急性肾衰竭的一个特征。文中提出了预防原则。