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目的为临床合理应用抗菌药物提供参考。方法根据相关文献从抗菌药物的肾损害机制及抗菌药物肾损害的临床表现等方面进行归纳总结。结果抗菌药物致肾损害的机制主要包括直接肾毒性和变态反应,也可累及肾血管与肾小球,出现血管炎和肾小球肾炎,少数药物可致梗阻性肾病变。临床表现为肾小管功能障碍、Fanconi综合征、远端肾小管性酸中毒、肾性尿崩症、急性肾功能衰竭等。结论应严格抗生素的应用范围,开展抗菌药物肾损害基础研究和临床研究,合理使用抗菌药物,降低肾毒性,避免肾损害;补充电解质或与脂肪乳混合输注,可能减轻两性霉素B的肾毒性;适当补液与碱化尿液,可减少磺胺结晶,减免肾损害;磷霉素可与氨基糖苷类药物联合应用,以提高氨基糖苷类药物的杀菌速度,减少氨基糖苷类的肾毒性。
Objective To provide a reference for clinical rational use of antimicrobial agents. Methods Based on the relevant literature, the mechanisms of renal damage and the clinical manifestations of antimicrobial agents were summarized. Results The mechanism of anti-bacterial drug induced renal damage mainly includes direct nephrotoxicity and allergic reaction. It can also affect renal blood vessels and glomeruli, causing vasculitis and glomerulonephritis. A few drugs can cause obstructive nephropathy. Clinical manifestations of renal tubular dysfunction, Fanconi syndrome, distal renal tubular acidosis, renal diabetes insipidus, acute renal failure and so on. Conclusion The application of antibiotics should be strictly carried out to carry out basic research and clinical studies of antimicrobial agents for renal damage, rational use of antimicrobial agents to reduce nephrotoxicity and avoid renal damage; electrolyte supplementation or mixed infusion with fat emulsion may reduce the renal damage of amphotericin B Toxicity; appropriate rehydration and alkalinization of urine, can reduce sulfonamides, reduce renal damage; fosfomycin can be used in combination with aminoglycosides to improve the speed of sterilization of aminoglycosides, reduce the aminoglycoside nephrotoxicity.