【摘要】 1例65岁的女性患者，因肺部感染于2022年3月30日入院。患者既往有糖尿病、高血压、陈旧性脑梗死病史8年，未遗留肢体活动、语言交流等障碍；慢性肾脏病5期，规律血透。对“增效联磺片”过敏。入院后给予莫西沙星和哌拉西林钠舒巴坦钠治疗肺部感染，4月5日因带状疱疹开始服用伐昔洛韦分散片和洛芬待因缓释片。4月8日出现言语不利，完善头颅CT与磁共振检查未见脑出血和新发脑梗死。4月9日症状加重，且出现认知障碍，嗜睡，考虑与伐昔洛韦相关。4月10日停用伐昔洛韦，行多次血液透析后患者神经系统症状好转出院。采用Naranjo不良反应因果关系评价量表进行关联性评价，该不良反应很可能为伐昔洛韦所致。伐昔洛韦的主要代谢产物浓度与其神经毒性有相关性。临床发生该不良反应时，首先需停用可疑药物，必要时可行腹膜透析或血液透促进药物的排泄。更多还原

【Abstract】 A female,65 years old;patient was admitted to the hospital on March 30,2022 due to topulmonary infection.The patient had a history of diabetes,hypertension,and old cerebral infarction for 8 years,and had no impairment in physical activity or language communication;she has a stage 5 chronic kidney disease with regular hemodialysis and is allergic to "synergistic sulfonate tablets".After admission,she was given moxifloxacin and piperacillin sodium and sulbactam sodium to treat pulmonary infection.On April 5,she started to take valaciclovir dispersive tablets and loprofendein sustained release tablets.On April 8,she developed speech impairment.Improved head CT and MRI examination showed no cerebral hemorrhage and new cerebral infarction.The symptoms worsened on April 9,and she developed cognitive impairment and drowsiness,which was considered to be related to valaciclovir.Valaciclovir was stopped on April 10,and the patient was discharged from hospital with improved neurological symptoms after multiple hemodialysis.According to the Naranjo Causality Evaluation Scale of adverse reactions,the association between this adverse reaction and valaciclovir was evaluated as probable.The concentration of main metabolites of valaciclovir was correlated with its neurotoxicity.When this adverse reaction occurs clinically,the suspected drug should be stopped at first.If necessary,peritoneal dialysis or hemodialysis can promote the excretion of the drug.更多还原