摘要
目的 探讨横纹肌溶解症（rhabdomyolysis,RM）的临床特点及预后.方法总结分析59例RM的临床资料及治疗、预后情况.结果 59例RM患者均有血肌酸激酶（CK）、肌红蛋白（Mb）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）增高,大多数RM患者Ca2＋水平降低.37例RM患者（62.7%）发生急性肾衰竭（ARF）,诊断时间（77.2±62.1）h;22例非ARF患者诊断时间（31.3±24.5）h,两组比较差异有统计学意义（P〈0.01）.死亡患者与存活患者诊断时间分别为（69.5±63.7）h、（55.6±51.8）h,两组比较差异无统计学意义（P〉0.05）.经治疗后40例好转或痊愈,19例（32.2%）死亡,其中18例死于多器官功能障碍综合征（MODS）.所有MODS患者26例,死亡18例（69.2%）.结论 RM病因广泛而复杂,常合并ARF,诊治关键在于早期诊断,早期液体复苏、碱化尿液,恢复肾脏血流灌注及提高毒素清除,如果出现严重ARF,则需要血液净化治疗,并发MODS者预后差.
Objective To investigate the clinical features and the prognosis of rhabdomyolysis. Methods Clinical data, the cause and renal function, the peak of creatine kinase （CK） and serum creatinine （Scr）, the changes of clinical status, the treatment and the prognosis of fifty -nine patients were investigated and analyzed. Results Many causes could induce rhabdomyolysis, such as crash injury, exercise, thermoplegia, drugs or infectious disease. The blood samples were analyzed, including CK, myoglobin（Mb） , liver and renal function analysis. The CK and Mb level increased significantly in all the patients, all the cases also had high level of ALT, AST and LDH in serum. Average time of diagnosis in 22 cases without acute renal failure （ARF） was （ 31.3 ± 24.5 ） h ; Average time of diagnosis in 37 cases with ARF was （77.2 ± 62.1 ） h （ P 〈 0.01 ）. After the treatment, 40 cases recovered and 19 cases died, 18 cases died of multiple organ dysfunction syndrome （MODS）. 26 cases developed MODS, 18 cases （69.2%） died. Conclusion Rhabdomyolysis was an acute disease caused by multiple etiology, often with ARF. Intervention of rhabdomyolysis consists of early recognition, treatment of the underlying cause, early volume replacement, urinary alkalinization, and aggressive diuresis, enhancing clearance of toxins from the circulation and kidneys. Hemopurification has good effect on rhabdomyolysis, and help patients recover from ARF, improve the prognosis. The cases with MODS have poor prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第11期1011-1014,共4页
Chinese Journal of Critical Care Medicine
