中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (11): 605-607.doi: 10.3969/j.issn.1671-4091.2013.11.00

• 临床研究 • 上一篇    下一篇

非创伤性横纹肌溶解综合征致急性肾衰竭18例临床分析及预后

  

  1. 杭州市第一人民医院肾内科
  • 收稿日期:2013-06-26 修回日期:2013-09-03 出版日期:2013-11-12 发布日期:2013-11-12

Non-traumatic rhabdomyolysis induced acute renal failure clinic and prognosis analysis of 18 cases

  • Received:2013-06-26 Revised:2013-09-03 Online:2013-11-12 Published:2013-11-12

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摘要： 【摘要】　目的　探讨非创伤性横纹肌溶解综合征(RM) 合并急性肾衰竭(ARF) 的病因、临床特点和转归。方法　收集我院2007年7月至2012年7 月住院的RM患者35例，其中合并ARF患者18 例，平均年龄55.3±11.2岁，其中男10例，女8例。所有患者均检测血尿便常规、血清肌酸磷酸激酶（CPK）、乳酸脱氢酶（LDH）、血肌红蛋白(Mb) 以及血电解质、肝功能(GPT、GOT、AKP) 、肾功能(BUN、Scr) 、血尿酸(UA)、血气分析、胸片、B 超、心电图等。采用综合治疗方案：全部病例尽快补足血容量和碱化尿液，对肿胀肢体进行局部对症处理，采用利尿保肾、纠正酸碱平衡和电解质紊乱、血液净化等治疗。结果　RM-AKI病因包括：药物引起者9例，剧烈运动5例，重症感染2例，皮肌炎1例，中暑1例。经液体复苏及血液净化综合治疗，本组2 例因合并基础疾病，并发多脏器功能衰竭死亡(病死率13. 33 %)，16例肾功能完全恢复正常出院。结论　RM并非少见疾病，且目前非创伤性比例较高，其为急性肾衰竭(ARF) 的主要病因之一；血清肌酶和血生化检测可提高RM-ARF早期诊断率；早期综合治疗、早期血液净化治疗，可提高治愈率；但患者年龄偏大，合并基础疾病者死亡率较高。【关键词】　非创伤性；横纹肌溶解综合症；急性肾衰竭； 临床；预后

关键词: 非创伤性, 横纹肌溶解综合症, 急性肾衰竭, 临床, 预后

Abstract: Objective To investigate the etiological factors, clinical characteristics and prognosis of acute kidney injury (AKI) due to non-traumatic rhabdomyolysis (RM). Methods A total of 18 patients (mean age 55.3±11.2 years; 10 males and 8 females) with RM-AKI were enrolled in this study. Serum creatine phosphokinase (CPK), lactate dehydrogenase (LDH), serum myoglobin (Mb), electrolytes, liver function (GPT, GOT and AKP), renal function (BUN, and Scr), uric acid (UA), blood gas, and electrocardiogram were assayed. The comprehensive therapy included quick volume restoration and alkalifying urine, local treatment of swollen limb, diuretics, and correction of acid-base imbalance and electrolyte disturbances, and blood purification treatment. Results After volume restoration and blood purification treatment, 2 cases (13.33%) died of underlying diseases and multiple organ failure, and 16 cases completely recovered from AKI and discharged from the hospital. Conclusion RM is a major cause of AKI. RM is not an uncommon disease, and the proportion of RM due to non-traumatic causes becomes higher recently. Serum CPK and blood biochemical parameters can be used for the early diagnosis of RM-AKI. Early comprehensive therapy including blood purification treatment can improve the prognosis. Higher mortality rate was found in older patients with underlying diseases.

Key words: Non-traumatic, Rhabdomyolysis, Acute kidney injury, Clinical, prognosis