血液净化技术在过度训练致横纹肌溶解症并发急性肾衰竭救治中的作用  

The role of blood purification in rhabdomyolysis complicated by acute renal failure with excessive exercise

作　　者：孟建中[1] 张永寿[1] 葛延明[1] 徐悦[1] 王琪[1] 邵玉萍[1] 高飞[1] 

机构地区：[1]济南军区总医院肾内科,济南250031

出　　处：《中国血液净化》2004年第9期468-470,492,共4页Chinese Journal of Blood Purification

摘　　要：目的　探讨血液净化技术在过度训练致横纹肌溶解症并发急性肾衰竭救治中的作用。方法　回顾性地研究 1993～ 2 0 0 3年 37例训练致耗竭性横纹肌溶解症患者的临床救治过程 ,分析其病情变化规律 ,探讨治疗时机及不同的血液净化方法对预后的影响。结果　①患者均在夏、秋季发病 ,主要表现为呕吐 ,发热、头昏、肌肉酸痛等非特异性症状 ,因此有 2 8例 (75 .6 7% )患者入院前被误诊为急性胃肠炎或肠型感冒 ,2 1例 (5 6 .75 % )被采用了庆大霉素等氨基甙类肾毒性药物治疗 ,使急性肾衰竭 (ARF)的诊断和治疗变得愈加复杂 ;②经过连续性肾脏替代治疗 (CRRT)、血液透析 (HD)及综合治疗 ,31例渡过少尿期 ,肾功能得以恢复。死亡 6例 ,死亡原因为多器官功能衰竭。结论　①高温高湿环境因素可加重过度训练后肌肉组织损伤和全身反应 ;②入院时患者器官功能障碍的数目越多 ,病死率越高 ,故早期诊断 ,及时去除病因及合理应用血液净化技术是降低病死率的关键 ;③CRRT可清除细胞破坏崩解产物 。Objective To explore the effect of blood purification therapy for acute renal failure(ARF) caused by rhabdomyolysis being induced by excess of military training. Methods Reviewing the clinical data and treating procedure of the 37 cases being diagnosed hyposthenic rhabdoryolysis after excess of military trains between 1993～2003, analyzed the influenle of different therapy opportunity and blood purification style on prognosis of ARF. Results ①Seasons of onset were autumn and summer, main symptoms were vomiting, fever, dizziness, muscle ache and other nonspecific symptoms. Among them 28 cases(75.67%) were diagnosed acute gastroenteritis or gastrointestinal type flu before hospitalization, 21 cases (56.75%) were treated with aminoglycoside antibiotic such as gentamicin which could injure kidney. Above clinical features made the diagnosis and treatment for ARF more complex; ②Serum levels of creatine phosphokinase (CK) which positively related with levels of serum kalium, urea nitrogen and creatinine significantly rose before muscle ache and myoglobin occurrence in urine (P<0.05); ③Being treated with continuous renal replacement therapy treatment (CRRT),hemodialysis (HD) and comprehensive therapy, renal function of 31 cases recovered from oliguria stoge; 6 pationts died, the cause of death was of multiple organ system failure. Conclusions ①The hot and humid environment would aggravate systemic reactions and tissue damage after excess of training, the plasma level increment of CK is one of the important mark of degeneration and dissolve of striated muscle; ②The more organs dysfunction, the higher the death rate, the keys to decrease mortality rate of ARF occured in rhabdomyolysis patients are to diagnose early, eliminate the causes promptly, and treat with blood purification more rationally; ③ Curative effect of CRRT is better than HD, which could improve prognosis of ARF.

关 键 词：热带医学 横纱肌溶解症 急性肾衰竭 连续性肾脏替代治疗 

分 类 号：R692.5[医药卫生—泌尿科学]