横纹肌溶解症致急性肾衰竭19例临床分析  

Clinical Analysis of Rhabdomyolysis Leading to Acute Renal Failure, a Report of 19 Cases

作　　者：刘殿强[1] 蔡青[1] 周珍[1] 

机构地区：[1]安徽省淮北矿务局职工总医院肾内科,235000

出　　处：《实用全科医学》2006年第4期432-433,共2页Applied Journal Of General Practice

摘　　要：目的探讨多种血液净化方式治疗横纹肌溶解症的治疗效果。方法回顾性分析我院收治的19例横纹肌溶解症患者临床表现及多种血液净化的治疗效果及转归。结果挤压综合征9例,重度酒精中毒3例,鞭击伤及大面积烫伤各2例,糖尿病肺部感染并发酮症酸中毒休克、高温下长跑及强负荷作业各1例。19例患者血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、天门冬氨酸基转移酶(AST)、丙氨酸氨基转移酶(ALT)峰值均超过正常值5倍以上,Scr>177μmol/L。所有患者在给予补液、碱化尿液、利尿、维持循环功能等综合治疗的基础上,单独HD6例,8例因并发MODS在HD前给予PE、HDF治疗,4例同时做了CRRT治疗,2例单纯采取了PE治疗,1例采取了PD治疗,内科保守治疗2例。转归:痊愈15例,死亡4例。结论HD、HF、HDF、PE、CRRT及PD治疗均有良好效果,均能帮助大部分患者渡过肾功能衰竭期,伴有MDOS者预后差,对血流动力学不稳定、高分解代谢及MODS者,HF、HDF或CRRT可能更为有效。Objective To investigate the curative effect of many blood purification modes for rhabdomyolysis. Methods The clinical manifestations of 19 cases with rhabdomyolysis and the curative effect by blood purification were analyzed respectively. Results There were 9 eases of crush syndrome, 3 severe alcoholism, 2 scourge injury, 2 large area scald, 1 diabetes keto acid and shock, 1 longdistance running, 1 high strength manual labor. All the 19 cases had high level of CK, LDH, AST and ALT in serum. Scr〉 177 μmol/L. 6 cases were cured with HD, 8 with HD＋ PE＋ HDF due to MODS,4 with HD＋ PE＋ HDF＋ CRRT, 2 with PE, 1 with PD, 2 with conservative treatment. 15 cases recovered and 4 cases died of MODS. Conclusions All HD, HF, HDF, PE, CRRT and PD have good effect to rhabdomyolysis, and help patients recovered from acute renal failure （ARF）. The eases with MODS have poor prognosis. HF, HDF and CRRT are more effective to the cases with instable hemodynamics, high catabolism and MODS.

关 键 词：横纹肌溶解症 肾衰竭 急性 

分 类 号：R685.5[医药卫生—骨科学] R692.5[医药卫生—外科学]