横纹肌溶解继发爆发型多器官功能衰竭的临床研究  

Clinical research on the secondary fulminant multiple organ dysfunction syndrome caused by rhabdomylysis

作　　者：马朋林[1] 苏瑾文[1] 王宇[1] 李秦[1] 闫芳[1] 刘京涛[1] 

机构地区：[1]解放军总医院第二附属医院ICU,北京100091

出　　处：《解放军医学杂志》2006年第10期1021-1023,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨横纹肌溶解（RM）继以爆发型多器官功能衰竭（MODS）的诱因，发病机制及可能的临床干预措施，方法 总结3例横纹肌溶解症患者的临床资料，分析其发病诱因，临床表现、病程中的实验监测指标变化与临床干预措施的关系及预后。结果 3例RM患者均继发爆发型多器官功能衰竭，其RM诱发原因并无牧民性。但早期病程中均有持续高热和剧烈抽搐。肌酸激酶（CK）显著升高，超过正常值50倍以上，受损器官分别为7，4，6个，MODS评分15-21分，APACHEⅡ评分均大于20分，1例存活，另2例死亡。持续肾替代治疗（CRRT）能有效降低剧烈升高的血清酶学指标，维持内环境相对稳定。结论 深度镇静控制抽搐及有效物理降温对减轻RM继发爆发型多器官功能衰竭的器官损伤具有重要意义，在恰当高级生命支持的前提下，CRRT是的必要治疗措施。Objective To analyze the canses of rhabdomylysis（RM）,patbogenctic mechanisms and possible effective interventions for secondary multiple organ dysfunction syndrome （MODS）caused by RM,Methods causes of RM,clinical manifestations,severity of disease evaluated by APACHEⅡand Marshall MODS Score,results of laboratory,clinical interventions and outcome were analyzed in all three MODS cases secondary to RM, Results The specific causes of RM were not clear,However,persistent acute twitch and hyperthermia occurred very carly in all three cases,Plasma CK was inereased 50fold over the normal level,Number of injured organs was 7,4and 6,respectively,Marshall MODS score ranged from 15 to 21,APACHEⅡ scores were greater than 80 in all cases,One patients sorvived,the other two died ,CRRT started early had been shown to be beneficial to decrease the markedly elevated plasma CK,CK-Mb,ALT,ALTand LDH,Conclusion Although the mechanism of RM with secondary MODS bas not beem elucidated yet ,deep sedation as well as effcctive hypothermia to control acute twitch and hyperthrmia should be the essential interventions to attenuate further organ injury,Additionally,based on effective advanced life support,CRRT started carly could be an important therapy for MODS secondary to RM.

关 键 词：横纹肌溶解 多器官功能衰竭 干预措施 

分 类 号：R59[医药卫生—内科学]