血液滤过治疗横纹肌溶解综合征急性肾衰竭23例临床分析  

Clinical Analysis of 23 Cases with Rhabdomyolysis Related Acute Renal Failure Treated by Continuous Veno-Venous Hemofiltration

作　　者：韩久怀[1] 刘伟[1] 端靓靓[1] 施杰[1] 张璟[1] 苏安生[1] 

机构地区：[1]安徽省安庆市立医院肾内科,246003

出　　处：《中华全科医学》2011年第8期1211-1212,共2页Chinese Journal of General Practice

摘　　要：目的探讨早期连续性血液滤过治疗横纹肌溶解综合征(RM)并发急性肾衰竭(ARF)对疾病转归的影响。方法 RM-ARF患者23例,检测血清肌酶(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、肾功能(BUN、SCr)、血尿酸(UA)、血气分析和DIC全套、胸片、B超、心电图等。23例均予以连续性静脉-静脉血液滤过(CVVH),3d后改行间隔性血液透析(IHD),同时采用综合治疗方案。观察CVVH治疗前及治疗48h后血常规、CPK、血肌红蛋白、肝肾功能、电解质改变。对于并发筋膜间室综合征患者,观察肢体肿胀及疼痛程度变化。结果 22例肾功能均完全恢复,3例并发筋膜间室综合征,经CVVH治疗48h后,肢体肿胀迅速消退,疼痛明显减轻。2例并发MODS,其中1人死亡。血BUN、SCr、K、WBC、CK和肌红蛋白均较前明显下降(P<0.01),其中CK及肌红蛋白下降最为明显,肌红蛋白接近正常水平。结论 ARF是RM的严重并发症,早期发现并予积极预防是防治ARF的关键。连续性血液净化治疗可以有效清除血液中的肌红蛋白及炎性介质,改善了ARF的预后。Objective To explore the effect of continuous veno-venous hemofihration（CVVH） on the outcomes of rhabdomyoly- sis （RM） related acute renal failure（ARF） in the early stage. Methods Twenty-three patients with RM-ARF received the intermittent hemodialysis （IHD） after the three days of CVVH. Before and after（48h late）, the serum level of CPK, LDH, myoglobin, electrolytes, BUN, SCr, UR and blood-gas analysis, and the Results of disseminated intravascular coagulation （ DIC ）, chest film, Bultrasound and ECG were checked. For the patients with compartment syndrome, the status of limb swelling and pain were ob- served. Results Renal function of 22 patients were completely recovered ,3 cases were complicated with compartment syndrome, limb swelling rapidly subsided and pain significantly reduced after 48 hours of CVVH. 2 cases complicated with MODS, and 1 died. Blood BUN, SCr, K, WBC, CK and myoglobin was significantly decreased after CVVH （P 〈 0.01 ）, CPK and myoglobin decreased obviously and myoglobin was near normal levels. Conclusion ARF is a serious complication of RM,the early detection and active treatment is the key of preventing ARF. Continuous blood purification treatment can remove the myoglobin and the inflammatory mediators in blood effectively and improve the prognosis of ARF.

关 键 词：横纹肌溶解综合征 肾衰竭 急性 早期 血液滤过 

分 类 号：R692.5[医药卫生—泌尿科学]