非创伤性横纹肌溶解综合征致急性肾损伤18例临床分析及预后  

Clinical analysis of 18 cases with acute kidney injury caused by non-traumatic rhabdomyolysis

作　　者：马立彬[1] 邓刚[1] 王鸣[1] 杨秀[1] 王本勇[1] 魏伟[1] 

机构地区：[1]浙江省杭州市第一人民医院肾内科,杭州310006

出　　处：《中国血液净化》2013年第11期605-607,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨非创伤性横纹肌溶解综合征(rhabdomyolysis,RM)合并急性肾损伤(acute kidney injury,AKI)的病因、临床特点和转归。方法 RM合并AKI患者18例,平均年龄55.3±11.2岁,其中男10例,女8例。所有患者均检测血清肌酸磷酸激酶(CPK)、血肌红蛋白(Mb)以及血电解质丙氨酸转氨酶(ALT)、尿素氮(BUN)、肌酐(Scr)、血气分析等。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%),其他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AKI的主要病因之一;血清肌酶和血生化检测可提高RM-AKI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。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）,serum myoglobin （Mb）,electrolytes,renal function （BUN,and Scr）,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 ofAKI.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.

关 键 词：非创伤性 横纹肌溶解综合征 急性肾损伤 临床 预后 

分 类 号：R692.5[医药卫生—泌尿科学]