冻伤致急性肾损伤病例分析及文献回顾  

Clinical analysis of acute kidney injury secondary to frostbite and literature review

作　　者：夏文丽 王晓飞[1] 杨洁[1] 赵斌[2] 丁致民[1] XIA Wenli;WANG Xiaofei;YANG Jie;ZHAO Bin;DING Zhimin(Department of Nephrology,Jishuitan Hospital,Beijing,100035,China;Department of Emergency,Jishuitan Hospital)

机构地区：[1]北京积水潭医院,北京大学第四临床医学院肾内科,北京100035 [2]北京积水潭医院,北京大学第四临床医学院急诊科

出　　处：《临床急诊杂志》2018年第12期834-838,共5页Journal of Clinical Emergency

摘　　要：目的:探讨冻伤致急性肾损伤(AKI)患者临床特点。方法:回顾性分析2001-12—2015-03期间我院因冻伤住院并合并AKI的患者与肾功能正常患者(非AKI组)之间临床及实验室检查结果,并回顾文献。结果:6/60例符合AKI诊断,1例死亡,余5例经治疗肾功能恢复。AKI组较非AKI组Ⅳ度冻伤患者比例更高(AKI组5/5vs非AKI组15/32,P=0.050),血肌酸磷酸肌酶(CK)升高者更多(AKI组5/5vs非AKI组14/47,P=0.004),具有更高的血乳酸脱氢酶水平(LDH)[AKI组(526±145.1)vs非AKI组(222±158.8)IU/L,P <0.001]和a-羟丁酸脱氢酶水平(HBDH)[(AKI组(473±48.5)vs非AKI组(175±112.2)IU/L,P<0.001)]。结论:冻伤所致急性肾损伤存在横纹肌溶解的参与,严重病例可致死亡,应尽早救治。Objective:To explore the clinical characters of patients with acute kidney injury(AKI)secondary to frostbite.Method:We retrospectively reviewed and compared the clinical data between patients with AKI secondary to frostbite and patients with normal renal function at admission.Result:Six patients fulfilled the diagnosis of AKI,in whom one patient died.In AKI group,higher proportion of patients hadⅣdegree cold injury(AKI 5/5 vs non-AKI 15/32,P=0.050)and elevated serum creatine phosphokinases level(AKI 5/5 vs non-AKI 14/47,P=0.004).Compared with patients in non-AKI group,patients with AKI had higher lactate dehydrogenase(LDH)level(AKI 526±145.1 vs non-AKI 222±158.8 IU/L,P<0.001)and higher hydroxybutyrate dehydrogenase(HBDH)level(AKI 473±48.5 vs non-AKI 175±112.2 IU/L,P<0.001).Conclusion:Rhabdomyolysis may be one etiological factor in AKI secondary to frostbite.Mortal case may occur,and early intervention is necessary.

关 键 词：冻伤 急性肾损伤 横纹肌溶解 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]