心血管疾病患者横纹肌溶解症17例诊治经验  

Clinical features of 17 cases of rhabdomyolysis

作　　者：黄雨晴[1] 詹嘉欣[1] 蒋磊[2] 魏学标[2] 陈纪言[1] 周颖玲[1] 冯颖青[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)广东省心血管病研究所心内科,广州510080 [2]南方医科大学广东省人民医院心内科

出　　处：《中华心血管病杂志》2015年第1期68-71,共4页Chinese Journal of Cardiology

摘　　要：目的 分析17例横纹肌溶解症患者的病因、诊治经过及预后.方法 广东省心血管病研究所心血管内科2005年1月至2014年3月收治的横纹肌溶解症患者17例,回顾性分析其发生的原因,治疗方法及治疗效果.结果 17例患者中男性13例,女性4例,平均年龄（60.4±15.7）岁.17例患者中冠心病合并高血压、高血脂、心房颤动者4例,扩张型心肌病合并冠心病、心房颤动、高血脂者10例,心房颤动合并高血压、冠心病、高血脂者8例,肺栓塞合并高血脂者1例,主动脉夹层合并高血压者1例,高血压合并心房颤动、冠心病、主动脉夹层、高血脂者10例,阵发性室上性心动过速合并抑郁症者1例.患者均存在不同程度的肝肾功能损害,血红蛋白下降,以及肌红蛋白尿.住院期间7例患者出现发热症状,5例出现相关神经系统体征,患者均出现消化道症状及肌肉乏力或肌痛症状.使用肾替代治疗者17例,使用呼吸机者14例,经治疗后10例好转,7例死亡.所有横纹肌溶解症的患者均服用了他汀类药物.结论 他汀类药物可能与心血管内科药物治疗引起横纹肌溶解症有关,横纹肌溶解症预后差、病死率高.Objective We retrospectively analyzed the causes,diagnosis,clinical characteristics,treatment and prognosis of 17 patients with rhabdomyolysis.Methods Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.Results A total of 17 rhabdomyolysis patients （male 13,mean age （60.4 ± 15.7）years） were analyzed.Four cases had coronary heart disease combined with hypertension,hyperlipaemia,atrial fibrillation,10 cases had dilated cardiomyopathy combined with coronary heart disease,hyperlipaemia,atrial fibrillation,8 cases had atrial fibrillation combined with hypertension,coronary heart disease,hyperlipaemia,1 patient had pulmonary embolism combined with hyperlipaemia,1 patient had aortic dissection combined with hypertension,10 hypertension patients were combined with coronary heart disease,hyperlipaemia,atrial fibrillation,aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction,reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases,relevant neurological signs in 5 cases.Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization.All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing.Post therapy,10 cases improved but 7 cases died.All 17 patients had history of statin use.Conclusion Statin may be the major cause of rhabdomyolysis in these patients,and the mortality of rhabdomyolysis is high despite various therapy stratigies.

关 键 词：心血管疾病 横纹肌溶解 降血脂药 预后 

分 类 号：R54[医药卫生—心血管疾病]