急性动脉闭塞致横纹肌溶解综合征的临床特征分析  

Clinical Features of Rhabdomyolysis Syndrome Caused by Acute Arterial Occlusion

作　　者：宋强 高楚淇 杨睿博 胡志 张曈欣 杨林[4] 强薇[2] SONG Qiang;GAO Chuqi;YANG Ruibo;HU Zhi;ZHANG Tongxin;YANG Lin;QIANG Wei(Department of Structural Heart Disease,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Endocrinology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Cardiovascular Disease,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Vascular Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院结构性心脏病科,陕西省西安市710061 [2]西安交通大学第一附属医院内分泌科,陕西省西安市710061 [3]西安交通大学第一附属医院心血管内科,陕西省西安市710061 [4]西安交通大学第一附属医院血管外科,陕西省西安市710061

出　　处：《实用心脑肺血管病杂志》2022年第3期112-116,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省重点研发计划项目(2021SF-322);陕西省自然科学基础研究计划项目(2020JQ-501)。

摘　　要：背景多种物理及非物理因素均可导致横纹肌溶解综合征(RM),其病因分布具有年龄特异性,对于青年及中年患者,运动为最常见的病因;而对于65岁以上患者,急性动脉闭塞是最常见的病因。目前急性动脉闭塞致RM的相关报道较少。目的分析急性动脉闭塞致RM的临床特征。方法选取2008年6月至2019年3月西安交通大学第一附属医院收治的急性动脉闭塞致RM患者17例为研究对象。收集患者基线资料、临床表现(包括急性动脉闭塞严重程度、持续性疼痛、患侧肢体苍白、无脉、感觉异常、运动障碍、肌肉疼痛、肌无力、茶色尿情况)、实验室检查指标〔包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、肌红蛋白(MYO)、血钾、胱抑素C〕、治疗情况〔包括手术方式,二次手术情况,补液、碱化尿液治疗情况,连续性肾脏替代治疗(CRRT)情况〕、并发症〔包括再灌注损伤、急性肾损伤(AKI)、多器官功能障碍综合征(MODS)〕发生情况、转归。结果17例患者中,男8例,女9例;平均年龄(67.4±9.9)岁;主诉主要为肢体疼痛〔14例(82.4%)〕;主要为下肢受累〔14例(82.4%)〕;平均起病至就诊时间(4.5±3.3)d;血管闭塞原因:下肢动脉硬化闭塞症合并急性血栓形成4例(23.5%),心房颤动栓塞13例(76.5%);闭塞血管部位主要为腹主动脉〔7例(41.2%)〕;8例(47.1%)患者存在感染;5例(29.4%)患者使用钙通道拮抗剂;11例(64.7%)患者使用调脂药。17例患者急性动脉闭塞严重程度主要为ⅡB级〔9例(52.9%)〕;17例患者中,出现持续性疼痛、肌肉疼痛17例(100.0%),患侧肢体苍白和感觉异常15例(88.2%),无脉13例(76.5%),肌无力4例(23.5%),无一例患者出现运动障碍和茶色尿。17例患者中,CK均升高,CK-MB升高13例(76.5%),AST升高14例(82.4%),ALT升高12例(70.6%),LDH升高12例(70.6%),HBDH升高13Background A variety of physical and non-physical factors can lead to rhabdomyolysis syndrome(RM),and its etiology distribution is age-specific.For young and middle-aged patients,exercise is the most common etiology,while for patients over 65 years old,acute arterial occlusion is the most common etiology.At present,there are few reports on RM caused by acute arterial occlusion.Objective To analyze the clinical features of RM caused by acute arterial occlusion.Methods Seventeen patients with RM caused by acute arterial occlusion who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2008 to March 2019 were selected as the research objects.Baseline characteristics,clinical manifestations(including severity of acute arterial occlusion,persistent pain,pallor of the affected limb,pulselessness,paresthesia,dyskinesia,muscle pain,muscle weakness,and tea-colored urine),laboratory test indicators[including creatine kinase(CK),creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST),alanine aminotransferase(ALT),lactate dehydrogenase(LDH),hydroxybutyrate dehydrogenase(HBDH),myoglobin(MYO),serum potassium,cystatin C],treatment[including surgery methods,secondary operation,rehydration and alkalized urine treatment,continuous renal replacement therapy(CRRT)],complications[including reperfusion injury,acute kidney injury(AKI),multiple organ dysfunction syndrome(MODS)]and outcomes of patients were collected.Results Among the 17 patients,there were 8 males and 9 females and the average age was(67.4±9.9)years old.The main complaints were limb pain(14 cases,82.4%)and lower limb involvement was observed in 14 cases(82.4%).The average duration from onset to visit was(4.5±3.3)d.The cause of vascular occlusion included lower extremity arteriosclerotic occlusion complicated with acute thrombosis(4 cases,23.5%),and atrial fibrillation embolism(13 cases,76.5%).Aorta abdominalis was the mot frequently involved(7 cases,41.2%).Infection was present in 8(47.1%)patients;calcium channel antagonists

关 键 词：横纹肌溶解 急性动脉闭塞 临床特征 

分 类 号：R685.5[医药卫生—骨科学]