过度训练致横纹肌溶解症并发急性肾衰竭的相关因素分析

Analysis on clinical relative factors for acute renal failure complicated with rhabdomyolysis from excess of trains

目的探讨过度训练导致体力耗竭性横纹肌溶解症发生急性肾衰竭(ARF)的相关因素。方法回顾性地研究1993～2003年37例训练致耗竭性横纹肌溶解症患者的临床救治过程,分析其病情变化规律和误诊的原因,探讨治疗时机及不同的血液净化方法对预后的影响。结果①患者均在夏、秋季发病,主要表现为呕吐、发热、头昏、肌肉酸痛等非特异性症状熏有28例(75.67%)患者入院前被误诊为急性胃肠炎或肠型感冒,21例(56.75%)被采用了庆大霉素等氨基甙类肾毒性药物治疗,使急性肾衰竭(ARF)的诊断和治疗变的愈加复杂;②血清肌酸磷酸激酶(CK)在肌肉出现明显酸痛之前熏或在尿中肌红蛋白检出之前熏已有明显升高,并与血清钾、尿素氮、血肌酐的变化呈现显著正相关(P<0.05);③经过连续性肾脏替代治疗(CRRT)、血液透析(HD)及综合治疗,31例渡过少尿期,肾功能得以恢复。死亡6例,死亡原因为多脏器功能不全。结论①高温高湿环境因素可加重过度训练后肌肉组织损伤和全身反应,而血浆CK水平显著增高熏是横纹肌广泛变性和溶解的重要标志之一;②入院时患者器官功能障碍的数目越多,病死率越高,故早期诊断、及时去除病因及合理应用血液净化技术是降低病死率的关键。

Objective To explore reason of misdiagnosis and erroneous therapy for acute renal failure(ARF) complicated with rhabdomyolysis being induced by excess of military trains.Methods Reviewing clinical data of 37 cases being diagnosed hyposthenic rhabdomyolysis after excess of military trains between 1993-2003- studying variety characteristics of conditions and analyzing factors of misdiagnosis- exploring effect from times of therapy and different technique of blood purification on prognosis of ARF were taken. Results (1)Season of onset was autumn or summer- main performances were vomiting- fever- dizziness and muscle ache and other nonspecific symptoms. Among them 28 cases(75.67%) were diagnosed acute gastroenteritis or gastrointestinal cold before hospitalization- 21 cases (56.75%)were treated by aminoglycoside antibiotic such as gentamicin which could injury kidney function. These above measures made the diagnosis and treatment for ARF more complex. (2)Serum levels of creatine phosphokinase (CK) which positively related with serum levels of kalium-urea nitrogen- creatinine significant rose before muscle ache appearing and myoglobin in urine being detected(P<0.05).(3)Being treated with continuous renal replacement treatment (CRRT)-hemodialysis(HD)and complex therapy-renal function of 31 cases recovered from oliguria period;6 cases were dead-their reason of death was insufficiency of multiple system organs.Conclusions (1)The hot and humid environment would aggravate systemic reactions and tissue damage after excess of trains,the plasma level increment of CK is one of the important marks of degeneration and dissolve of striated muscle;(2)More the number of organs dysfunction is-higher the death rate is;thus the key to decrease mortality of ARF with rhabdo-myolysis patients is to diagnose early- to eliminate the causes promptly-and to use technique on blood purification more rationally.