伴急性肾功能衰竭横纹肌溶解综合征临床分析

Clinical Analysis of Rhabdomyolysis Leading to Acute Renal Failure

目的探讨横纹肌溶解综合征伴急性肾功能衰竭(ARF)的临床特点、治疗及预后。方法对20例横纹肌溶解综合征伴ARF患者进行回顾性分析。结果20例伴ARF的横纹肌溶解综合征患者中,14例无尿,4例少尿;20例尿蛋白、隐血均阳性;血肌红蛋白(2961.2±285.3)mg/L,血肌酐(823.7±184.1)μmol/L,谷草转氨酶(712.3±82.6)U/L、谷丙转氨酶(978.4±71.9)IU/L、肌酸磷酸激酶(12753.5±18.2)U/L、CPK-MB(138.4±25.8)U/L;15例(75%)为高钾血症。给予补充液体、血液透析滤过等治疗后,18例(90%)存活,2例(10.0%)死于多器官功能障碍综合征;存活者出院时均脱离透析,14例血肌酐恢复正常,血清酶均恢复正常。结论横纹肌溶解综合征伴ARF时常表现为少尿型,高钾血症常见,血清酶学和血肌红蛋白明显升高有助于诊断,血液透析滤过治疗效果良好,存活者肾功能多可恢复。

Objective To investigate the clinical feature, therapeutic effect and prognosis of rhabdomyolysis with acute renal failure （RM-ARF）. Methods Twenty patients of rhabdomyolysis with acute renal failure （RM-ARF） were analyzed. Results Among these 20 cases, there were 14 patients with anuria and 4 with oliguria. All 20 patients had protein and occult blood in their urine. The levels of serum myohemoglobin, creatinine, aspartate aminotransferase, glutamate-pyruvate transaminase, creatine phosphokinases（CPK）, and CPK-MB were （2 961.2±285.3） mg/L, （823.7± 184.1） μmol/L, （712.3±82.6） U/L, （978.4±71.9） IU/L, （12 753.5±18.2） U/L and （138.4±25.8） U/L, respectively. 15 patients （75%） had hyperkalemia. After the treatments of fluid supplement and hemodiafihration, 18 patients （90%） survived and 2 patients （10.0%） died of multiple organ dysfunction syndrome. All survivors detached hemodiafiltration when they were discharged. Their levels of sero-enzymes were restored to normal. 14 survivors recovered with normal serum creatinine level. Conclusion Oliguria and hyperkalemia were often showed in RM-ARF. The levels of sero-enzymes and serum myohemoglobin were increased significantly and could be used as markers for diagnosis. Hemodiafihration was effective in treating RM-ARF. Most of the survivors recovered with normal renal function.