非外伤性横纹肌溶解症39例临床分析

Non-traumatic rhabdomyolysis:clinical analysis of thirty-nine cases.

目的总结非外伤性横纹肌溶解症的病因、临床特点、治疗及预后。方法回顾性分析1999年1月至2006年11月北京协和医院收治的39例非外伤性横纹肌溶解症患者的病因、临床特点、治疗及预后。结果非外伤性横纹肌溶解症的主要表现为发热、乏力、受累肌肉疼痛和(或)压痛、肌肉肿胀、尿色改变及少尿或无尿,均有血清肌酶和血肌红蛋白明显升高。非外伤性横纹肌溶解症的并发症或合并症有急性肾衰竭、电解质和代谢紊乱、肌间隙综合征和多器官功能衰竭(MOSF)等。感染(33.3%)和药物(25.6%)是本组非外伤性横纹肌溶解症最常见的病因,其次为代谢紊乱(10.3%)、酒精中毒(7.7%)。治疗包括减少肌肉损伤、补液、碱化尿液及并发症的处理,必要时行肾脏替代治疗。总体病死率为15.4%,合并急性肾衰竭(ARF)者病死率为20.7%。MOSF是死亡的预测因素。存活者若无慢性肾功能异常,其肾功能均可恢复或维持正常。结论非外伤性横纹肌溶解症是一种病因、临床表现、并发症及合并症多样的综合征,早期诊断有一定困难。但只要治疗正确、及时,存活者肾功能多有望恢复或维持正常。

Objective To evaluate clinical features, predisposing factors, therapeutic regimen and prognosis of non-traumatic rhabdomyolysis. Methods Clinical picture, therapeutic regimen and prognosis were investigated in 39 cases with non-traumatic rhahdomyolysis by retrospective analysis. Results Non-traumatic rhahdomyolysis mostly presented fever, asthenia, myalgia and/or muscular tenderness, swelling of involved muscles, red urine and oliguria or anuria. The complications and comorbidity of rhabdomyolysis included acute renal failure （ARF）, disorders of metabolites and electrolytes, compartmental syndrome,infection, and multiple organ dysfunction. Infection（ 33.3% ）was the most common etiology of non-traumatic rhabdomyolysis, followed by drugs （25.6%） , mctabolite or electrolyte derangements （ 10. 3 % ） and alcohol intoxication（7. 7% ）etc. Therapeutic regimen covered treatment of the underlying diseases, volume repletion, alkalization and dealing with the complications. For the patients with established renal failure, renal replacement therapy was essential. Overall mortality was 15.4% ,while the mortality in the patients with ARF was 20. 7%. If surviving ARF,the patients＇ renal function promised to be normalized consequently. Conclusion Non-tranmatic rhabdomyolysis is a syndrome with a variety of causes, different clinical presentations and versatile combination of complications, which confounds the diagnosis. However,if treated properly and in time, the survivors in all probability will recover from ARF.