酒精中毒合并横纹肌溶解症的诊治体会

Diagnosis and treatment experiences of alcohol poisoning complicated with rhabdomyolysis

目的:探讨酒精中毒合并横纹肌溶解症(RM)的临床特点、病因及诊治方法。方法:总结分析15例酒精中毒合并横纹肌溶解症患者的临床资料及治疗、预后情况。结果:15例患者均为重度酒精中毒,并发急性肾衰竭(ARF)6例,昏迷时间及饮酒至入院时间长,酗酒合并挤压伤、吸入性肺炎、血糖代谢紊乱是主要原因,行连续性肾脏替代治疗(CRRT)2例,血液透析(HD)1例。痊愈14例(93.3%),死亡1例(6.7%),为挤压伤并发尿毒症、多器官功能障碍综合征(MODS)。结论:酒精中毒合并横纹肌溶解症常见于酗酒者,早期都为昏迷患者,酗酒合并挤压伤、感染、血糖异常、电解质紊乱是其主要诱因,血肌酸激酶(CK)是反映RM肌肉损害程度和范围最敏感的指标,RM常并发ARF,MODS是其主要死亡原因。早期诊断,及时去除病因、补液、碱化尿液及合理应用血液净化技术是降低病死率的关键。CRRT可清除细胞破坏崩解产物,对预防和减轻肾功能不全疗效确切。

Objective：To investigate the clinical features,etiology and therapy of alcoholism complicated with rhabdomyolysis（RM）.Method：The clinical data,treatment and prognosis of 15cases of alcoholism complicated with rhabdomyolysis were analyzed.Result：Fifteen cases of severe alcoholism were enrolled in our study,and 6cases were complicated with acute renal failure（ARF）.The main reasons can be listed as follows：long coma time from drinking to hospitalization,alcoholism combined with crush injury,aspiration pneumonia,Abnormal glucose metabolism.Two cases accepted continuous renal replacement therapy（CRRT）,and 1case accepted hemodialysis（HD）.Fourteen cases recovered（93.3%） and 1case died（6.7%） for crush injury complicated with uremia and multiple organ dysfunction syndrome（MODS）.Conclusion：Alcoholism complicated with rhabdomyolysis is common in alcoholics.The early clinical manifestation is coma.Crush injury,infection,abnormal blood glucose,electrolyte disturbance are the main incentives.Serum creatine kinase（CK） is the most sensitive index that reflects the level and range of RM muscle damage.RM is often complicated with ARF and MODS is the main cause of death.Early diagnosis,removal of etiology in time,rehydration,urinary alkalinization and reasonable application of blood purification technology is the key to decrease mortality.CRRT,which can eliminate cell destruction disintegrating products,is effective and safe for preventing and alleviating renal insufficiency.