神经内科急危重症患者并发横纹肌溶解综合征的临床分析

Clinical analysis of rhabdomyolysis secondary to severe nervous system disease

目的 分析神经内科急危重症患者并发横纹肌溶解综合征的临床表现.方法 回顾性分析解放军第二炮兵总医院神经内科2011年7月至2014年2月收治的4例神经内科急危重症并发横纹肌溶解综合征患者的临床资料.结果 4例患者中2例原发病为大面积脑梗死,均以突发意识不清为首发症状,均伴有挤压伤;1例原发病为多发脑梗死,以癫癎持续状态为首发症状;1例原发病为癫癎持续状态.癫癎持续状态的发作形式均为全面强直阵挛性发作.4例患者肌酸激酶及肌红蛋白水平明显升高,均合并横纹肌溶解综合征,3例合并急性肾功能障碍;2例好转出院,2例死亡.结论 神经内科急危重症患者并发横纹肌溶解综合征临床罕见,一旦发生病情危重,早期诊断及治疗可明显改善预后.

Objective To analyze the clinical manifestation of rhabdomyolysis （RM） secondary to severe nervous systemdisease.Method Clinical data of 4 patients with RM secondary to severe nervous system disease were retrospectively analyzed.Results The primary disease was large area cerebral infarction complicated with crush injury with sudden unconsciousness as the first symptom in 2 patients;multiple cerebral infarction with status epilepticus as the first symptom in 1 patient;SE manifesting as generalized tonic clonic seizure in 1 patient.The levels of creatine kinase and myoglobin were increased in all cases.Meanwhile,acute renal dysfunction occurred in 3 cases.Twopatients got good recovery.Conclusions RM secondary to severe nervous system disease is rare,urgent and critical.Early diagnosis and treatment are important for prognosis.