神经科急症合并横纹肌溶解症28例临床分析

Clinical analysis of neurological emergency combined with rhabdomyolysis: 28 cases report

目的探讨神经科急症合并横纹肌溶解症的特点,以提高对该症的认识及诊疗水平。方法回顾性分析解放军477医院神经内科2010年6月至2015年6月收治的28例神经科急症合并RM患者的临床资料,对临床特点和治疗方法进行总结分析。结果本组患者28例,主要发病诱因为突然停用抗癫痫药物、急性脑部疾病、高强度体能训练、高温下作业、服毒自杀或意外中毒、感染等。肌痛、肌无力、棕色尿在运动性横纹肌溶解症和酒精中毒合并骨室筋膜综合征患者中表现最明显,且此类患者更易出现磷酸肌酸激酶大幅升高、严重的肝肾功能损害、凝血功能异常和代谢紊乱。以昏迷或意识障碍入院的患者,或因患者不能自诉,或原发病症状重,掩盖了肌痛及无力症状,可导致横纹肌溶解症的漏诊或误诊。结论神经科急症合并横纹肌溶解症有其自身特点,患者由于发病诱因、原发病及基础疾病不同,临床表现差异较大。正确认识该症,避免漏诊和误诊,做到早期诊断和治疗,预后相对较好,否则会造成严重后果。

Objective To explore characteristics of neurological emergency combined with rhabdomyolysis,to raise the level of awareness of the disease and the diagnosis. Methods Retrospectively clinical analysis of 28 cases with neurological emergency combined with rhabdomyolysis. Results This group of patients is mainly the triggers for a sudden stop antiepileptic drugs,acute brain diseases,high strength and physical training,high temperature operation,commit suicide by poison or accidental poisoning,infections,etc. Muscle pain,muscle weakness,brown urine in exercise-induced rhabdomyolysis and alcohol poisoning combined bone room fascia syndrome in patients with the most obvious,and such patients are more likely to appear a dramatic rise in the creatine phosphate kinase,severe damage of liver and kidney function,blood coagulation dysfunction and metabolic disorders. In coma or disturbance of consciousness in hospital patients,or patients,could not prosecution or the primary disease symptoms,mask the symptoms of muscle pain and weakness,could result in missed diagnosis or misdiagnosis of rhabdomyolysis. Conclusion Neurological emergency combined with rhabdomyolysis has its own characteristic. Patients differ as a result the triggers,primary disease and basic diseases,clinical manifestations are different. Correct understanding of the disease,avoid missed diagnosis and misdiagnosis,do early diagnosis and treatment,the prognosis is relatively good,otherwise it will cause serious consequences.