不同剂量连续性血液滤过治疗维持性血液透析患者横纹肌溶解症的临床疗效观察

Clinical observation of different doses of continuous hemofiltration in the treatment of rhabdomyolysis in maintenance hemodialysis patients

目的:观察不同剂量连续性血液滤过技术治疗维持性血液透析(maintenance hemodialysis,MHD)患者横纹肌溶解症(Rhabdomyolysis,RM)的临床疗效。方法:将确诊RM的MHD患者随机分为两组:(1)连续性静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组;(2)高容量血液滤过(high volume hemofiltration,HVHF)组。监测两组治疗前后生命体征、肌酸激酶(creatine kinase,CK)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌红蛋白(myoglobin,Mb)及治疗后1个月内尿量变化。结果:患者生命体征较治疗前稳定,CK、ALT、AST、LDH、Mb明显下降。Mb降低两组间有差异,HVHF组下降更明显。1个月后HVHF组4例(50%)、CVVH组2例(40%)尿量恢复至患RM前水平。结论:CVVH与HVHF均能有效降低MHD合并RM患者体内CK、ALT、AST、LDH、Mb水平,HVHF清除Mb更有效。对有残肾功能(residual renal function,RRF)及尿量保护需求的MHD患者,治疗RM可优先选择HVHF。

Objective To observe the clinical efficacy of different doses of continuous hemofiltration technique in the treatment of rhabdomyolysis（RM） in maintenance hemodialysis（MHD） patients.Method MHD patients who were diagnosed with RM were randomly divided into two groups：（1）Continuous veno-venous hemofiltration（CVVH） group;（2）High volume hemofiltration（HVHF） group.The changes of vital signs,creatine kinase,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and myoglobin were observed before and after treatment,and the change of urine volume in 1 month after treatment was monitored.Results Compared with pretreatment,the vital signs were more stable.The creatine kinase,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,and myoglobin levels decreased significantly.Myoglobin was significantly reduced in HVHF group than that in CVVH group.The creatine kinase,alanine aminotransferase,aspartate aminotransferase,and lactate dehydrogenase levels were not significantly different between the two groups.The urine volume monitoring for 1 month after treatment showed that 4 patients（50%） in HVHF group and 2 patients（40%） in CVVH group had a recovery of urine volume compared with before.Conclusion CVVH and HVHF can both effectively reduce the levels of creatine kinase,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and myoglobin in MHD patients with RM.HVHF can more effectively remove myoglobin than CVVH.For MHD patients who have residual renal function（RRF） and urine protection requirements,HVHF is the preferent method for treating RM.