10例呼吸道感染合并横纹肌溶解症的临床分析

Clinical analysis of 10 cases of respiratory tract infection complicated with rhabdomyolysis

目的了解呼吸道感染合并横纹肌溶解症的临床特点、治疗及预后,提高对该疾病的诊疗水平。方法回顾性分析2003年1月至2017年5月在上海交通大学附属第六人民医院住院诊断为肺炎或上呼吸道感染合并横纹肌溶解10例患者的病历资料。结果 10例患者主要临床表现为发热、咳嗽、咳痰、意识障碍、肌痛、气促、尿少,体征主要为湿啰音及肌压痛、肌无力。肌酸激酶、肌红蛋白、乳酸脱氢酶及谷草转氨酶、羟丁酸脱氢酶有不同程度的升高。10例患者中肝功能损害9例、电解质紊乱8例、急性肾功能衰竭6例、心力衰竭5例、凝血时间延长3例、呼吸衰竭2例、肺栓塞1例、休克1例。住院期间给予了抗感染、激素、大量补液、碱化尿液、保肝保肾、透析、营养心肌、有创/无创通气等治疗。最终死亡3例(30%),2例未愈(病情危重,患者家属要求自动出院),其余5例(50%)经治疗9-33d康复出院。结论呼吸道感染合并横纹肌溶解症并发症多,预后较单纯呼吸道感染差,早发现、早诊断、早治疗,有助于减少患者住院时间、降低死亡率。

Objective To investigate the clinical characteristics,treatment and prognosis of respiratory tract infection complicated with rhabdomyolysis and then to improve the level of diagnosis and treatment of this disease.Methods A total of 10 patients with pneumonia or upper respiratory tract infection complicated with rhabdomyolysis were recruited from January 2003 to May 2017. The data of these patients were retrospectively collected and analyzed. Results The main clinical symptoms of 10 cases were fever,cough,expectoration,conscious disturbance,myosalgia,breathlessness and oliguria. The main signs were moist rales,muscle tenderness and muscle weakness.Creatine kinase,myoglobin,lactate dehydrogenase,aspartate aminotransferase and hydroxybutyrate dehydrogenase were increased in different degrees. Of the 10 patients,9 patients had hepatic dysfunction,8 patients had electrolyte disturbances,6 patients had acute renal failure,5 patients had heart failure,3 patients had prolonged coagulation time,2 patients had respiratory failure,1 patient had pulmonary embolism and 1 patient had shock. During hospitalization,they were treated with antibiotics,glucocorticoids,aggressive fluid resuscitation,alkalinization of the urine,hepatoprotective drugs,kidney-protective drugs,dialysis,myocardial nutritional drugs,and invasive/noninvasive mechanical ventilation. 3 cases died（ 30%）,2 cases gave up treatment,the remaining 5 cases（ 50%） were cured after treatment for 9-33 d. Conclusion Compared with simple respiratory tract infection,respiratory tract infection complicated with rhabdomyolysis has more complications and poorer prognosis. Early diagnosis and early treatment can reduce hospital stay and decrease mortality.