横纹肌溶解综合征患者预后影响因素分析

The risk factors on the prognosis of patients with rhabdomyolysis syndrome

目的研究影响横纹肌溶解综合征(RM)患者预后的相关因素。方法安徽医科大学附属省立医院重症医学科收治的57例重症RM患者,根据患者预后分为死亡组(21例)和治愈组(36例)。对两组患者入院时病情状况和治疗措施等资料进行分析。结果与治愈组比较,死亡组入院时APACHEⅡ评分较高(分:18.61±5.62 vs.22.14±3.45,P﹤0.01)、GCS评分较低(分:11.28±3.87 vs.7.81±4.19,P﹤0.01),血尿酸(μmol/L:380.31±223.74 vs.499.71±214.18)、血糖(mmol/L:7.61±3.09 vs.12.76±6.75)、凝血酶原时间(s:13.30±2.48 vs.30.60±11.54)、活化部分凝血活酶时间(s:42.03±28.24 vs.60.48±45.55)、肌红蛋白[ng/mL:249(126,254)vs.1750(931,9632)]、肌酸激酶同工酶(CK-MB)[U/L:47.00(32.25,62.50)vs.106.00(52.00,396.50)]均较高(P﹤0.05),而血红蛋白(g/L:122.69±20.47 vs.99.24±32.25)、血小板(×10^9/L:167.81±89.25 vs.113.76±58.19)、总蛋白(g/L:59.36±10.68)、白蛋白(g/L:34.94±8.01 vs.27.10±8.66)、血钙(mmol/L:2.00±0.23 vs.1.78±0.31)等较低(P﹤0.05),心率较快(次/min:100.08±22.01 vs.113.00±16.65,P﹤0.05);死亡组入院时已发生MODS者较多(P﹤0.05),肾功能处于急性损伤期和衰竭期的患者病死率高(P﹤0.01);死亡组因感染引起RM者较多(P﹤0.01)。治疗措施方面,死亡组机械通气时间较长(P﹤0.05);非早期治疗者病死率较高(P﹤0.05),快速补液的患者病死率较低(P﹤0.05)。Logistic回归分析显示,APACHEⅡ评分、GCS评分、血糖、凝血酶原时间、活化部分凝血活酶时间、肌红蛋白、CK-MB、血红蛋白、血小板、白蛋白、血钙、补液速度、机械通气时间、早期治疗、快速补液是影响RM预后的独立危险因素。结论RM患者入院时病情重、内环境紊乱,处于急性肾损伤(AKI)期者预后较差,早期快速补液可降低患者病死率。

Objective To investigate the risk factors on the prognosis of patients with rhabdomyolysis syndrome(RM).Methods 57 patients with RM in the intensive.care unit were chosen in this retrospective study.APACHEⅡscore,MODS score,GCS score and the results of laboratory examination at the time of admission were recorded and analyzed.According to the prognosis,the 57 patients were divided into the death group(21 cases)and the cured group(36 cases).Results Compared with the cured group,the score of APACHEⅡ(score:18.61±5.62 vs.22.14±3.45,P﹤0.01),blood uric acid(pnol/L:380.31±223.74 vs.499.71±214.18),blood sugar(mmol/L:7.61+3.09 vs.12.76+6.75),prothrombin time(PT)(s:13.30+2.48 vs.30.60±11.54),activation of partial thrombin time(APTT)'(s:42.03±28.24 vs.60.48±45.55),myoglobin(MYO)[ng/mL:126(249,254)vs.1750(931,9632)],creatine kinase isozyme(CK-MB)[U/L:47.00(62.50)vs.106.00(396.50)],heart rate(beat/min:100.08±22.01 vs.113.00±16.65)were higher significantly(P﹤0.05).The GCS score(score:11.28±3.87 vs.7.81±4.19),blood haemoglobin(Hb)(g/L:122.69±20.47 vs.99.24+32.25),platelet(PLT)(×10^9/L:167.81±89.25 vs.113.76±58.19),total protein(g/L:59.36±10.68),albumin(Alb)(g/L:34.94±8.01 vs.27.10±8.66)and calcium(mmol/L:2.00±0.23 vs.1.78±0.31)were lower significantly(P﹤0.05)in the death group.Additionally,compared to the cured group,the incidence of MODS was high,more RM induced by infection,more acute kidney injury,longer time of mechanical ventilation,lower the rate of fast infusion in the death group(P﹤0.05).It was revealed that APACHE H and GCS score,blood glucose,PT,APTT,MYO,CK-MB,Hb,PLT,Alb,calcium,fluid speed,mechanical ventilation time,early treatment,rapid liquid resuscitation were independent risk factors of prognosis by Logistic regression analysis.Conclusion The patient with RM in a critical condition,internal environment disturbance,and acute kidney injury(AKI),indicates a poor prognosis.And the early fast infusion is helpful to improve the prognosis of patients with RM.