急性中毒致横纹肌溶解综合征22例临床分析

Clinical analysis of 22 cases of syndrome caused by acute poisoning

目的分析急性中毒引起横纹肌溶解综合征(rhabdomyolysis,RM)的临床特点、治疗及预后。方法收集并总结22例急性中毒致RM患者的临床资料、治疗及预后情况。结果21例患者(95.5%)有肌肉受损表现,13例(59.1%)伴昏迷,8例(36.4%)伴棕色、茶色甚至酱油色尿,6例(27.3%)出现急性肾损伤(AKI),4例(18.2%)出现多器官功能障碍综合征(MODS)。经治疗后21例(95.5%)病情好转或痊愈,1例自动出院。6例AKI患者均存活,其中3例经血液透析治疗,另外3例经补液及对症支持治疗后肾功能均逐渐恢复正常。结论急性中毒合并RM在临床上应注意检查血清酶学等指标,观察临床症状,提早做出诊断。

Objective To analyze the clinical characteristics,treatment and prognosis of rhabdomyolysis(RM)caused by acute poisoning.Summarize the clinical characteristics and treatment experience,pay attention to the complications and improve the quality of rescue.Methods We collecte and summarize the clinical data,treatment and prognosis of 22 cases of RM caused by acute poisoning.Results We found that 21 patients(95.5%)had muscle damage,13(59.1%)with coma,8(36.4%)with brown,tea or even soy sauce urine,6(27.3%)had acute renal injury(AKI),and 4(18.2%)had multiple organ dysfunction syndrome(MODS).After the treatment,21 cases(95.5%)got better,and one case were discharged.All the patients with AKI were survived,three of them were treated by hemodialysis,and the other recovered gradually after massive fluid replacement.Conclusion Acute poisoning combined with RM is not uncommon in clinic.We should pay attention to examination of serum enzymes and other indicators,observe the clinical symptoms and make early diagnosis.The key to diagnosis and treatment is early fluid resuscitation,comprehensive treatment,blood purification and maintain the stability of water and electrolyte.