364例横纹肌溶解综合征临床特征及并发急性肾损伤后的临床疗效观察

Observation on Clinical Characteristics of 364 Cases of Rhabdomyolysis and Clinical Efficacy on Its Complication of Acute Kidney Injury

目的:观察横纹肌溶解综合征(RM)的发病诱因、临床表现及并发急性肾损伤(AKI)后的连续性血液净化(CBP)治疗时机、相关化验指标水平变化和预后等,并进行探索及分析。方法:选取某院2006年1月~2023年1月收治的364例RM患者为研究对象,根据患者是否发生AKI分成AKI组和非AKI组,其中,AKI患者根据是否进行CBP治疗分成CBP组和非CBP组。收集并分析患者性别、年龄、急性生理和慢性健康状况Ⅱ评分(APACHE-Ⅱ)、RM发病诱因、RM临床表现、RM并发AKI患者的临床疗效以及预后。结果:共纳入364例RM患者,年龄为38(25,65)岁;177例(48.63%)患者并发AKI,其中117例给予CBP治疗。RM的主要临床表现为肌肉酸痛、肌无力、尿色改变、肌肉肿胀等。挤压创伤、药物中毒导致的RM更易发生AKI;运动损伤、哈夫病导致RM的概率高但不易发生AKI;代谢性疾病等因素导致RM的概率较低,但有可能导致并发AKI。治疗后,AKI组血清肌酸激酶(CK)、肌红蛋白(Mb)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、血清肌酐(Scr)水平均较治疗前下降,且CBP组各指标水平均低于非CBP组(P<0.05)。住院期间共有16例(4.40%)患者死亡,且均为RM并发AKI患者。其中,非CBP组有13例,CBP组有3例。死亡原因主要有多器官功能障碍综合征(MODS)、呼吸衰竭、心力衰竭、休克等。结论:RM的发病因素与临床表现多样化,个体化综合治疗是治疗RM的基础。AKI的发生与患者年龄和多种发病诱因密切相关,CBP治疗能有效降低患者CK水平、改善肾功能,提高其抢救成功率。建议AKI患者应尽早接受CBP治疗,降低死亡率。

Objective:This study is to explore and analyze the clinical manifestations,the triggers of its development and the timing of continuous blood purification(CBP)treatment after complication of acute kidney injury(AKI),the changes in the levels of relevant laboratory indicators and the prognosis of rhabdomyolysis(RM).Methods:Patients diagnosed with RM and admitted to our hospital from January 2006 to January 2023 were included in this retrospective observational study.The patients were initially divided into acute kidney injury(AKI)group and non-AKI group according to whether AKI occurred,and then into CBP group and non-CBP group according to whether AKI patients received CBP treatment.Patients'gender,age,acute physiology and chronic health evaluation-Ⅱscore(APACHE-II),triggers of RM onset,clinical manifestations of RM,clinical outcomes of patients with RM complicating AKI,and prognosis were collected and analyzed.Results:A total of 364 patients with median age of 38(25,65)were included in the study.177 patients(48.63%)developed AKI,with 117 patients of them receiving CBP treatment.The main clinical manifestations of RM were muscle soreness,muscle weakness,urine color change,muscle swelling,etc.RM caused by crush trauma and drug poisoning had a higher likelyhood of developing AKI,while sports injury and Haff disease had a high incidence but were less likely to result in AKI.Metabolic diseases had a low incidence but were more likely to lead to AKI.After treatment,the levels of creatine kinase(CK),myoglobin(Mb),alanine transaminase(ALT),aspartate transaminase(AST),lactate dehydrogenase(LDH)and serum creatinine(Scr)in CBP group significantly decreased.A total of 16(4.40%)patients died during hospitalization and all of them were patients with AKI complicated by RM.Among them,there were 13 cases in the non-CBP group and 3 cases in the CBP group. The main causes of death were multiple organ dysfunction syndrome (MODS), respiratory failure, heart failure and shock. Conclusion: The pathogenesis and clinical manifestations of RM are diverse, and individualized comprehensive treatment is the basis for the treatment of RM. The occurrence of AKI is closely related to the age and pathogenesis of the patients. CBP can reduce the level of CK in patients, improve renal function, and increase the success rate of rescue.