军事训练致横纹肌溶解症并发急性肾功能衰竭的临床研究

Clinical study of acute renal failure complicated by rhabdomyolysis induced by special military training

目的 了解高强军事训练(军训)后横纹肌溶解症(RM)并发急性肾功能衰竭(ARF)的发病情况及临床特点。方法 对我院14年间(1988年1月至2002年7月)因5公里武装越野跑致病住院患者的发病情况及临床特点进行分析。结果 12例患者符合入选标准,占RM患者的42.8％,近5年发病10例,占83％,占同期住院ARF患者的6.8％。重症ARF6例,占50％。12例患者除ARF表现外可有高热、意识障碍、抽搐、肌痛及肢体肿胀、棕色尿、低钙高磷及高钾血症;12例患者血清酶CK、CK-MB、LDH、HBDH、ALT、AST均明显高于正常;6种血清酶升高时间及峰值时间无明显差别,但重症ARF患者的血清酶升高的幅度大且恢复慢;血Cr与CK、HBDH呈明显正相关(P<0.05),血Ur与CK、CK-MB、HBDH也呈明显正相关(P<0.05)。12例患者治愈9例,治愈率为75％,死亡3例,病死率为25％,均为重症ARF患者。结论 ①高强军训后RM已构成近年来ARF的重要病因。②血清酶升高与肾功能损害程度呈正相关,升高幅度越大,病情越重;血清酶恢复越慢,预后越差。③早期应用肾剂量的多巴胺和山莨菪碱有助于肾功能的恢复,一旦ARF确立应尽早介入血液净化治疗。④患者生存率的高低不仅取决于肾功能损害的程度,更重要的是取决于其他脏器损伤的程度,其预后取决于其他器官的功能恢复情况。

Objective To understand the incidence and clinical feature of acute renal failure(ARF) on rhabdomyolysis( RM) in special military trainning. Methods The incidence and clinical feature of patients hospitalized in the period between January, 1988 and July,2000 due to five-kilometer armed cross-country race were analysed. Results 12 patients were selected according to the inclusion criteria, making up 42. 8 percent of the RM patients hospitalized. Of these selected cases, 10 came down with the disorder in the last 5 years,accounting for 83% and 6. 8% of ARF patients in the same period of time. 6 patients were in sever condition, 50% of the study subjects. In all the 12 cases,besides manifestations of ARF,high temperature,disturbance of conciousness,convulsion, muscle pain and swelling of extremitates, black urine, hypocalcemia, hyperphosphatemia and hyperkalemia could be seen. The serum enzymes of CK,CK-MB ,HBDH,LDH, ALT, AST significantly elevated in patients with ARF on RM. The beginning of rising time and the peak time of the above 6 serum enzymes were not significantly different from each other, but the values of serum enzymes were higher and its recovery were delayed in severe ARF. There were positive correlations between Cr and CK,HBDH(P < 0.05) ,and between Ur and CK,CH-MB HBDH(P < 0. 05). Of the 12 cases,9 were cured with a cure rate of 75 percent; 3 cases died with the death rate of 25 percent. Conclusions ①The RM induced by military trainning has become one of the important causes of ARF in recent years. ②Elevation of serum enzymes were positively correlated with renal function, the higher the serum eznymes levels,the more severe the condition was. Consequently, the more slowly the recovery process and the worse the prognosis would be.③The administration of renal-dose dopamine and Anisodamine in the early stage were useful for the recovery of renal function. Early blood purification was prefered as soon as ARF was confirmed. ④The survival of the patients with ARF depended on not only the severity of renal damage but also on damage of other organs.