食用小龙虾致横纹肌溶解症2例

横纹肌溶解综合症( rhabdomyolysis syndrome, RS)是指由各种原因引起的横纹肌细胞溶解、破坏后释放大量肌红蛋白、肌酸激酶( CK)和乳酸脱氢酶( LDH)等进入血液循环引起的一组临床综合征,常可导致急性肾衰,病情凶险。 RS常见病因有肌肉损伤、药物及食物中毒等,而由小龙虾引起的横纹肌溶解症并不多见。现将我院收治的2例食用小龙虾后出现的横纹肌溶解症报道如下,以加强医护人员对该病的重视。     

运动性横纹肌溶解症2例及文献复习

由剧烈运动所致的横纹肌溶解称为运动性横纹肌溶解症,以肌痛、乏力、肌肉肿胀、深色尿及血中肌细胞内容物（特别是肌红蛋白和肌酸激酶）的含量增高为临床特征。严重的运动性横纹肌溶解症可并发急性肾衰竭、急性筋膜间室综合征、弥漫性血管内凝血及多器官功能障碍综合征,甚至危及生命。2012年,我院军人病区收治了2例因体能训练导致的横纹肌溶解症患者,现报告如下。     

酒精中毒致急性横纹肌溶解综合征并急性肾衰竭1例护理

横纹肌溶解综合征是横纹肌损伤释放大量肌红蛋白和肌酸磷酸激酶、乳酸脱氢酶进入外周血的一组临床和实验室综合征.是多种原因引起的临床重症,常因导致急性肾衰竭或多脏器功能衰竭而危及生命.2010年4月我科收治一患者因大量饮酒后出现神志不清,胡言乱语,行为过激,横纹肌溶解释放大量肌红蛋白,肌红蛋白滤入肾小管直接损伤肾小管引起急性肾小管坏死而发生急性肾衰竭.经过1个月的系统治疗和精心的护理,患者病愈出院.     

病毒性脑炎合并横纹肌溶解症的总结分析

目的探讨病毒性脑炎患儿在疾病急性期合并横纹肌溶解症（rhabdomyolysis,RM）的发病情况、治疗效果及预后,以提高其诊治水平。方法总结分析我院2009年1月~2011年12月期间诊治的病毒性脑炎患儿,合并横纹肌溶解症的发病率、临床治疗及预后。结果 120例病毒性脑炎患儿有9例合并横纹肌溶解症,主要表现为急性尿色改变,典型者呈红褐色,实验室检查提示血清肌酸激酶显著升高,血清肌红蛋白升高,尿肌红蛋白阳性。经过水化、碱化、利尿等对症、支持治疗,所有患儿临床症状均好转,复查血清肌红蛋白下降,尿肌红蛋白阴性。结论病毒性脑炎患儿病程中可以合并横纹肌溶解症且并不罕见,在临床上应引起高度重视。     

越野训练致横纹肌溶解症1例

横纹肌溶解症是指横纹肌细胞由于各种原因发生坏死溶解，释放肌红蛋白等毒性产物人血所引起的一组综合症。又称热射病，在国际上比较罕见。目前，本症尚无明确统一的诊断标准。现将本院发生的一例越野训练致横纹肌溶解症的病例报告如下。     

急性一氧化碳中毒合并横纹肌溶解症1例报告

横纹肌溶解症见于挤压伤综合征，是指肌肉遭受重物砸压伤，在不易发生筋膜区综合征的部位，如大腿、上臂、臂部等，由于肌肉出血、渗出等，局部肿胀严重，大腿周径可增加1倍。由于损伤、出血及肿胀，肌组织可发生坏死。坏死肌肉释放出大量代谢产物如：肌红蛋白、钾离子、肌酸、肌酐。其主要临床表现：休克，肌红蛋白尿，代谢性酸中毒，高钾血症。在随后24小时内发生少尿或无尿，〈17ml／小时，尿液呈褐色，出现肌红蛋白、挤压伤综合征即横纹肌溶解症。它常见于外科，内科罕见，尤以急性一氧化碳中毒后出现的更为罕见，现报告1例如下。     

外伤所致横纹肌溶解症1例报告

<正>横纹肌溶解症(Rhabdomyolysis)是由于挤压、运动、高热、药物、炎性反应等原因所致横纹肌破坏和崩解,导致肌酸激酶、肌红蛋白等肌细胞内成分进入细胞外液及血液循环,引起内环境紊乱、急性肾损伤等组织器官损害的临床综合症。笔者现将我院肾内科收治的1例外伤所致横纹肌溶解症的治疗经验和体会报告如下。     

运动性横纹肌溶解症2例诊治分析

<正>运动性横纹肌溶解症在1971年首先被提出[1],主要是指由于剧烈运动后肌纤维崩解断裂从而导致肌细胞内容物释放入血液引起的一系列临床综合征,以肌肉肿痛、全身乏力、排酱油色尿及血中肌酸激酶和肌红蛋白的含量增高为主要临床特征。其中严重的运动性横纹肌溶解症患者可以并发急性肾衰竭、弥漫性血管内凝血以及多脏器功能障碍综合征等,严重威胁到患者的生命健康。此病临床较少见,需要早期诊断且及时治疗。现报道运动     

横纹肌溶解症的临床研究进展

横纹肌溶解症是一种急性、潜在的致命综合征,发病机制是横纹肌分解和肌肉细胞内容物随后释放进入血液循环。大量肌红蛋白、肌酸激酶、电解质等突然释放到血液中可引起急性肾损伤,电解质紊乱、休克甚至死亡。早期治疗可使并发症最小化,但早期患者可能没有横纹肌溶解症的典型症状,甚至有可能无临床表现。本文对横纹肌溶解症的病因、发病机制、对机体的危害、临床表现、治疗及预后等方面作一综述。     

军事训练导致横纹肌溶解症的护理

横纹肌溶解症（rhabdom yolysis,RM）是一种内科急症,而运动性横纹肌溶解是指过度运动后所致的骨骼肌损伤、细胞膜破坏,大量肌红蛋白、肌酸激酶和乳酸脱氢酶等物质释放入外周血引起的临床综合征,严重的会导致急性肾衰竭,则预后较差。临床诊断标准为血清肌酸激酶、肌红蛋白升高,尿肌红蛋白呈阳性,尿中有棕褐色颗粒管型,临床表现为不同程度的肌肉肿胀,肌肉酸痛、肌无力、棕色尿。其发病的主要诱因是肌肉运动过度,环境温度过高〔1〕。本科2013年7月13日同时收治7例因消防演练而导致横纹肌溶解症官兵,由于早期明确诊断,经过2∽3周的治疗与精心护理,所有指标均恢复正常后陆续出院,现报告如下。     

Hypokalemic rhabdomyolysis and acute renal failure. Occurrence following total parenteral nutrition.

A patient experienced severe hypokalemia in the setting of prolonged nasogastric suction and total parenteral nutrition. Severe rhabdomyolysis and acute renal failure ensued. Review of the literature failed to disclose a similar case of hypokalemic rhabdomyolysis and acute renal failure, although the syndrome has been associated with other causes of hypokalemia, and its pathophysiology has been investigated in experimental models. The morbidity associated with extensive myonecrosis and severe, acute renal failure in this patient indicates that hypokalemia and other electrolyte abnormalities should be aggressively corrected in similar clinical settings.     

Acute rhabdomyolysis associated with atypical Guillain-Barré syndrome

We report a patient with atypical Guillain-Barré syndrome associated with acute rhabdomyolysis. Rhabdomyolysis may be the cause of elevation of creatine kinase sometimes seen in patients with Guillain-Barré syndrome.     

重叠综合征与房颤的相关性分析

目的 探讨不同严重程度的重叠综合征与房颤发生的相关性.方法 回顾性分析2011年1月至2014年12月于北京安贞医院接受便携式睡眠监测的1 939例患者的临床资料.呼吸暂停低通气指数(apnea-hypopneaindex,AHI)≥15次/h作为诊断阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的标准.慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的诊断均由当时主管医生根据临床表现和肺功能检查结果确定,同时罹患OSA与COPD者诊断重叠综合征.采用多因素logistic回归分析房颤的独立相关因素.结果 与对照组相比,重叠综合征患者房颤的发生几率大(OR=6.71,95％CI:3.81～11.86,P＜ 0.001),这一差异在矫正人口学与合并症后仍有统计学意义(OR=2.04,95％CI:1.09～3.78,P=0.025).亚组分析显示,在非重度OSA(15次/h≤AHI＜30次/h)和重度OSA(AHI≥30次/h)患者中,重叠综合征与房颤的发生几率增加均具有相关性(OR-4.49,95％ CI:1.69～11.97,P=0.003和OR=2.38,95％CI:1.06～5.10,P=0.036).结论 重叠综合征与房颤的发生显著相关.     

Fatal rhabdomyolysis and renal failure associated with hand, foot and mouth disease

Fatal severe rhabdomyolysis and anuric renal failure developed in a young man who had contracted hand, foot and mouth disease during an epidemic of this disease. Viral studies implicated coxsackievirus A16 as the infecting agent. This appears to be the first reported case of rhabdomyolysis that was associated with hand, foot and mouth disease and infection with coxsackievirus A16.     

热射病中肾损伤的发病机制及液体管理

热射病是由于暴露在高温高湿环境中导致机体核心温度迅速升高,超过40℃,伴有皮肤灼热,意识障碍等多器官系统损伤的严重临床综合征。热射病可致肾脏损伤,其可能的机制有电解质紊乱与氧化应激损伤、高温的毒性作用、凝血功能障碍、横纹肌溶解综合征及内毒素血症和全身炎症反应综合征。热射病治疗中的一个重要环节为液体复苏,然而由于热射病液体管理仍未统一,其规范化的治疗仍有待完善。本文就热射病肾损伤的机制及液体管理进行综述,以加深对热射病理解,为其防治奠定基础。     

Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness.

BACKGROUND: Rhabdomyolysis is severe and acute skeletal muscle damage resulting in sarcolemma disruption. During injury, intracellular muscle contents are released into the plasma. The consequences may cause hypovolemia, electrolyte abnormalities, compartment syndrome, or even acute renal failure and dialysis. CASE REPORT: We present the history of a patient in whom exertional rhabdomyolysis was misdiagnosed. A 20-year-old male police recruit was admitted to a psychiatric hospital because of complaints about black urine and severe thigh pain. Serum creatinine kinase (CK) was significantly elevated at 87,335 U/l. Urinalysis showed brown color and cloudiness. Serum myoglobin was also significantly increased. Aspartate aminotransferase was elevated as was alanine aminotransferase. Immediate intravascular fluid hydration and hospital rest under renal, metabolic, and hematological monitoring was performed. CONCLUSIONS: Gymnastic teachers and people at environmental risk of rhabdomyolysis, such as members of the armed forces, police, and supervisors of physical laborers, need to remember the risks of intensive and repetitive exercise. Symptoms such as dark urine, myalgia, and muscle weakness should immediately arouse suspicion of rhabdomyolysis. Especially dark-colored urine should always be investigated for the occurrence of rhabdomyolysis.     

Rhabdomyolysis and aggravation of arthritis in a rheumatoid arthritis patient as a result of sepsis due to Staphylococcus aureus infection of a rheumatoid nodule; a catastrophic outcome

A 63-year-old man with rheumatoid arthritis presented with rhabdomyolysis and intractable arthritis of acute onset. He was diagnosed to have sepsis due to Staphylococcus aureus infection through of an ulcerated rheumatoid nodule. Staphylococcus aureus isolated from pus in the ulcerated rheumatoid nodule and a blood sample obtained from the heart post-mortem produced the toxic shock syndrome toxin-1 (TSST-1). The TSST-1 and/or unmethylated CpG motifs in the oligonucleotides present in a bacterium, Staphylococcus aureus in this case, might be implicated in the induction of rhabdomyolysis and intractable arthritis.     

睡眠重叠综合征与糖尿病发病率的横断面调查研究

目的: 阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)均增加冠状动脉粥样硬化性心脏病(简称冠心病)和代谢性疾病的风险,但鲜有研究关注二者合并的睡眠重叠综合征是否比单一疾病更为增加临床患病概率,本研究目的是调查睡眠重叠综合征与糖尿病发病率的相关性。方法: 回顾2011年1月至2014年12月在北京安贞医院睡眠医学中心接受便携式睡眠监测的1 939名患者。COPD的诊断基于临床表现和肺功能,OSA的诊断需要呼吸暂停低通气指数 ≥15次/h。研究对象被分为对照组(n=1 093)、单纯COPD组(n=62)、单纯OSA组(n=735)、重叠综合征组(n=49),使用Logistic回归模型分析糖尿病发病的相关因素。结果: 重叠综合征患者患2型糖尿病的概率均高于对照组和单纯OSA患者(OR=5.82, 95%CI:3.23~10.48, P<0.001和OR=4.35, 95%CI:2.41~7.88, P<0.001)。矫正年龄、性别、体重指数等因素后差异仍有统计学意义(OR=2.69, 95%CI:1.13~6.52, P=0.026和OR=3.64, 95%CI:1.53~8.83, P=0.004)。年龄<58岁的患者和女性患者中,重叠综合征与2型糖尿病的发生存在独立相关性(OR=8.45, 95%CI:1.46~65.90, P=0.018与OR=4.39, 95%CI:1.04~22.50, P=0.044);年龄≥58岁的患者和男性患者中,重叠综合征与糖尿病发病无显著相关性。结论: 睡眠重叠综合征与2型糖尿病的发病存在相关性,需要进一步研究证实治疗重叠综合征是否能降低代谢异常的风险,甚至减少未来并发症的概率。     

Rhabdomyolysis in a recreational swimmer

Rhabdomyolysis is a clinical and biochemical syndrome resulting from skeletal muscle injury, which may ultimately lead to acute renal failure (ARF) and death. Exertional rhabdomyolysis refers to skeletal muscle injury that is usually induced by strenuous eccentric exercises in a hot and humid environment. It is usually seen in marathoners and military personnel. We present the case of a 32-year-old Malaysian man who had rhabdomyolysis and myoglobinuria without ARF after two episodes of unaccustomed swimming. He was treated conservatively, and recovered uneventfully. A brief discussion on the pathophysiology of rhabdomyolysis, the principles of management and recuperation is included.     

Atraumatic gluteal compartment syndrome.

A case of atraumatic gluteal compartment syndrome complicated by sciatic nerve palsy and acute rhabdomyolysis is presented. A presumed diagnosis of deep venous thrombosis led to a delay in diagnosis. Gluteal compartment syndrome should be considered in the differential diagnosis of the swollen leg.