急性横纹肌溶解症并发急性肾功能衰竭1例报道

急性横纹肌溶解症（rhabdomyolysis，Rha）系由不同原因引起的急性肌细胞坏死、横纹肌溶解和肌红蛋白从尿中排出所致的综合征，临床少见。并发急性肾功能衰竭（acute，eml failure，ARF）后病死率很高。近期本院采用血液透析成功抢救1例Rha并AFP的患者，现报道如下。     

脂质沉积性肌病合并横纹肌溶解的临床与病理特征(附1例报告)

目的 研究脂质沉积性肌病(lipid storage myopathies,LSM)合并横纹肌溶解( rhabdomyolysis,RM)的临床与病理学特征.方法 回顾性分析1例LSM合并RM患者的临床和病理学资料.结果 本例患者青年起病,主要表现为运动不耐受,上消化道出血后病情加重,出现四肢近端肌无力,咀嚼、抬头困难,肌痛明显,一过性棕色尿.肌酸激酶(creatine kinase,CK)显著升高.肌电图示:肌源性损害.病理检查示:HE染色见大量筛状空泡纤维和坏死肌纤维,油红"O"(ORO)染色见脂滴显著增加.经糖皮质激素和左旋肉碱等治疗后,患者症状迅速缓解.结论 LSM患者短时间内出现肌无力明显加重伴棕色尿及CK显著升高,应考虑合并RM,肌活检示肌纤维内脂滴显著增加并出现大量坏死肌纤维是其肌肉病理特征.     

甘露醇治疗脑卒中致急性肾功能衰竭(附24例报告)

24例脑卒中患者在应用大剂量甘露醇快速静脉滴注治疗脑水肿时导致ARF发生。其中男14例,女10例,年龄50～80岁。结合文献对其发病机制,发病原因进行了分析,并对防治措施进行了讨论。     

文拉法辛致横纹肌溶解症1例报告

横纹肌溶解症可由外伤、缺血缺氧、药物、毒物、代谢障碍、感染等多种原因引起.引起横纹肌溶解症的药物中比较常见的包括水杨酸类药物及其衍生物,神经松弛剂,麻醉药,金鸡纳碱,皮质内固醇激素,他汀类药物,茶碱,三环类抗抑郁药,选择性5-羟色胺再摄取抑制剂类抗抑郁药,氨基己酸,苯丙醇胺和异丙酚[1].而药物引起的横纹肌溶解症中因服用文拉法辛所致却非常罕见,现将我科临床诊治一例报道如下.     

大剂量甘露醇致急性肾功能衰竭2例报告

本文报告2例输入大剂量甘露醇导致急性肾功能衰竭(ARF)的病例,并结合文献对其产生的机理等问题进行讨论。1 临床资料1.1 一般资料 2例均为男性,年龄分别为54和37岁。1例因突发头痛伴意识不清,左侧肢体活动障碍20h入当地医院;诊断为高血压脑出血;转诊前18h内输入甘露醇450g,入院时血压23/17kPa,昏迷,头颅CT示右基底节区血肿。另1例因醉酒后颅脑损伤12h入当地县医院,浅昏迷,瞳孔左0.6cm,右0.2cm,右侧肢体轻瘫。头颅平片示右枕骨线形骨折,考虑左额颞部对冲性颅脑损伤伴硬膜下血肿。1.2 治疗方法与结果 高血压脑出血病例入院后2h在局麻下行右颞部小骨窗开颅血肿清除术。术中尿量记录不详,术后3h无尿;加快输液速度并应用速尿40mg,术后5h仍无尿;急查血清Na、K、Cl浓度正常,肌酐490mmol/L,确认为大     

颅脑损伤并发急性肾功能衰竭22例报告

颅脑损伤并发急性肾功能衰竭２２例报告林时松自１９８０年１月至１９９３年１月共遇到颅脑损伤并发急件肾功能衰竭（ＡＲＦ）２２例，占本院同期收治颅脑损伤１８９３例的１．１６％，现报告如下。临床资料男１５例，女７例，年龄１６～５９岁，平均２５．９岁。均有确切...     

急性脑血管病并发急性肾功能衰竭124例临床分析

目的探讨急性脑血管病(CVD)并发急性肾功能衰竭(ARF)的发生率、发生原因、死亡率及防治措施。方法对548例急性CVD并发的124例ARF的临床资料进行回顾性分析。结果急性CVD并发ARF发生率为22·6%,发生的主要原因为脑部病变本身及脑水肿、颅内压升高引起的神经内分泌功能紊乱及大量甘醇露的应用。急性CVD并发ARF的死亡率为58%,且死亡的主要原因为ARF。结论ARF是急性CVD的严重并发症,发生率较高,死亡率更高。对危重病人应密切观察肾功能,并避免使用大剂量甘露醇,以减少ARF的发生。     

A case of anorexia nervosa with acute renal failure resulting from rhabdomyolysis

Symptoms of acute renal failure were observed in an anorexia patient who had a history of frequent vomiting. The acute renal failure might have resulted from rhabdomyolysis subsequent to a disturbance of electrolyte balance. This acute renal failure might have resulted in death if not treated. We postulate that even a mild case of anorexia nervosa should be carefully observed to prevent such possible tragedy.     

Dermatomyositis presenting with rhabdomyolysis and acute renal failure; an uncommon manifestation

Rhabdomyolysis and myoglobinuria are a rare complication of dermatomyositis. Such patient can land up in acute renal failure. Recognition of this fact has important therapeutic implications as patients require immunotherapy in addition to the symptomatic treatment for renal failure. We report a case of dermatomyositis with evidence of rhabdomyolysis and myoglobinuria presenting with acute renal failure. The patient responded dramatically to corticosteroid therapy.     

General convulsions and rhabdomyolysis

Two patients who developed rhabdomyolysis secondary to generalized seizures are presented. Minor traumas of skeletal muscles due to seizures may be associated with myoglobinuria and the development of acute renal failure. The diagnosis rhabdomyolysis may easily be confirmed by following serum creatine kinase. Myoglobinuria is present if the urine turns dark brown with a heavily positive dipstick for urinary hemoglobin while microscopy of urinary sediment contains but a few red blood cells. Darkly pigmented granular urinary casts may also be present. In order to prevent development of acute renal failure, it is important to keep the diuresis high and alkaline. If renal failure develops it is usually reversible, but may necessitate peritoneal dialysis or hemodialysis for a couple of weeks.     

连续性肾脏替代疗法救治重型颅脑损伤并发急性肾功能衰竭的效果分析

目的 探讨连续性肾脏替代治疗（continuous renal replacement therapy,CRRT)在重型颅脑损伤后并发急性肾功能衰竭（ARF）的救治作用。方法 回顾性分析5例重型颅脑损伤后并发ARF患采用CRRT结果。结果 1例治疗后48h肾功恢复正常。经其它综合治疗恢复良好出院；2例透析后12h，突发呼吸骤停。瞳孔散大，抢救无效死亡，1例深昏迷。于治疗后24h死亡；1例经36h治疗后肾功恢复正常，后因多器官功能衰竭死亡。结论 重型颅脑损伤后并发ARF的治疗仍是个难题，脑水肿加重或迟发颅脑出血可能是影响CRRT成功率的关键。     

Acute alcoholic myopathy, rhabdomyolysis and acute renal failure: a case report

A case of middle aged male who developed swelling and weakness of muscles in the lower limbs following a heavy binge of alcohol is being reported. He had myoglobinuria and developed acute renal failure for which he was dialyzed. Acute alcoholic myopathy is not a well recognized condition and should be considered in any intoxicated patient who presents with muscle tenderness and weakness.     

Acute rhabdomyolysis associated with acute cocaine intoxication. A case report

We report a case of acute rhabdomyolysis associated with acute intravenous cocaine intoxication in an asymptomatic HIV-positive young man and discuss the possible pathogenetic mechanisms. Recent cocaine use must be considered among the causes of acute rhabdomyolysis without obvious precipitanting factors in our country too. The characteristically uncollaborative attitude of habitual drug users may make differential diagnosis very difficult to establish.

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Sommario Viene descritto un caso di rabdomiolisi acuta associata ad intossicazione acuta da cocaina in un giovane HIV-positivo asintomatico e sono discussi i possibili meccanismi patogenetici del danno muscolare. Si sottolinea che una recente assunzione di cocaina deve essere considerata tra le cause di rabdomiolisi acuta senza fattori precipitanti evidenti anche nel nostro paese. L'atteggiamento tipicamente poco collaborante degli abituali consumatori di stupefacenti può rendere molto difficile il completamento della diagnosi differenziale.

     

淋巴瘤样肉芽肿病的临床与病理学特征(附1例报告)

目的探讨淋巴瘤样肉芽肿(LG)病的临床和病理学特点。方法对1例LG患者进行临床分析,并对其脑组织活检标本进行病理学和免疫组化研究。结果本例主要表现为头痛、头晕、言语不清及四肢无力;影像学检查见双侧大脑半球白质、脑桥、小脑及颈胸髓多节段的异常信号,增强扫描上述部位呈点片状强化;脑脊液蛋白及IgG轻度升高;脑组织活检证实为血管中心性、血管破坏性、伴有多种细胞浸润的肉芽肿样改变;免疫组化染色证实浸润细胞为淋巴细胞、单核吞噬细胞;原位杂交示EB病毒阳性。经放疗和糖皮质激素治疗病情缓解。结论淋巴瘤样肉芽肿病临床、实验室及影像学缺乏特征性改变,诊断依赖病理学检查。     

脑卒中患者急性肾功能衰竭与高渗透压血症相关性的研究

目的研究脑卒中并发急性肾功能衰竭(急性肾衰)与高渗透压血症的相关性及有关因素。方法总结59例脑卒中并发急性肾衰患者(急性肾衰组)和76例肾功能正常的脑卒中患者(对照组)的临床资料。将两组患者的血浆渗透压与血清肌酐值进行相关分析。用Logistic回归分析确定脑卒中并发急性肾衰的有关因素。结果平均血浆渗透压急性肾衰组[(320.98±30.63)mOsm/L]明显高于对照组[(295.49±17.7)mOsm/L](P<0.001)。平均血清肌酐急性肾衰组[(298.15±94.72)μmol/L]明显高于对照组[(93.47±33.34)μmol/L](P<0.001)。两组患者的血浆渗透压与肌酐均呈正相关(r=0.452,P<0.001)。多因素分析显示,高渗透压血症(OR=4.40,95%C I=1.91~10.14)、全身炎症反应综合征(SIRS)3~4级(OR=4.58,95%C I=2.01~10.43)、静滴甘露醇(OR=8.88,95%C I=1.74~45.27)与脑卒中患者急性肾衰有关联。结论血浆渗透压升高与脑卒中并发急性肾衰有密切关系。高渗透压血症、SIRS 3~4级和静滴甘露醇是脑卒中并发急性肾衰的联合因素或独立因素。     

麻风性神经炎的临床与病理特征(附1例报告)

目的探讨麻风性神经炎的临床与病理特点。方法分析1例麻风性神经炎患者的临床资料,对其腓肠神经活检标本进行组织病理和超微病理观察。结果本例患者的临床特点以感觉损害为主,主要表现为肢体远端麻木、疼痛,伴自主神经功能障碍,不对称性尺神经粗大;病理改变主要为神经内外膜大量淋巴细胞浸润,血管内膜增厚,管腔狭窄,管壁及周围大量淋巴及单核吞噬细胞浸润,伴有上皮样细胞形成,抗酸染色可见神经纤维内散在分布的麻风杆菌,有髓纤维几乎完全脱失,纤维组织明显增生;电镜观察发现无髓纤维轴突变性及雪旺细胞里大量麻风杆菌聚集。本例患者经氨苯砜和泼尼松治疗1年,病情好转。结论麻风性神经炎的确诊有赖于神经活检。早期治疗可减轻伤残。     

周期性瘫痪的临床与病理学特点

目的探讨周期性瘫痪(PP)的临床与病理学特点。方法分析9例PP患者的临床及病理学资料。结果9例患者临床表现均符合PP的一般表现;7例骨骼肌活检标本中,4例可见肌管聚集,少见变性肌纤维,未见坏死、再生肌纤维;电镜下见管状聚集横断面呈蜂窝状,充满糖原颗粒。结论根据临床表现及一般实验室检查,可临床诊断PP;其主要病理学改变为:大量肌纤维胞浆内管状聚集;电镜分析推测聚集的小管状物质可能为横管或肌浆网扩张形成。