5例非创伤性横纹肌溶解症的救治分析

横纹肌溶解症常由挤压综合征引起,是各种原因引起的横纹肌破坏与细胞膜完整性改变,细胞内容物释放入血引起的代谢紊乱及脏器功能损害的一组综合征.按病因可分为创伤性和非创伤性横纹肌溶解症(non-traumatic rhabdomyolysis,NRM).前者多发生在战时、地震、塌方、交通事故等灾害;而后者常发生在和平时期,临床经常被遗漏.近年来报道非创伤性所致的横纹肌溶解症逐渐增多[1-5].现将近几年收集的5例非创伤性横纹肌溶解症致急性肾功能衰竭的病例,结合文献和笔者的体会,报道如下.     

横纹肌溶解症所致的急性肾功能衰竭：附16例分析及文献复习

本文通过16例分析,发现酒醉的长期僵卧是我国非创伤性横纹肌溶解症所致急性肾衰的主要病因,病人入院较晚,多数入院己有肌肉肿胀,疼痛等表现,与国外报告不一。充分碱化尿液可防治急性肾衰发生,一旦发生急性肾衰,早期连续多次血透较重要,病人若伴有多系统损害时预后较差。文章通过复习国外近期文献,结合病例介绍了最新研究进展及临床工作中应注意的问题。     

一氧化碳中毒致非创伤性横纹肌溶解症并发急性肾功能衰竭5例

一氧化碳中毒致非创伤性横纹肌溶解症并发急性肾功能衰竭５例徐辉朱旭光非创伤性横纹肌溶解症（ＮＲＭＬ）多因剧烈运动、低钾性麻痹、吸毒及饮酒过量等所致，对此国内外已有较多的报道，但因急性一氧化碳（ＣＯ）中毒导致ＮＲＭＬ，尤其并发急性肾功能衰竭（ＡＲＦ），却...     

感染致非创伤性横纹肌溶解症并急性肾衰2例分析

由感染导致的非创伤性横纹肌溶解症引起的急性肾衰临床较少见，属特殊类型的急性肾衰，作者遇到2例，现报导如下。     

他汀类药致急性横纹肌溶解症并肾功能衰竭

急性横纹肌溶解症(RM)由Meyer Betz在1891年首次报道,早期认为该病主要由创伤造成,20世纪70年代后认识到卒中、中毒及感染等非创伤因素亦可致RM。我院近年收治2例因服用他汀类药物致横纹肌溶解症并肾功能衰竭(肾衰)的病例,现报告如下。     

有关非创伤性横纹肌溶解症的几个问题

近年来非创伤性横纹肌溶解症相当多见,日益认识到是急性肾功能衰竭的一个原因,在临床上较为重要,本文就此症在临床上有关的几个问题进行讨论。 (一)病因方面至今被确认为非创伤性横纹肌溶解症的病因约有50种,主要分为以下各类,这些原因能给有本症可疑的病例提供线索。     

1例肺部感染致横纹肌溶解症病人的护理

横纹肌溶解症(rhabdomyolysis,RML)是指任何原因引起的广泛横纹肌细胞坏死,其直接后果是肌细胞内容物外漏至细胞外液及血液循环中,并可导致急性肾功能衰竭(ARF)、电解质紊乱等一系列并发症,有时病情凶险,预后差[1].RML病因极其广泛而复杂,分为创伤性和非创伤性,创伤性因素包括挤压综合征、过度运动、强体力活动、肌肉缺血、烧伤等.非创伤性因素包括:药物、中毒、感染、内分泌及代谢紊乱、遗传性及自身免疫性疾病等[2].我科于2011年5月收治1例因肺部感染引起的横纹肌溶解症病人,现报道如下.     

非创伤性横纹肌溶解症的病因及其护理

综述了非创伤性横纹肌溶解症的病因及护理进展。     

非创伤性横纹肌溶解症的病因及其护理

综述了非创伤性横纹肌溶解症的病因及护理进展.     

运动性横纹肌溶解症致急性肾功能损伤3例报告及

目的探讨运动性横纹肌溶解症致急性肾功能损伤的病因、临床特点、诊断、治疗及预后。方法回顾性分析收治的3例运动性横纹肌溶解症致急性肾功能损伤患者的临床资料。结果患者表现肌肉酸痛,血清酶学、尿素氮、肌酐明显升高,病情轻者予以补液,病情重者予以血液净化,经治疗后血清酶学及血肌酐恢复正常,脱离透析,预后好。结论对于运动性横纹肌溶解症致急性肾功能损伤,早期预防,及时诊断,早期血液净化治疗,是提高生存率的关键。     

Rhabdomyolysis and acute renal failure following an ethanol and diphenhydramine overdose

OBJECTIVE: To report a case of nontraumatic rhabdomyolysis complicated by oliguric, acute renal failure following an intentional overdose of ethanol and diphenhydramine. CASE SUMMARY: A 21-year-old white man was admitted through the emergency department following an intentional overdose of ethanol and diphenhydramine. The patient subsequently developed acute renal failure, and a diagnosis of nontraumatic rhabdomyolysis was made. With the absence of other common causes in this case, the rhabdomyolysis was believed to be due to the combined ethanol and diphenhydramine overdose. DISCUSSION: Rhabdomyolysis is a severe and life-threatening syndrome caused by various insults to skeletal muscle, including drug-induced injury. Early detection and institution of effective treatments are essential to minimizing the complications of this syndrome. A delay in establishing the diagnosis in this case likely contributed to the severity of the renal failure. CONCLUSIONS: Nontraumatic rhabdomyolysis is an uncommon adverse outcome of drug and toxin ingestion. Due to the potential severity of the complications of this syndrome and the importance of early recognition and treatment to prevent renal failure, clinicians should have a high index of suspicion for rhabdomyolysis following overdoses that involve alcohol or antihistamines.     

横纹肌溶解症并发急性肾功能衰竭患者的护理

目的探讨横纹肌溶解症(rhabdomyolysis,RM)合并急性肾功能衰竭(acute renal failure,ARF)患者的护理方法。方法回顾性分析2010年以来第二军医大学长征医院收治的7例RM致ARF患者的临床资料,并总结其护理方法。结果所有患者均于发病48～72h内接受透析治疗。通过治疗与护理,所有患者各项肾功能指标均恢复正常,尿量增多,痊愈出院。结论加强晚夜间血液透析(hemodialysis,HD)的护理,对ARF患者的治疗具有一定的必要性与积极意义。     

Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management.

Acute renal failure related to exertional rhabdomyolysis is a medical condition that, if not diagnosed correctly and treated aggressively, can lead to serious dysfunction and may result in death. Although the history is invaluable in diagnosing this condition, it must be confirmed by laboratory testing. The sometimes subtle manifestations of exertional (nontraumatic) rhabdomyolysis make it mandatory that the health care team is able to recognize the signs and symptoms and understand the pathophysiology for prompt treatment and referral.     

Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome

An outbreak of severe acute respiratory syndrome (SARS) occurred in Taiwan in 2003. SARS complicated with rhabdomyolysis has rarely been reported. This study reported three cases of rhabdomyolysis developing during the clinical course of SARS. Thirty probable SARS patients were admitted to the isolation wards at Linkou Chang Gung Memorial Hospital between 4 April and 4 June 2003. Thirty patients, including four men and 26 women aged from 12 to 87 years (mean age 40). Eleven (36.7%) patients had respiratory failure and required mechanical ventilation with paralytic therapy; three (10%) patients had rhabdomyolysis complicated with acute renal failure and one received haemodialysis; four (13.3%) patients died. Three cases with rhabdomyolysis all received sedative and paralytic therapy for mechanical ventilation. Haemodialysis was performed on one patient. Two patients died from multiple organ failure, and one patient fully recovered from rhabdomyolysis with acute renal failure. SARS is a serious respiratory illness, and its aetiology is a novel coronavirus. Rhabdomyolysis resulting from SARS virus infection was strongly suspected. Immobilisation under paralytic therapy and steroids may also be important in developing rhabdomyolysis.     

连续性血液滤过治疗横纹肌溶解症致急性肾损伤患者的效果观察及护理

目的探讨连续性血液滤过治疗横纹肌溶解症致急性肾损伤(akiacutekidneyinjury,AKI)患者的效果及总结护理经验。方法对10例横纹肌溶解症致AKI患者采用连续性血液滤过治疗及相应的护理措施。结果经过治疗,10例患者中有7例肾功能恢复正常,治愈出院;2例病情好转出院;1例需要长期维持性血液透析治疗。治疗后患者血清肌酸磷酸激酶(creatine phosphate kinase,CPK)、肌红蛋白(myoglobin,Mb)、尿素氮(urea nitrogen,BUN)、肌酐(creatinine,Scr)、天门冬氨酸氨基转移酶(aspartate amino transferase,AST)浓度逐渐下降,血K+恢复至正常水平,尿量逐渐增多恢复至正常,治疗前后比较,均P0.05,差异具有统计学意义。结论连续性血液滤过治疗及相应的护理对保证连续性血液滤过治疗的效果,改善横纹肌溶解症预后有着重要意义。     

梗阻性急性肾衰的腔内微创治疗

目的：探讨输尿管结石梗阻导致急性肾功能衰竭的急诊微创治疗方法和效果。方法：对1998年2月～2002年3月收治的42例输尿管结石梗阻致急性肾功能衰竭的患者，急诊行输尿管镜下气压弹道碎石、留置双J管等腔内技术治疗。结果：42例均临床痊愈，疗效满意。结论：腔内技术创伤小、恢复快、安全高效，可同时处理双侧输尿管梗阻，可作为目前治疗梗阻性急性肾功能衰竭的首选方法。     

Rhabdomyolysis: two pediatric case reports

We report two pediatric cases of rhabdomyolysis. This disease involves the destruction of skeletal muscle, which can present with myalgia and a brown-pigmented urine. The first patient presented with acute renal failure, hypertension, and hyponatremia. The second patient was pyrexic, hypernatremic, and hypokalemic, and later developed hypertension. Evidence of rhabdomyolysis in both patients included dark, o-tolidine-positive urine, granular casts in the urinary sediment, and grossly increased activities of creatine kinase (greater than 60 000 U/L) in serum. An uncommonly recognized entity in the pediatric age group, rhabdomyolysis often presents as an acute disease with severe onset but can be diagnosed with relatively simple laboratory tests.     

Fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure due to nephrotic syndrome: a rare case report

ObjectivesFenofibrate is a fibric acid derivative that is used alone or combination with statins in the treatment of hyperlipidemia. These drugs have potential risks, including rhabdomyolysis and acute renal failure. Despite reports of rhabdomyolysis with the use of fenofibrate alone or with statin-fibrate combinations, there have been no cases of rhabdomyolysis described when fenofibrate was used alone to treat patients with chronic renal failure owing to nephrotic syndrome.Design and methodsWe report on a 26-year-old male who presented with fenofibrate-induced rhabdomyolysis with chronic renal failure due to nephrotic syndrome.ResultsAfter the discontinuation of fenofibrate, the patient was treated with intravenous fluid replacement and urine alkalization. Subsequently, his clinical and biochemical findings improved.ConclusionsBefore starting fenofibrate therapy, the causes of secondary hyperlipidemia, especially nephrotic syndrome, should be investigated. In the presence of chronic renal failure and hypoalbuminemia, the fenofibrate dose should be adjusted. Physicians should be aware of the potential toxicities of fenofibrate, and patients should be informed about its potential side effects.     

Severe rhabdomyolysis following a viral illness: A case report and review of the literature

Rhabdomyolysis is a syndrome often associated with alcohol and drug abuse. It may also be seen following viral infections, but is a complication not often considered. We report a case of severe rhabdomyolysis following an influenza-like illness. Despite the extreme elevation of creatinine phosphokinase, 230,600 IU/L, this patient did not develop acute renal failure in contrast to most of the previously documented case reports of rhabdomyolysis associated with influenza virus. This case report illustrates the difficulty in predicting which patients are at risk for developing acute renal failure and emphasizes the need for aggressive treatment of any patient, suspected of having rhabdomyolysis.     

输尿管镜技术治疗输尿管结石致孤立肾急性肾功能衰竭

目的探讨输尿管结石致孤立肾急性肾功能衰竭的治疗方法。方法采用输尿管镜直视下气压弹道碎石或将结石推回肾盂等方法治疗输尿管结石梗阻致孤立肾肾功能衰竭16例。结果16例均临床治愈,疗效满意。结论应用输尿管镜技术治疗输尿管结石致孤立肾急性肾功能衰竭,具有疗效可靠、安全、损伤小的优点,有条件者可作为首选方法。