持续性肾脏替代疗法治疗横纹肌溶解征的时机选择

目的:探讨早晚期应用持续性肾脏替代疗法(CRRT)治疗横纹肌溶解征(RM)的临床效果。方法:回顾性分析43例接受CRRT治疗的RM患者的临床资料,根据患者发病到开始进行CRRT治疗的时间分为早期组和晚期组,其中早期组22例,发病起至肌酸磷酸激酶(CPK)升高超过5万U/L或者较入院时升高3倍以上时行CRRT治疗;晚期组21例,发病起至出现急性肾损伤(AKI)时行CRRT治疗。比较其治疗前、后的血肌红蛋白(Mb)、CPK、肌酐(SCr)、尿素氮(BUN)等指标和急性生理与慢性健康评分(APACHEⅡ)的变化,探讨应用CRRT治疗RM的时机及对预后的影响。结果:早期组的死亡率和平均住院日均明显低于晚期组[9. 1%vs 33. 3%;(18. 5±5. 8) d vs(27. 8±4. 7) d,均P 0. 05];经过CRRT治疗后,早期组血Mb、CPK、SCr、BUN等各指标亦明显低于晚期组(P 0. 05)。结论:早期CRRT治疗RM效果更显著。

Rhabdomyolysis treated by continuous renal replacement therapy in different periods

Objective: To study the clinical effect of continuous renal replacement therapy (CRRT) to treat rhabdomyolysis (RM) during the early and late stages. Methods: Clinical data of 43 patients with RM undergoing CRRT were retrospectively analyzed. According to the time period from the onset of RM to CRRT, the patients were divided into early group (CRRT was given when the CPK went up over 50000 U or it was 3 times higher than that at admission) (n=22), and late group (CRRT was given when acute kidney injury occurred) (n=21). The changes in Mb, CPK, SCr, and BUN, and APACHE II scores were analyzed before and after CRRT to explore the appropriate opportunity using CRRT for RM. Results: The mortality was significantly lower and the average hospital stay was significantly shorter in the early group than in the late group [ 9.1% vs. 33.3%; (18.5±5.8) d vs. (27.8±4.7) d]. After the therapy, Mb, CPK, SCr and BUN in the early group were significantly lower than those in the late group (P<0.05). Conclusion: Early CRRT is more effective in treating RM.