血液净化治疗横纹肌溶解症致急性肾功能衰竭19例临床分析

目的探讨多种血液净化方式治疗横纹肌溶解症并发急性肾功能衰竭的治疗效果。方法回顾性分析我院收治的19例横纹肌溶解症并发急性肾功能衰竭患者临床表现及多种血液净化的治疗效果及转归。结果建筑物崩塌4例、车祸8例,酒精中毒3例、一氧化碳中毒后僵卧2例,体能考试2例。19例患者均出现包括急性肾功能衰竭在内的2个以上器官损害。尿素氮、肌酐、尿酸、血磷、磷酸肌酸激酶、乳酸脱氢酶均明显升高。所有患者在补液、碱化尿液、利尿、维持循环功能等综合治疗的基础上行血液净化治疗,其中7例单纯血液透析(HD)治疗;6例血液透析滤过(HDF);2例行血浆置换(PE);3例血液透析串联血液灌流;1例行床边持续血液透析滤过治疗。痊愈13例,好转1例,进入替代治疗1例,死亡2例,失访2例。结论针对不同的合并症选择不同的血液净化方式利于减少并发症,提高生存率。

Clinical analysis of rhabdomyolysis leading to acute renal failure,a report of 19 cases

Objective To investigate the curative effect of different blood purification modes for rhabdomyolysiswith acute renal failure.Methods The clinical manifestation of 19 cases with rhabdomyolysis leading to acute renal failure and the curative effect were analyzed retrospectively.Results There were 4 construction collapse,8 traffic accident,3 severe alcoholism,2 drop down due to CO toxicosis and 2 physical examination.Remarkable augmentations of BUN,Cr,UA,Phos,CK and LDH in serum were observed in all cases.All patients received basic treatment of supplying liquor,urine alkalization,diuresis and circulatory function maintenance.7 cases were treated with HD,6 cases with HDF,2 cases with PE,2 cases with HD HP and 1 case with continuous bed-side hemofiltration.13 cases recovered,1 ameliorated,1 received renal replacement therapy,2 died and 2 were lost while followed up.Conclusions Choosing the right blood purification mode for miscellaneous situation and combination is of advantage to survival increase and complication decrease.