血液净化治疗大负荷军事训练所致横纹肌溶解症并急性肾衰竭的多脏器功能障碍综合征

目的观察血液净化治疗大负荷军事训练所致横纹肌溶解并急性肾衰竭的多脏器功能障碍综合征（MODS）的临床效果。方法回顾性分析1988～2010年10例大负荷军事训练所致横纹肌溶解症并急性肾衰竭的MODS患者的临床资料,观察患者血液净化治疗前后尿素、肌酐、肌酸激酶及同工酶、乳酸脱氢酶、丙氨酸转氨酶、电解质、生命体征变化及预后。结果 10例均行血液净化治疗,其中4例采用单纯血液透析治疗,2例采用血液透析、血液透析滤过交替进行的方法,4例采取持续性血液净化疗法。死亡3例,痊愈出院7例。结论对于大负荷军事训练所致横纹肌溶解症并急性肾衰竭的MODS患者应尽早行血液净化治疗,特别是及时行持续性血液净化治疗可改善患者预后。

Blood Purification Therapy in Treatment of Rhabdomyolysis Induced by Over Military Training and Complicated with Multiple Organ Dysfunction Syndrome Involved in Acute Renal Failure

Objective To investigate the clinical effects of blood purification therapy and its influence on survival of patients with rhabdomyolysis induced by overtraining and complicated with multiple organ dysfunction syndrome involved in acute renal failure(OTI-RM-MODS-ARF).Methods The clinical data of 10 patients with OTI-RM-MODS-ARF who underwent blood purification therapy during 1988 and 2010 were reviewed and analyzed retrospectively,and the changes of BUN,SCr,CK,CK-MB,ALT,LDH,HBDH,K+,P+,Ca2+,CO2-CP,vital signs,and prognosis before and after the blood purification therapy were observed.Results Among the 10 patients,4 underwent pure hemodialysis,2 underwent alternative treatment of hemodialysis and hemofiltration,4 underwent continuous blood purification therapy.7 patients recovered after blood purification therapy,and 3 died from severe MODS.There were no complications during the blood purification therapy.Conclusion Blood purification therapy,especially CRRT,for treating patients with over training induced rhabdomyolysis complicated with MODS might be helpful to stabilize hemodynamics and eliminate the solution and inflammation response,with better prognosis.