老年人横纹肌溶解症的临床特点及病因分析

目的:探讨老年人横纹肌溶解症的病因、并发症与预后关系。方法:回顾性分析我院急诊科2018年1月1日至2019年12月31日横纹肌溶解患者，根据年龄分为非老年组(<65岁)及老年组(≥65岁)，对比两组患者病因分布情况、合并急性肾损伤(AKI)及其与预后的关系。结果:老年组2种及以上病因导致横纹肌溶解患者(40.3%、4...

Clinical characteristics and etiological analysis of rhabdomyolysis in the elderly

Objective To investigate the relationship of etiology and complications of rhabdomyolysis with its prognosis in the elderly.Methods Patients with rhabdomyolysis at the emergency department of our hospital from January 1,2018 to December 31,2019 were retrospectively analyzed.Based on age,patients were divided into the non-elderly group(<65 years old)and the elderly group(≥65 years old).The frequency distribution of etiological factors,concurrent acute kidney injury,and their association with prognosis were analyzed.Results The number of patients with rhabdomyolysis caused by 2 or more etiologies was higher in the elderly group than in the non-elderly group(40.3%or 48/119 vs.17.0%or 16/94,χ2=13.582,P=0.000).The frequency distribution of etiological factors was different between the two groups.The top-five etiologies were infection,muscle ischemia/hypoxia,endocrine metabolic abnormalities,trauma and muscle fatigue in the elderly group and muscle fatigue,infection,endocrine metabolic abnormalities,drugs/toxicants and trauma in the non-elderly group.Compared with the non-elderly group,the elderly group had fewer patients with typical clinical manifestations(32.8%or 39/119 vs.48.9%or 46/94,χ2=5.067,P=0.024).In contrast,patients who newly presented with disturbance of consciousness were more likely to be found in the elderly group than in the non-elderly group(40.3%or 48/119 vs.21.3%or 20/94)(χ2=7.923,P=0.005).There were 37 patients with AKI(38.9%or 37/95)in the elderly group and 13 of them died(35.1%),and there were 17 patients with AKI in the non-elderly group(19.3%or 17/88)and 4 died(23.5%),indicating the elderly were prone to AKI(χ2=7.545,P=0.006).There was a significant correlation between AKI and prognosis in the non-elderly group(χ2=7.196,P=0.007).Conclusions Rhabdomyolysis caused by multiple etiologies is more common in elderly patients than in non-elderly patients.The etiological classification of rhabdomyolysis in the elderly is different from that in the non-elderly.Elderly patients are less likely to have typical clinical manifestations and are more prone to AKI.Elderly patients with rhabdomyolysis combined with AKI have a poor prognosis.