横纹肌溶解症引起急性肾衰竭13例临床诊断和治疗分析

目的探讨横纹肌溶解症(RM)引起急性肾衰竭(ARF)的病因、临床特点、治疗及预后。方法回顾性分析我院收治的13例RM-ARF患者的临床表现、多种治疗效果及转归。结果13例患者治疗前血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、天门冬氨酸基转移酶(AST)、丙氨酸氨基转移酶(ALT)峰值均超过正常值5倍以上,Scr>177μmol/L。给予综合治疗、血液透析、肢体筋膜切开减压术等治疗后,存活10例(76.92%),死亡3例(23.08%)。死于多器官功能障碍综合征2例,高钾血症1例。存活者出院时均脱离透析,血肌酐和血清酶恢复正常。结论RM-ARF时常表现为少尿型,高钾血症常见;血清酶学和血肌红蛋白检测可提高RM并ARF诊断率;早期综合治疗和血液净化,血液透析治疗效果良好,存活者肾功能多可恢复。

Clinical Diagnosis and Treatment on 13 Cases of Acute Renal Failure Caused by Rhabdomyolysis

Objective To investigate the etiological factor, clinical characteristics, treatment and prognosis of acute renal failure caused by rhabdomyolysis. Method Retrospectively analyzed the clinical manifestation, varied therapeutic efficacy and turnover of acute renal failure caused by rhabdomyolysis. Result Before the treatment, the serum creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase all increased more than five times of normal, Scr >177 μmol/L; after treatment with combined therapy, hematodialysis and so on, 10 (76.92%) survived, 3(23.08%) died. After treatment, the serum creatinine and sero-enzyme of survivals all recovered. Conclusion Acute renal failure-rhabdomyolysis often display oliguresis, oliguresis; the detection of sero-enzyme and myohemoglobin can elevate diagnosis, the early combined therapy and blood purification can enhance therapeutic effect.