横纹肌溶解致急性肾损伤的临床分析

目的探讨横纹肌溶解(RM)引起急性肾损伤(AKI)的病因、临床特点、治疗及预后。方法对21例RM致AKI患者进行回顾性分析。结果 21例患者中,13例出现无尿、少尿及茶色尿;7例出现高钾血症,血肌红蛋白升高,肌酸磷酸激酶升高,乳酸脱氢酶升高,血肌酐升高。经过血液净化等综合治疗,17例(81.0%)患者存活,4例(19.0%)患者死于多器官衰竭;存活者出院时均脱离透析,血清酶均恢复正常,15例血肌酐恢复正常。结论 RM病因多样,大多为非创伤性,临床上不易发现,血清肌酶和血生化检测可提高诊断率,早期诊断、充分血液净化等综合治疗,可提高治愈率和改善预后,降低死亡率。

Clinical analysis of patients with acute kidney injury caused by rhabdomyolysis

Objective To investigate the etiological factor,clinical characteristics,treatment and prognosis of acute kidney injury caused by rhabdomyolysis.Methods Retrospectively analysis was carried for 21 patients with rhabdomyolysis related with acute kidney injury.Results Among these 21 cases,there were 13 patients with anuria,oliguria and tea-colored urine,7 patients with hyperkalemia,increased serum myohemoglobin,increased creatine phosphokinase,increased lactic dehydrogenase,serum creatinine.After the treatments with combined therapy,including blood purification and other treatments,17(81.0%) patients survived and 4(19.0%) died of multiple organ dysfunction syndrome.All survivors were out of dialysis at discharge,serum enzymes were back to normal,15 cases of creatinine returned to normal.Conclusions Rhabdomyolysis has various etiological factors,most pathogenesis are non-traumatic,it is not easily founded in clinic.The levels of sero-enzymes and serum myohemoglobin can raise the diagnosis rate.Early diagnosis,comprehensive treatment,including effective blood purification,can improve the curative effect and prognosis,lower the mortality rate.