摘要 目的比较不同血液净化模式在横纹肌溶解症(RM)治疗中的疗效。方法回顾性分析中南大学湘雅三医院肾内科2013年1月至2019年1月收治的56例RM患者的临床特点,其中男性38例,女性18例;年龄1岁~85岁,平均年龄(37.2±18.4)岁,收集患者的发病诱因、临床症状、实验室检查、治疗方式(包括血液净化、激素、抗氧化、碱化尿液)及预后等相关信息,比较连续血液滤过(CVVH)组、血液灌流(HP)组及CVVH+HP组3种不同血液净化模式下,患者的预后、肾功能[肌酐(Crea)]及肌酶学[磷酸肌酸激酶(CK)、肌红蛋白(MB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)及乳酸脱氢酶(LDH)]水平的变化。结果3种血液净化模式治疗后,患者好转出院率均达80%以上。与治疗前比较,3种模式治疗后CK、MB、AST、ALT、LDH水平均明显下降,CVVH组:[CK(2247±572)U/L比(44940±17494)U/L;MB(465±138)U/L比(3323±1329)U/L;AST(318±109)U/L比(837±284)U/L;ALT(201±180)U/L比(315±287)U/L;LDH(725±199)U/L比(2591±788)U/L]。HP组:[CK(1265±633)U/L比(40859±16239)U/L;MB(339±130)U/L比(2612±1012)U/L;AST(200±68)U/L比(666±271)U/L;ALT(118±82)U/L比(190±173)U/L;LDH(435±159)U/L比(1741±722)U/L]。CVVH+HP组:[CK(555±120)U/L比(27749±11329)U/L];MB(220±60)U/L比(2204±1080)U/L];AST(245±87)U/L比(1228±877)U/L;ALT(554±221)U/L比(965±853)U/L];LDH(304±88)U/L比(2028±786)U/L]。肾功能改善CVVH组:Crea(297±124)μmoL/L比(309±112)μmoL/L;HP组:Crea(150±87)μmoL/L比(165±95)μmoL/L;CVVH+HP组:Crea(175±103)μmoL/L比(184±65)μmoL/L],差异有统计学意义(P均<0.05),且CVVH+HP组的肌酶学水平下降更明显;但组间比较的差异无统计学意义(P>0.05)。结论RM的病因多样,临床表现以肌肉疼痛、肌无力、肌红蛋白尿最常见,AKI是其常见的合并症,CVVH、HP、CVVH+HP可有效治疗RM及其并发症,改善患者预后。 Objective To compare the effects of different blood purification modes in the treatment of rhabdomyolysis(RM).Methods A retrospective analysis was performed on the clinical characteristics of 56 RM patients admitted to the Department of Nephrology,Xiangya Third Hospital,Central South University from January 2013 to January 2019,including 38 males and 18 females.The age ranged from one-year-old to 85 years,with an average age of(37.2±18.4).Information on the etiology,clinical symptoms,laboratory tests,treatment(including blood purification,hormones,antioxidant and alkaline urine)and prognosis of the patients were collected.In three different blood purification groups[continuous veno-venous hemofiltration(CVVH),and blood perfusion(HP)and CVVH+HP],the prognosis of patients,kidney/creatinine(Crea)and muscle enzymology[creatine phosphate kinase(CK),myoglobin(MB),aspertate aminotransferase(AST),alanine aminotransferase(ALT)and lactate dehydrogenase(LDH)]level changes were compared.Results After the three modes of blood purification,the discharge rate of patients was improved(more than 80%).Compared with that before treatment,the CK,MB,AST,ALT and LDH levels were significantly decreased:CVVH[CK(2247±572)U/L vs.44940±17494)U/L;MB(465±138)U/L vs.(3323±1329)U/L;AST(318±109)vs.(837±284)U/L;ALT(201±180)U/L vs.(315±287)U/L;LDH(725±199)U/L vs.(2591±788)U/L].HP:[CK(1265±633)U/L vs.(40859±16239)U/L;MB(339±130)U/L vs.(2612±1012)U/L;AST(200±68)U/L vs.(666±271)U/L;ALT(118±82)U/L vs.(190±173)U/L;LDH(435±159)U/L vs.(1741±722)U/L].CVVH+HP:[CK(555±120)U/L vs.(27749±11329)U/L];MB(220±60)U/L vs.(2204±1080)U/L];AST(245±87)U/L vs.(1228±877)U/L;ALT(554±221)U/L vs.(965±853)U/L];LDH(304±88)U/L vs.(2028±786)U/L],and the renal function improved[CVVH:Crea(297±124)vs.(309±112)μmoL/L;HP:Crea(150±87)vs.(165±95)μmoL/L;CVVH+HP:Crea(175±103)vs.(184±65)μmoL/L];the difference before and after treatment was statistically significant(All P<0.05).CVVH+HP group showed a more significant decrease in myosinase level.How
机构地区 中南大学湘雅三医院肾内科
出处 《中华卫生应急电子杂志》 2020年第6期332-336,共5页 Chinese Journal of Hygiene Rescue:Electronic Edition
关键词 横纹肌溶解 急性肾损伤 连续性血液滤过 血液灌流 Rhabdomyolysis Acute kidney injury Continuous veno-venous hemofiltration Blood perfusion
分类号 R47 [医药卫生—护理学]
