横纹肌溶解及其导致急性肾衰竭的临床诊治.doc

文档介绍：横纹肌溶解及其导致急性肾衰竭的临床诊治
作者:张日欣,王立明,于健,王澍,苗健,罗福文,高振明,杨丽,梁锐
【摘要】目的探讨横纹肌溶解(RM)及其导致急性肾衰竭(ARF)的病因、发病机制及临床治疗方法。方法对1例RM-ARF患者的临床资料结合文献加以分析总结。结果此例患者因大量饮酒导致长时间昏睡,持续压迫左胸及左肩部肌肉而诱发RM-ARF,通过大量补液治疗低血容量休克,碱化尿液、血液透析治疗RM-ARF,本例患者痊愈。结论本例患者RM-ARF的发病具有急性酒精中毒及骨骼肌长时间受压而致局部肌肉发生缺血再灌注损伤这两个诱因,而早期诊断、及时应用血液滤过治疗是本例患者获得良好疗效的关键。
【关键词】横纹肌溶解;急性肾衰竭;血液滤过
Clinical treatment on rhabdomyolysis with acute renal failure
[Abstract] Objective To investigate the etiology,pathogenesy and treatment in patient with rhabdomyolysis (RM) complicated with acute renal failure (ARF).Methods Analysis of the clinical date of one bined with literatures were made for patients with RM- The patient who had bulk drinking and long time deep slumber had pressed led to RM- principle management of RM was generous fluid replacement to prevent hypovolemia shock and alkalified was used for treatment of This patient because of bulk drinking and long time deep slumber had pressed to RM- diagnosis and hemofiltration treatment in time are the key point of this case to get favorable effect.
[Key words] rhabdomyolysis;acute renal failure;hemofiltration
横纹肌溶解(RM)是指各种原因导致的肌纤维(骨骼肌+平滑肌)坏死溃解,肌细胞内容物释放入血最后从尿中排出的综合征[1,2]。临床表现为患处肌痛、肌肉肿胀;解棕色尿;常继发急性肾衰竭而危及患者生命[3,4]。有研究显示RM有很高的死亡率(3%~27%),当RM继发急性肾衰竭等多器官功能衰竭时的死亡率超过50%[5],因此对该病及时准确的诊断和治疗对患者的预后有重要的意义。本文对我院收治的1例RM-ARF患者的临床资料结合文献探讨如下。
1 临床资料