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目的回顾横纹肌溶解综合征(RM)致急性肾损伤(AKI)的病因、临床表现和治疗转归,分析创伤性RM与非创伤性RM的特点。方法收集RM合并AKI患者51例,平均年龄为(45.0±21.1)岁,男40例,女11例;所有患者均检测血清肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、血肌红蛋白(Mb)、尿酸(UA)、尿素氮(BUN)、血清肌酐(sCr)和血电解质等;AKI患者采取综合治疗,必要时行血液净化治疗。结果创伤性RM 24例(47.1%);非创伤性RM 27例(52.9%),感染为最常见病因(占23.5%)。创伤性RM组的sCr、磷、钾水平均显著高于非创伤性RM组(P值均<0.05)。31例(60.8%)患者行血液净化治疗,1年病死率为29.4%,91.7%的存活者肾功能完全恢复。结论 RM病因多样,以感染最为常见;RM合并AKI病情重,创伤性RM较非创伤性RM更严重。RM合并AKI患者病死率高,但存活患者的肾功能恢复情况较好。
Objective To review the etiology, clinical manifestations and treatment outcome of acute renal injury (AKI) caused by rhabdomyolysis syndrome (RM) and to analyze the characteristics of traumatic and non-traumatic RM. Methods Fifty-one patients with RM and AKI were collected. The average age was (45.0 ± 21.1) years old, 40 males and 11 females. Serum creatine phosphokinase (CPK), lactate dehydrogenase (LDH) (Mb), uric acid (UA), blood urea nitrogen (BUN), serum creatinine (sCr) and blood electrolytes; AKI patients with comprehensive treatment, if necessary, blood purification treatment. Results Traumatic RM was found in 24 cases (47.1%), non-traumatic RM in 27 cases (52.9%) and infection as the most common cause (23.5%). The levels of sCr, P and K in traumatic RM group were significantly higher than those in non-traumatic RM group (all P <0.05). Thirty-one patients (60.8%) were treated with blood purification. The one-year mortality rate was 29.4%, and 91.7% survivors recovered completely. Conclusion There are many causes of RM infection with the most common infection. RM combined with AKI is more severe and traumatic RM is more serious than non-traumatic RM. Patients with AK and AKI have a high case fatality rate, but surviving patients have better renal function recovery.