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目的探讨早期连续性血液滤过治疗横纹肌溶解综合征(RM)并发急性肾衰竭(ARF)对疾病转归的影响。方法 RM-ARF患者23例,检测血清肌酶(肌酸磷酸激酶CPK、乳酸脱氢酶LDH)、血肌红蛋白(Mb)以及血电解质、肝功能、肾功能(BUN、SCr)、血尿酸(UA)、血气分析和DIC全套、胸片、B超、心电图等。23例均予以连续性静脉-静脉血液滤过(CVVH),3d后改行间隔性血液透析(IHD),同时采用综合治疗方案。观察CVVH治疗前及治疗48h后血常规、CPK、血肌红蛋白、肝肾功能、电解质改变。对于并发筋膜间室综合征患者,观察肢体肿胀及疼痛程度变化。结果 22例肾功能均完全恢复,3例并发筋膜间室综合征,经CVVH治疗48h后,肢体肿胀迅速消退,疼痛明显减轻。2例并发MODS,其中1人死亡。血BUN、SCr、K、WBC、CK和肌红蛋白均较前明显下降(P<0.01),其中CK及肌红蛋白下降最为明显,肌红蛋白接近正常水平。结论 ARF是RM的严重并发症,早期发现并予积极预防是防治ARF的关键。连续性血液净化治疗可以有效清除血液中的肌红蛋白及炎性介质,改善了ARF的预后。
Objective To investigate the effect of early continuous hemofiltration on the outcome of patients with rhabdomyolysis syndrome (AR) complicated with acute renal failure (ARF). Methods Twenty-three patients with RM-ARF were enrolled in this study. Serum muscle enzymes (creatine phosphokinase CPK, lactate dehydrogenase LDH, Mb), blood electrolytes, liver function, renal function (BUN, SCr) UA), blood gas analysis and a full set of DIC, chest X-ray, B ultrasound, ECG and so on. All 23 patients were given continuous venovenous hemofiltration (CVVH). Intervals of hemodialysis (IHD) were switched after 3 days, and combined treatment was given. Observed before CVVH treatment and after 48h treatment of blood, CPK, hemoglobin, liver and kidney function, electrolyte changes. For patients with compartment syndrome, observation of limb swelling and pain changes. Results All 22 cases of renal function recovered completely, and 3 cases had compartment syndrome. After 48 hours of CVVH treatment, limb swelling quickly subsided and pain was relieved. 2 cases complicated with MODS, 1 of them died. The levels of BUN, SCr, K, WBC, CK and myoglobin in blood decreased significantly (P <0.01), especially in CK and myoglobin, and myoglobin was close to the normal level. Conclusion ARF is a serious complication of RM. Early detection and prevention of ARF is the key to prevention and treatment of ARF. Continuous blood purification treatment can effectively remove the blood of myoglobin and inflammatory mediators, improve the prognosis of ARF.