26例儿童横纹肌溶解综合征致急性肾衰竭临床分析

发布时间：2018-03-26 08:03

本文选题：横纹肌溶解综合征　切入点：急性肾衰竭　出处：《中国当代儿科杂志》2017年02期

【摘要】：目的探讨儿童横纹肌溶解综合征(RM)致急性肾衰竭(ARF)的临床特点及预后。方法对77例RM患儿中合并ARF的26例患儿的临床资料、实验室检查、治疗转归进行分析。结果合并ARF的26例RM患儿病因均为非创伤性疾病,感染(69%)、糖尿病(12%)、代谢性疾病(8%)是前3位病因。合并ARF的RM患儿出现频率前5位的临床表现包括发热(69%)、多脏器功能障碍(69%)、抽搐(46%)、少尿或无尿(35%)、茶色尿(27%)。26例合并ARF的RM患儿血肌酸激酶(CK)均1 000 IU/L,伴AST升高的26例,ALT升高的25例,CK-MB升高的25例,LDH升高23例。合并ARF的RM患儿中22例检测了血肌红蛋(Mb),均有增高。合并ARF的26例RM患儿CK降至1 000 IU/L以下的平均时间为10±5 d。常规治疗基础上接受持续静脉-静脉血液滤过治疗的10例患儿的CK恢复时间与非血液净化治疗者的差异无统计学意义(P0.05)。合并ARF的26例RM患儿中7例放弃治疗,19例肾功能均恢复正常。结论急性肾衰竭及多脏器功能障碍是儿童RM的主要并发症,合并ARF的RM患儿原发病主要是感染性疾病,CK是诊断RM的主要指标。早期诊断、合理治疗可使ARF逆转,改善预后。
[Abstract]:Objective to investigate the clinical features and prognosis of acute renal failure (ARF) caused by rhabdomyolysis syndrome in children. Results the etiology of 26 cases of RM children with ARF were all non-traumatic diseases. The clinical manifestations of RM patients with ARF include fever 69, multiple organ dysfunction 6910, convulsion 464C, oliguria or anuria 355B, brown urine 272727.2%, and 26 cases with ARF. The serum creatine kinase (CK) in RM children was 1 000 IUU / L, and in 26 patients with elevated AST, 25 patients with elevated alt and 25 patients with elevated CK-MB were elevated in 23 cases. In the RM children with ARF, 22 cases were detected for MbN in serum. 26 cases of RM children with ARF were detected. The average time for CK to fall below 1 000 IU/L was 10 卤5 days. There was no significant difference in CK recovery time between the 10 children who received continuous veno-venous hemofiltration on the basis of routine therapy and those who were not treated with blood purification therapy (P 0.05). In the 26 cases of ARF with RM, 7 cases gave up treatment and 19 cases of renal function returned to normal. Conclusion Acute renal failure and multiple organ dysfunction are the main complications of RM in children. The primary disease of RM children with ARF is the infectious disease CK is the main index for the diagnosis of RM. Early diagnosis and reasonable treatment can reverse ARF and improve the prognosis.
【作者单位】：首都医科大学附属北京儿童医院肾病科;
【分类号】：R726.8

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