Brown Carlos V R, Rhee Peter, Chan Linda, Evans Kelly, Demetriades Demetrios, Velmahos George C
Department of Surgery, Division of Trauma and Critical Care, University of Southern California and the Los Angeles County Medical Center, Los Angeles, California, USA.
J Trauma. 2004 Jun;56(6):1191-6. doi: 10.1097/01.ta.0000130761.78627.10.
The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/ MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma.
This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal,>520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion.
Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels of CK still failed to show any benefit of BIC/MAN.
Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with post-traumatic rhabdomyolysis should be reevaluated.
尽管缺乏充分证据证实其有效性，但碳酸氢盐与甘露醇联合使用（BIC/MAN）常用于预防横纹肌溶解患者的肾衰竭（RF）。本研究的目的是确定BIC/MAN对预防创伤性横纹肌溶解患者的肾衰竭是否有效。
本研究回顾了5年期间（1997年1月至2002年9月）所有入住成人创伤重症监护病房（ICU）的患者。每天检查肌酸激酶（CK）水平（异常，>520 U/L）。肾衰竭定义为肌酐大于2.0 mg/dL。患者根据外科医生的判断接受BIC/MAN治疗。
在2083例入住创伤ICU的患者中，85%的患者CK水平异常。总体而言，10%的创伤ICU患者发生了肾衰竭。CK水平为5000 U/L是与肾衰竭相关的最低异常水平；382例CK大于5000 U/L的患者中有74例（19%）发生了肾衰竭，而1701例CK小于5000 U/L的患者中有143例（8%）发生了肾衰竭（p < 0.0001）。在CK大于5000 U/L的患者中，接受BIC/MAN治疗的患者与未接受治疗的患者在肾衰竭、透析或死亡率方面没有差异。对不同CK水平组的亚分析仍未显示BIC/MAN有任何益处。
严重受伤患者中CK水平异常很常见，CK水平大于5000 U/L与肾衰竭相关。BIC/MAN不能预防CK水平大于5000 U/L的患者发生肾衰竭、透析或死亡。应对创伤后横纹肌溶解患者使用BIC/MAN的标准进行重新评估。
