Welch R D, Todd K, Krause G S
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Ann Emerg Med. 1991 Feb;20(2):154-7. doi: 10.1016/s0196-0644(05)81215-6.
Rhabdomyolysis is a common complication of cocaine use, and muscle symptoms fail to predict its development.
A prospective, convenience sample of patients presenting to the emergency department of a large inner-city hospital with complaints related to cocaine use were eligible for inclusion. Patients were excluded if they had other potential causes of elevated creatine kinase (CK) levels or rhabdomyolysis. A control group comprised patients who were not cocaine users and satisfied the exclusion criteria. Sixty-eight patients were studied.
Initial evaluation included determination of the presence of muscle pain or swelling and total CK levels. Patients with a CK level of more than 800 U/L had additional tests, including a urine myoglobin, urine drug screen, and serum phosphorus. Rhabdomyolysis was defined by a serum CK level of more than 1,000 U/L (more than fivefold that of normal). CK levels were compared by two-tailed Student's t test. Muscle symptoms were compared with the development of rhabdomyolysis by Fisher's exact test.
The CK level in the cocaine group was 931 +/- 1,785 U/L (mean +/- 1 SD). The CK level in the control group was 242 +/- 168 U/L (P = .028). Of the cocaine users, 24% (eight of 34) had rhabdomyolysis; one developed multiorgan failure and died. No patient in the control group had a CK level of more than 1,000 U/L. Only one cocaine user who developed rhabdomyolysis had muscle symptoms. Three cocaine users had muscle symptoms but did not develop rhabdomyolysis. No patient in the control group had muscle symptoms or developed rhabdomyolysis. Muscle symptoms did not predict the CK level (P = .55).
This study revealed that 24% of the cocaine users had rhabdomyolysis. Many of the cases of rhabdomyolysis were not predictable from history or physical examination, making laboratory evaluation essential.
横纹肌溶解是可卡因使用的常见并发症，肌肉症状无法预测其发生。
在一家大型市中心医院急诊科就诊的、主诉与可卡因使用相关的患者组成的前瞻性便利样本符合纳入标准。如果患者有其他导致肌酸激酶（CK）水平升高或横纹肌溶解的潜在原因，则被排除。对照组由非可卡因使用者且符合排除标准的患者组成。共研究了68例患者。
初始评估包括确定是否存在肌肉疼痛或肿胀以及CK总水平。CK水平超过800 U/L的患者进行额外检查，包括尿肌红蛋白、尿液药物筛查和血清磷检测。横纹肌溶解的定义为血清CK水平超过1000 U/L（超过正常水平的五倍）。CK水平采用双尾Student t检验进行比较。肌肉症状与横纹肌溶解的发生情况采用Fisher精确检验进行比较。
可卡因组的CK水平为931±1785 U/L（平均值±1标准差）。对照组的CK水平为242±168 U/L（P = 0.028）。在可卡因使用者中，24%（34例中的8例）发生了横纹肌溶解；1例出现多器官功能衰竭并死亡。对照组中没有患者的CK水平超过1000 U/L。只有1例发生横纹肌溶解的可卡因使用者有肌肉症状。3例可卡因使用者有肌肉症状但未发生横纹肌溶解。对照组中没有患者有肌肉症状或发生横纹肌溶解。肌肉症状不能预测CK水平（P = 0.55）。
本研究表明，24%的可卡因使用者发生了横纹肌溶解。许多横纹肌溶解病例无法通过病史或体格检查预测，因此实验室评估至关重要。
