Burghi G, Berrutti D, Manzanares W
Cátedra y Centro de Tratamiento Intensivo del Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Med Intensiva. 2011 Apr;35(3):170-8. doi: 10.1016/j.medin.2010.07.014. Epub 2010 Nov 26.
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolyte metabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia, and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for the management of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic tools that allow to the ICU physician to recognize the population at high risk for developing the TLS, and outline a proper strategy for treating and preventing this serious complication.
肿瘤溶解综合征（TLS）是一种由核酸、钾和磷酸盐大量释放入血引起的危及生命的并发症。这种并发症是肿瘤细胞溶解的结果，肿瘤细胞溶解可能因对药物敏感的治疗而发生，其特征是增殖能力迅速，通常起源于血液系统。此外，由于自发的肿瘤细胞死亡，在开始治疗前即可观察到TLS，且在启动化疗时常常会恶化。TLS死亡率很高，因此其预防仍然是最重要的治疗措施。在重症监护病房（ICU），医生应了解TLS的临床特征，其会导致严重的电解质代谢紊乱，尤其是高钾血症、高磷血症和低钙血症，以及急性肾损伤，而急性肾损伤是ICU患者死亡的主要原因。一种适当的TLS管理策略，联合补液、尿酸氧化酶以及早期入住ICU，可在大多数患者中控制这种并发症。本综述的目的是提供诊断工具，使ICU医生能够识别发生TLS的高危人群，并概述治疗和预防这种严重并发症的适当策略。
