Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom.
Burns. 2011 Nov;37(7):1241-7. doi: 10.1016/j.burns.2011.05.014. Epub 2011 Jun 23.
Rhabdomyolysis (RML), defined as creatine phosphokinase (CPK) >1000 U/L, is relatively common immediately after a significant burn. Late-onset RML, occurring a week or more after a burn, is less well understood and recognised. All patients admitted to the Intensive Care Unit (ICU) following an acute burn between May 2006 and December 2009 were retrospectively identified. Patients with CPK>1000 U/L a week or more after their burn had a detailed notes review. Seventy-six patients were admitted during 43 months. Late-onset RML was demonstrated in 7/76 (9%) patients. They had a similar pattern of normal or mildly raised CPK on admission that resolved over the following days, but suddenly increased sharply to over 1000 U/L, a week or more after their burn, usually around day ten. A severe late-onset RML occurred in 5/76 (7%) patients, with a CPK rise of over 5000 U/L, and all required haemodialysis. Potential triggering factors for late-onset RML include sepsis, nephrotoxic drugs and hypophosphataemia. It is important to consider measuring CPK in all patients with the above complications, even after it has previously been observed to be normal, in order to initiate early treatment.
横纹肌溶解症（RML）定义为肌酸磷酸激酶（CPK）>1000U/L，在严重烧伤后即刻较为常见。发病时间较晚的 RML，即在烧伤后一周或更长时间发生的 RML，其发病机制和临床表现认识尚不充分。回顾性分析了 2006 年 5 月至 2009 年 12 月间入住重症监护病房（ICU）的所有急性烧伤患者。对烧伤后一周或更长时间 CPK>1000U/L 的患者进行详细病历复查。在 43 个月期间共收治 76 例患者。7/76（9%）例患者表现为迟发性 RML。这些患者入院时 CPK 表现为正常或轻度升高，数天后逐渐恢复正常，但在烧伤后一周或更长时间（通常为伤后第 10 天）突然急剧升高至>1000U/L。5/76（7%）例患者发生严重迟发性 RML，CPK 升高>5000U/L，所有患者均需要血液透析。迟发性 RML 的潜在触发因素包括感染、肾毒性药物和低磷血症。对于上述并发症患者，即使之前 CPK 正常，也应考虑测量 CPK，以便及早治疗。
