Janković Snezana R, Stosić Jasmina Jović, Vucinić Slavica, Vukcević Natasa Perković, Ercegović Gordana Vuković
Institute for Scientific Information, Military Medical Academy, Belgrade, Serbia.
Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade, Serbia.
Vojnosanit Pregl. 2013 Nov;70(11):1039-45. doi: 10.2298/vsp1311039j.
BACKGROUND/AIM: Rhabdomyolysis (RM) is potentially lethal syndrome, but there are no enough published data on its frequency and characteristics in acute poisonings. The aim of this study was to determine the causes and severity of RM in acute poisonings.
Patients hospital charts were retrospectively screened during a one-year period in order to identify patients with RM among 656 patients treated due to acute poisonings with different agents. All the patients with RM were selected. Entrance criterion was the value of creatine kinase (CK) over 250 U/L. The severity of RM was assessed according to the Poison Severity Score. The patients were divided into three groups: the first one with mild RM (CK from 250 to 1,500 U/L), the second with moderate RM (CK from 1,500 to 10,000 U/L) and the third with severe RM (CK greater than 10,000 U/L).
RM occurred in 125 (19%) of the patients with acute poisonings. It was mainly mild (61%), or moderate (36%), and only in 3% of the patients was severe RM. The incidence of RM was the highest in poisonings with opiates (41%), pesticides (38%), neuroleptics (26%), anticonvulsants (26%), ethyl alcohol (20%), and gases (19%). Psychotropic agents were the most common causes of poisoning, and consequently of RM. Fatal outcomes were registered in 32 (25.60%) of all RM patients. The incidence of fatal outcomes in poisonings with mild, moderate and severe RM was 19.73%, 31.11% and 75%, respectively.
RM syndrome occurs at a relatively high rate in acute poisonings. Although agent's toxicity is crucial for the outcome, severe RM and its complications may significantly influence the clinical course and prognosis of poisoning. Routine analysis of CK, as a relevant marker for RM may indicate the development of RM in acute poisoning and initiate prompt therapeutic measures in preventing acute renal failure as the most frequent consequence of extensive rhabdomyolysis.
背景/目的：横纹肌溶解症（RM）是一种潜在致命性综合征，但关于其在急性中毒中的发生率和特征，尚无足够的公开数据。本研究的目的是确定急性中毒中RM的病因和严重程度。
回顾性筛查了一年期间患者的住院病历，以便在656例因不同毒物急性中毒而接受治疗的患者中识别出患有RM的患者。所有患有RM的患者均被纳入。入选标准为肌酸激酶（CK）值超过250 U/L。根据中毒严重程度评分评估RM的严重程度。患者分为三组：第一组为轻度RM（CK为250至1500 U/L），第二组为中度RM（CK为1500至10000 U/L），第三组为重度RM（CK大于10000 U/L）。
125例（19%）急性中毒患者发生了RM。主要为轻度（61%）或中度（36%），仅3%的患者为重度RM。RM的发生率在阿片类药物中毒（41%）、农药中毒（38%）、抗精神病药物中毒（26%）、抗惊厥药物中毒（26%）、乙醇中毒（20%）和气体中毒（19%）中最高。精神药物是中毒以及RM最常见的病因。所有RM患者中有32例（25.60%）出现了致命结局。轻度、中度和重度RM中毒患者的致命结局发生率分别为19.73%、31.11%和75%。
RM综合征在急性中毒中发生率相对较高。尽管毒物的毒性对结局至关重要，但重度RM及其并发症可能会显著影响中毒的临床病程和预后。作为RM相关标志物的CK常规分析，可能提示急性中毒中RM的发生，并启动及时的治疗措施以预防急性肾衰竭这一广泛横纹肌溶解最常见的后果。
