Paaske W P, Bagl P, Lorentzen J E, Olgaard K
Department of Vascular Surgery RK, Rigshospitalet, University of Copenhagen, Denmark.
J Vasc Surg. 1988 Jun;7(6):757-8. doi: 10.1067/mva.1988.avs0070757.
A 75-year-old man developed acute, fulminating compartment syndrome of the femoral and crural muscles together with acute toxic nephropathy caused by severe myoglobinemia after uncomplicated embolectomy of the common femoral artery. In addition to fasciotomies and administration of mannitol, sodium hydrogen bicarbonate, and furosemide, we performed plasma exchanges on three occasions. The urine and serum concentrations of myoglobin fell from above 180.0 and 50.0 mg/dl, respectively, to 0.14 and 0.11 mg/dl after the third plasma exchange on the ninth day after admission. The serum creatinine concentration was normal on admission, peaked at 2.85 mg/dl, and returned to normal values at discharge. We suggest that plasma exchange may be considered an adjunct to conventional therapy of compartment syndrome with associated acute toxic nephropathy caused by myoglobinemia.
一名75岁男性在股总动脉无并发症的栓子切除术之后，出现了股部和小腿肌肉的急性暴发性骨筋膜室综合征，并伴有严重肌红蛋白尿血症所致的急性中毒性肾病。除了进行筋膜切开术以及给予甘露醇、碳酸氢钠和呋塞米外，我们还进行了三次血浆置换。入院第九天第三次血浆置换后，尿液和血清中的肌红蛋白浓度分别从高于180.0和50.0mg/dl降至0.14和0.11mg/dl。血清肌酐浓度入院时正常，峰值为2.85mg/dl，出院时恢复至正常水平。我们建议，对于伴有肌红蛋白尿血症所致急性中毒性肾病的骨筋膜室综合征，血浆置换可被视为传统治疗的辅助手段。
