Yuan Shi-Yang, Xie Kai-Fan, Yang Jian
Department of Critical Care Medicine, Nanping First Hospital Affiliated to Fujian Medical University, Nanping 353000, Fujian Province, China.
Department of Respiratory Medicine, 907 Hospital of the Joint Logistics Team, Nanping 353000, Fujian Province, China.
World J Clin Cases. 2021 Apr 26;9(12):2838-2844. doi: 10.12998/wjcc.v9.i12.2838.
Rhabdomyolysis is a serious complication of heat stroke. Unlike that in acute kidney injury, the risk of muscle bleeding in rhabdomyolysis is often ignored and can substantially increase the widespread use of anticoagulants, leading to the formation of intramuscular hematoma.
During the summer, a middle-aged man and an elderly man were diagnosed with heat stroke, rhabdomyolysis, and acute renal impairment. Low-dose enoxaparin sodium was initiated for prophylaxis of deep vein thrombosis after the disease was stabilized with continuous renal replacement therapy. After that, the patients' hemoglobin decreased progressively, and no obvious intracranial, thoracic, digestive, or skin bleeding tendency was found. However, one of the patients had hip muscle pain, and computed tomography and color ultrasound confirmed that the patients separately had lumbar back and hip intermuscular hematoma. After discontinuation of anticoagulant drugs and monitoring of the steady increase in hemoglobin, the intermuscular hematomas were gradually absorbed. Following the use of prophylactic anticoagulation therapy, the patients' hemoglobin showed a progressive downward trend. Hematoma formation in the lumbosacral and buttock muscles was confirmed after excluding bleeding in typical regions (such as the digestive tract, thoracic cavity, and abdominal cavity). Anticoagulant drugs were discontinued immediately, and nutritional support was increased. Subsequently, the hemoglobin levels gradually increased, and the hematoma volumes gradually decreased.
Patients with rhabdomyolysis have a risk of muscle bleeding, and inappropriate use of anticoagulants may lead to an increased risk or even to the formation of an intermuscular hematoma. When continuous blood loss is found in the body, the possibility of bleeding in the muscles and more typical sites should be considered.
横纹肌溶解是中暑的一种严重并发症。与急性肾损伤不同，横纹肌溶解症中肌肉出血的风险常被忽视，这可能大幅增加抗凝剂的广泛使用，导致肌内血肿形成。
夏季，一名中年男性和一名老年男性被诊断为中暑、横纹肌溶解症和急性肾功能损害。在通过持续肾脏替代疗法使病情稳定后，开始使用低剂量依诺肝素钠预防深静脉血栓形成。此后，患者血红蛋白逐渐下降，未发现明显的颅内、胸腔、消化道或皮肤出血倾向。然而，其中一名患者出现髋部肌肉疼痛，计算机断层扫描和彩色超声证实患者分别患有腰背部和髋部肌间血肿。停用抗凝药物并监测血红蛋白稳步上升后，肌间血肿逐渐吸收。在使用预防性抗凝治疗后，患者血红蛋白呈逐渐下降趋势。在排除典型部位（如消化道、胸腔和腹腔）出血后，确认腰骶部和臀部肌肉形成血肿。立即停用抗凝药物，并加强营养支持。随后，血红蛋白水平逐渐升高，血肿体积逐渐减小。
横纹肌溶解症患者存在肌肉出血风险，不当使用抗凝剂可能导致风险增加甚至形成肌间血肿。当发现体内持续失血时，应考虑肌肉及更典型部位出血的可能性。
