Cruette D, Navarre M C, Pinaquy C, Siméon F
Ann Fr Anesth Reanim. 1986;5(1):67-9. doi: 10.1016/S0750-7658(86)80125-3.
Two cases are described of surgery for spondylolisthesis requiring prolonged knee-chest position (5 h 20 min and 4 h 30 min); acute renal failure with anuria occurred early in one case (within the first 24 h postoperatively), and later in the other case (on the 8th day). The diagnosis of rhabdomyolysis was made on the increase of CPK and myoglobin blood levels. Post-haemodialysis evolution was satisfactory. The possible mechanism was muscle compression against the rests. Diagnosis must be made quickly; the only treatment is early fasciotomy, with the supplying of alkali to prevent acute renal failure. It would appear that the knee-chest position can be kept a maximum of 3 h without any problem.
描述了两例腰椎滑脱手术,术中需要长时间采用膝胸位(分别为5小时20分钟和4小时30分钟);其中一例术后早期(术后24小时内)出现急性肾衰竭无尿,另一例较晚(第8天)出现。根据血中肌酸磷酸激酶(CPK)和肌红蛋白水平升高诊断为横纹肌溶解症。血液透析后的病情进展令人满意。可能的机制是肌肉受到支撑物的压迫。必须迅速做出诊断;唯一的治疗方法是早期进行筋膜切开术,并补充碱性药物以预防急性肾衰竭。似乎膝胸位最多保持3小时不会有任何问题。