Eisenhuber E, Zauner C, Madl C, Kramer L, Ratheiser K
Klinik für Innere Medizin IV, Universität Wien.
Wien Klin Wochenschr. 1996;108(16):521-4.
Acute rhabdomyolysis is a rare complication in patients with status asthmaticus receiving mechanical ventilation. Individual reports implicate several factors, whereby the simultaneous use of high-dose glucocorticoids and non-depolarizing muscle blocking agents appears to be the major patho-physiological mechanism. A 48 year-old female patient with a 3-year history of granulomatous vasculitis Churg-Strauss was admitted to the intensive care unit (ICU) due to severe status asthmaticus, which necessitated endotracheal intubation and mechanical ventilation. Antiobstructive therapy consisted of beta 2-sympathomimetics, theophylline and high-dose intravenous prednisolone (5440 mg in 10 days). Additionally, the patient was treated with non-depolarizing muscle blocking agents (atracurium 2070 mg over 7 days). Six days after admission to the ICU the patient developed severe rhabdomyolysis, with an increased creatine kinase (CK) level and myoglobinuria. The maximum CK value occurred 12 days after ICU admission (3810 U/l), accompanied by a serum myoglobin level of 13,900 ng/ml. 5 days after cessation of muscle relaxant therapy and reduction of intravenous glucocorticoids, the serum CK level decreased, reaching normal values 9 days later.
急性横纹肌溶解是机械通气的哮喘持续状态患者中一种罕见的并发症。个别报道涉及多种因素，其中大剂量糖皮质激素与非去极化肌松剂的同时使用似乎是主要的病理生理机制。一名48岁女性患者，有3年肉芽肿性血管炎（Churg-Strauss）病史，因严重哮喘持续状态入住重症监护病房（ICU），需要气管插管和机械通气。抗梗阻治疗包括β2-拟交感神经药、茶碱和大剂量静脉注射泼尼松龙（10天内5440毫克）。此外，该患者接受了非去极化肌松剂治疗（7天内使用阿曲库铵2070毫克）。入住ICU 6天后，患者出现严重横纹肌溶解，肌酸激酶（CK）水平升高并出现肌红蛋白尿。CK最高值出现在入住ICU 12天后（3810 U/l），同时血清肌红蛋白水平为13900 ng/ml。在停止肌松剂治疗并减少静脉注射糖皮质激素5天后，血清CK水平下降，9天后恢复正常。
