Kopsa H, Zazgornik J, Schmidt P, Pall H, Pok S J, Bayer P M, Balcke P, Pils P
Schweiz Med Wochenschr. 1977 Jul 9;107(27):942-7.
Two cases with acute renal failure after prolonged hypothermia are presented. Both patients were found in come, became rapidly uremic and required hemodilaysis treatment. Although the laboratory findings were typical of severe muscle damage, e.g. elevated levels of serum creatinine phosphokinase, serum lactic dehydrogenase and serum aldolase activities, visible "crush-injuries" were not found. Acute renal failure was characterized by extreme catabolism and severe metabolic acidosis. After 4 and 10 hemodialyses respectively, the patients became polyuric and finally were discharges with normal renal and muscle function. Hypotension with diminished renal perfusion and nontraumatic rhabdomyolysis due to prolonged hypothermia are regarded as the dominant pathogenetic factors in the acute renal failure.
本文报告了2例长时间低温后发生急性肾衰竭的病例。两名患者均被发现昏迷,迅速出现尿毒症并需要进行血液透析治疗。尽管实验室检查结果是严重肌肉损伤的典型表现,如血清肌酐磷酸激酶、血清乳酸脱氢酶水平升高以及血清醛缩酶活性增加,但未发现明显的“挤压伤”。急性肾衰竭的特点是极度分解代谢和严重代谢性酸中毒。分别经过4次和10次血液透析后,患者出现多尿,最终肾功能和肌肉功能恢复正常出院。因长时间低温导致的肾灌注减少引起的低血压和非创伤性横纹肌溶解被认为是急性肾衰竭的主要致病因素。