Homsi E, Barreiro M F, Orlando J M, Higa E M
Intensive Care Unit, Hospital Municipal Artur Ribeiro de Saboya, São Paulo, Brazil.
Ren Fail. 1997 Mar;19(2):283-8. doi: 10.3109/08860229709026290.
Patients that develop rhabdomyolysis of different causes are at high risk of acute renal failure. Efforts to minimize this risk include volume repletion, treatment with mannitol, and urinary alkalinization as soon as possible after muscle injury. This is a retrospective analysis (from January 1, 1992, to December 31, 1995) of therapeutic response to prophylactic treatment in patients with rhabdomyolysis admitted to an intensive care unit (ICU). The diagnosis of rhabdomyolysis was based on creatinine kinase (CK) level (> 500 Ui/L) and the criteria for prophylaxis were: time elapsed between muscle injury to ICU admission < 48 h and serum creatinine < 3 mg/dL. Fifteen patients were treated with the association of saline, mannitol, and sodium bicarbonate (S + M + B group) and 9 patients received only saline (S group). Serum creatinine at admission was similar in both groups: 1.6 +/- 0.6 mg/dL in the S + M + B group and 1.5 +/- 0.6 mg/dL in the S group (p > 0.05). Maximum serum CK measured was 3351 +/- 1693 IU/L in the S + M + B group and 1747 +/- 2345 IU/L in the S group (p < 0.05). However the measurement of CK was earlier in S + M + B patients (1.7 vs 2.7 days after rhabdomyolysis). APACHE II scores were 16.9 +/- 7.4 and 13.4 +/- 4.9 in the S + M + MB and S groups, respectively (p > 0.05). Despite the treatment protocol the serum levels of creatinine had similar behavior and reached normal levels in all patients in 2 or 3 days. The saline infusion during the first 60 h on the ICU was 206 mL/h in the S group and 204 mL/h in S + M + B (p > 0.05). Mannitol dose was 56 g/day, and bicarbonate 225 mEq/day during 4.7 days. Our data show that progression to established renal failure can be totally avoided with prophylactic treatment, and that once appropriate saline expansion is provided, the association of mannitol and bicarbonate seems to be unnecessary.
不同病因导致横纹肌溶解的患者有发生急性肾衰竭的高风险。将这种风险降至最低的措施包括补充血容量、使用甘露醇治疗以及在肌肉损伤后尽快进行尿液碱化。这是一项对入住重症监护病房（ICU）的横纹肌溶解患者预防性治疗的疗效进行的回顾性分析（时间跨度为1992年1月1日至1995年12月31日）。横纹肌溶解的诊断基于肌酸激酶（CK）水平（>500 Ui/L），预防标准为：从肌肉损伤到入住ICU的时间间隔<48小时且血清肌酐<3 mg/dL。15例患者接受了生理盐水、甘露醇和碳酸氢钠联合治疗（S+M+B组），9例患者仅接受生理盐水治疗（S组）。两组患者入院时的血清肌酐水平相似：S+M+B组为1.6±0.6 mg/dL，S组为1.5±0.6 mg/dL（p>0.05）。S+M+B组测得的最高血清CK为3351±1693 IU/L，S组为1747±2345 IU/L（p<0.05）。然而，S+M+B组患者的CK测量时间更早（横纹肌溶解后1.7天对2.7天）。S+M+B组和S组的急性生理与慢性健康状况评分系统（APACHE II）评分分别为16.9±7.4和13.4±4.9（p>0.05）。尽管采用了治疗方案，但所有患者的血清肌酐水平变化相似，并在2或3天内恢复正常。在ICU的前60小时，S组的生理盐水输注速度为206 mL/h，S+M+B组为204 mL/h（p>0.05）。甘露醇剂量为56 g/天，碳酸氢钠在4.7天内为225 mEq/天。我们的数据表明，预防性治疗可完全避免进展为确诊的肾衰竭，并且一旦提供了适当的生理盐水扩容，甘露醇和碳酸氢钠联合使用似乎并无必要。
