Bertrand M, Godet G, Fléron M H, Bernard M A, Orcel P, Riou B, Kieffer E, Coriat P
Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, France.
Anesth Analg. 1997 Jul;85(1):11-5. doi: 10.1097/00000539-199707000-00003.
Lumbar muscle rhabdomyolysis has been very rarely reported after surgery. The aim of this study was to determine its incidence and main characteristics in a large population undergoing abdominal aortic surgery. Over a 21-mo period, 224 consecutive patients, 209 male and 15 female, mean age 65 +/- 10 yr, underwent abdominal aortic surgery (aortic aneurysm in 142 patients and occlusive aortic degenerative disease in 82 patients). Surgical incision was a midline incision with exaggerated hyperlordosis in 173 patients and a flank incision with a retroperitoneal approach in 51 patients. Postoperative rhabdomyolysis was diagnosed in 20 patients. In these patients, 9 (4%) experienced severe low back pain, and lumbar muscle rhabdomyolysis was confirmed by tomodensitometry (n = 6) or muscle biopsy (n = 3). The remaining 11 patients had lower limb muscle rhabdomyolysis. Rhabdomyolysis occurred after surgery of longer duration, which involved more frequent visceral artery reimplantation, with longer duration of aortic clamping and greater intraoperative bleeding. Lumbar rhabdomyolysis occurred in younger patients who were more frequently obese. On first postoperative day, the mean creatine kinase (CK) value was greater in lumbar rhabdomyolysis than in lower limb rhabdomyolysis (17,082 +/- 15,003 vs 3,313 +/- 3,120 IU/L, P < 0.05). Acute renal failure and postoperative death did not occur in patients with lumbar muscle rhabdomyolysis. Lumbar rhabdomyolysis was not a rare event after abdominal aortic surgery (4%). This syndrome was characterized by postoperative low back pain of unusual severity, which required analgesic therapy, and induced a very high increase in CK with typical findings at tomodensitometry or muscle biopsy but was not associated with postoperative renal failure.
腰椎肌肉横纹肌溶解症在手术后的报道极为罕见。本研究旨在确定在接受腹主动脉手术的大量人群中其发生率及主要特征。在21个月的时间段内，连续224例患者接受了腹主动脉手术，其中男性209例，女性15例，平均年龄65±10岁。142例患者为主动脉瘤，82例患者为闭塞性主动脉退行性疾病。173例患者采用中线切口并伴有明显的腰椎前凸加大，51例患者采用侧腹切口及腹膜后入路。20例患者被诊断为术后横纹肌溶解症。在这些患者中，9例（4%）出现严重的腰痛，经体层密度测定（n = 6）或肌肉活检（n = 3）确诊为腰椎肌肉横纹肌溶解症。其余11例患者为下肢肌肉横纹肌溶解症。横纹肌溶解症发生在手术时间较长的患者中，这些手术更频繁地涉及内脏动脉再植，主动脉阻断时间更长且术中出血更多。腰椎横纹肌溶解症发生在更年轻且更常肥胖的患者中。术后第一天，腰椎横纹肌溶解症患者的平均肌酸激酶（CK）值高于下肢横纹肌溶解症患者（17,082±15,003 vs 3,313±3,120 IU/L，P < 0.05）。腰椎肌肉横纹肌溶解症患者未发生急性肾衰竭和术后死亡。腰椎横纹肌溶解症在腹主动脉手术后并非罕见事件（4%）。该综合征的特点是术后出现异常严重的腰痛，需要进行镇痛治疗，导致CK大幅升高，在体层密度测定或肌肉活检中有典型表现，但与术后肾衰竭无关。
