摘要
目的:探讨老年脓毒症合并横纹肌溶解的临床特点,提高临床诊治水平。方法:收集2014年8月~2019年12月在上海市第五康复医院住院诊断为脓毒症并发横纹肌溶解的9例患者资料,对其发病情况、临床表现、实验室检查、治疗及预后进行回顾性分析。结果:9例老年脓毒症合并横纹肌溶解,主要临床表现为纳差、发热、意识障碍、乏力、肌痛、尿色深、尿少、胸闷。肌酸激酶、肌红蛋白、乳酸脱氢酶、天冬氨酸氨基转移酶和肌酐有不同程度的升高。9例患者中肝功能损害7例、电解质紊乱8例、急性肾损伤7例。住院期间给予抗感染、液体复苏、抗休克、纠正电解质紊乱、碱化尿液、保肝护肾及其他对症支持治疗。最终死亡2例(22.22%),1例未愈(病情危重,患者家属要求自动出院),其余6例(66.67%)经治疗16~43 d康复出院。结论:老年脓毒症患者可发生横纹肌溶解,早发现、早诊断、早治疗,有助于减轻肾功能恶化及其他并发症的发生,改善预后。
Objective To investigation the clinical characteristics of elderly patients with sepsis with rhabdomyolysis and improve the level of clinical diagnosis and treatment.Method From August 2014 to December 2019,9 cases of sepsis complicated with rhabdomyolysis in Shanghai Fifth rehabilitation hospital were collected,and their incidence,clinical manifestations,laboratory examination,treatment and prognosis were analyzed retrospectively.Results Nine cases of elderly patients with sepsis with rhabdomyolysis were mainly manifested as poor appetite,fever,disturbance of consciousness,asthenia,myalgia,dark urine color,little urine and chest distress.Creatine kinase,myoglobin,lactate dehydrogenase,aspartate aminotransferase and creatinine were increased in different degrees.Of the 9 patients,7 patients had hepatic dysfunction,8 patients had electrolyte disturbances,7 patients had acute renal failure,1 patient had shock.During hospitalization,they were treated with anti infection,fluid resuscitation,anti shock,correction of electrolyte disorder,alkalization of urine,protection of liver and kidney and other symptomatic support treatment.2 cases died(22.22%),1 case gave up treatment,the remaining 6 cases(66.67%)were cured after treatment for 16~43 days.Conclusion Rhabdomyolysis can occur in the elderly with sepsis.Early detection,early diagnosis and early treatment are helpful to reduce the deterioration of renal function and other complications and improve the prognosis.
作者
赵刚
郁红萍
ZHAO Gang;YU Hong-ping(Department of Gerontology,Shanghai Fifth rehabilitation hospital,Shanghai 201620,China;Infectious Disease Department,Shanghai Songjiang Central Hospital Shanghai 201620,China)
出处
《吉林医学》
CAS
2021年第5期1075-1079,共5页
Jilin Medical Journal
