o***s
发帖数: 42149 | 1 上周五，24岁的小周和同事比体能，一口气做了200个俯卧撑。孰料，第二天浑身肌肉酸疼，到医院一查竟然得了横纹肌溶解症。鄞州二院肾内科主任包蓓艳说，高温下的剧烈运动、创伤、病毒感染、药物等都会引起横纹肌溶解症。
病历1
和同事比赛一口气做200个俯卧撑
小周当过兵，在体能上非常自信。上周五午休的时候，有个同事提出比比谁的体能最好，比赛项目是做俯卧撑。
“原来在部队训练的时候，一天要做800个俯卧撑，上午400个，下午400个，所以我觉得做200个一点都没什么。”在同事们的“加油”声中，小周完成了200个俯卧撑，并且一脸轻松地站了起来。
晚上，同事聚餐，小周在同事们的赞美声中一口气喝下了24瓶啤酒。
当天晚上回到家，小周感觉到手臂肌肉开始酸痛，于是拿出放在冰箱里的冰袋开始冰敷，一个多小时后小周安然睡觉。第二天早上起床上厕所，发现小便变成了酱油色，一向对身体很关注的他慌了，立即赶到就近的鄞州二院。
看着报告单上的“横纹肌溶解症”这6个字，小周傻眼了，“我身体一向很好的呀。”
包蓓艳说：“200个俯卧撑和24瓶啤酒应该就是引起小周横纹肌溶解症的‘罪魁祸首’。”
病历2
突然剧烈运动后没有及时补充水分
跟小周的遭遇类似，6月23日端午节那天，39岁的徐先生参加了一场划龙舟比赛，第二天，浑身肌肉酸痛。两天后，肌肉酸痛不但没有减轻，反而更加严重了。到医院一诊断，得的也是横纹肌溶解症。徐先生说，自己平时很少运动，这次划了半天的龙舟，感觉很累，因为比赛，也没及时喝水。
“长时间不运动，突然剧烈运动，再加上高温天气，没及时、大量补充水分，肌肉中大量产生的肌酸激酶来不及排出，释放到血液中，引起肾小管堵塞，导致急性肾功能损伤。”包蓓艳说，“所以切不可在长时间没运动的情况下，突然做剧烈运动，运动应该循序渐进，最好能有健身教练安排每次运动量。同时，在运动的时候，要及时补充水分。”
专家提醒
浑身肌肉酸痛、小便酱油色，要及时治疗
据了解，病毒感染也会引起横纹肌溶解症。
6月初，鄞州二院就接到过这么一个病例。患者李先生头痛发热，浑身肌肉酸痛，看了两天急诊，都不见好转。后来做了血液检查，发现肌酸激酶非常高。医生诊断他是由病毒感染引起的横纹肌溶解症。
此外，服用他汀类的降血脂药物和地震等外力创伤也会引起横纹肌溶解症。
要注意的是，服用他汀类降血脂药物的当天，不能喝葡萄酒，不然引起横纹肌溶解症的几率会更大。
包蓓艳说，横纹肌溶解症不是一种可怕的病，只要及时治疗，一般不会留下后遗症；如果治疗不及时，就会引起急性肾功能损伤，那后果也是挺严重。
如果浑身肌肉酸痛，小便出现酱油色，建议及时到医院明确病情，及时治疗。 | M*****e
发帖数: 279 | 2 "肌肉中大量产生的肌酸激酶来不及排出，释放到血液中，引起肾小管堵塞，导致急性
肾功能损伤".
应当不是“肌酸激酶”。而是骨骼肌（属横纹肌）损伤后，大量的“肌球蛋白”(
myoglobin)释放到血液中，引起肾小管堵塞，导致急性肾功能损伤。
Reference:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001505/
A.D.A.M. Medical Encyclopedia.
Rhabdomyolysis
Last reviewed: September 19, 2011.
Rhabdomyolysis is the breakdown of muscle fibers that leads to the release
of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is
harmful to the kidney and often causes kidney damage.
Causes, incidence, and risk factors
When muscle is damaged, a protein called myoglobin is released into the
bloodstream. It is then filtered out of the body by the kidneys. Myoglobin
breaks down into substances that can damage kidney cells.
Rhabdomyolysis may be caused by any condition that damages skeletal muscle,
especially injury.
Risk factors include the following:
•
Alcoholism (with muscle tremors)
•
Crush injuries
•
Drugs, especially cocaine, amphetamines, statins, heroin, or PCP
•
Genetic muscle diseases
•
Heatstroke
•
Ischemia or necrosis of the muscles (which may occur with arterial occlusion
, deep venous thrombosis, or other conditions)
•
Low phosphate levels
•
Seizures
•
Severe exertion, such as marathon running or calisthenics
•
Shaking chills
•
Trauma
Symptoms
•
Abnormal urine color (dark, red, or cola colored)
•
Decreased urine production
•
General weakness
•
Muscle stiffness or aching (myalgia)
•
Muscle tenderness
•
Weakness of the affected muscles
Other symptoms that may occur with this disease:
•
Fatigue
•
Joint pain
•
Seizures
•
Weight gain (unintentional)
Signs and tests
An examination shows tender or damaged skeletal muscles.
The following tests may be done:
•
Creatine kinase (CK) level
•
Serum calcium
•
Serum myoglobin
•
Serum potassium
•
Urinalysis
•
Urine myoglobin test
This disease may also affect the results of the following tests:
•
CK isoenzymes
•
Serum creatinine
•
Urine creatinine
Treatment
Getting fluids that contain bicarbonate may prevent kidney damage by quickly
flushing myoglobin out of the kidneys. Fluids may need to be given through
a vein (by IV). Some patients may need kidney dialysis.
Medicines that may be prescribed include diuretics and bicarbonate (if there
is enough urine output).
Hyperkalemia and low blood calcium levels (hypocalcemia) should be treated
right away, if present. Kidney failure should also be treated.
Expectations (prognosis)
The outcome depends on the amount of kidney damage. Acute kidney failure
occurs in many patients. Getting treated soon after rhabdomyolysis begins
will reduce the risk of permanent kidney damage.
People with milder cases may return to their normal activities within a few
weeks to a month. However, some people continue to have problems with
fatigue and muscle pain.
Complications
•
Acute tubular necrosis
•
Acute renal failure
•
Harmful chemical imbalances in the blood
•
Shock (low blood pressure)
Calling your health care provider
Call your health care provider if you have symptoms of rhabdomyolysis.
Prevention
Drink plenty of fluids after strenuous exercise to dilute your urine and
flush any myoglobin that is released from your muscles out of your kidneys.
Also drink a lot of fluids after any condition or event that may have
damaged skeletal muscle.
References
1.O'Connor FG, Deuster PA. Rhabdomyolysis. In: Goldman L, Ausiello D, eds.
Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 114.
2.Remuzzi G, Perico N, DeBroe ME. Acute kidney injury. In: Brenner BM, ed.
Brenner and Rector's the Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier
; 2007:chap 29.
Review Date: 9/19/2011.
Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of
General Medicine, Department of Medicine, University of Washington School of
Medicine; and Herbert Y Lin, MD, PhD, Nephrologist, Massachusetts General
Hospital; Associate Professor of Medicine, Harvard Medical School. Also
reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Disclaimer
Copyright © 2012, A.D.A.M., Inc. |
|
