Abstract:
Objective To compare the effects of different blood purification modes in the treatment of rhabdomyolysis (RM).
Methods A retrospective analysis was performed on the clinical characteristics of 56 RM patients admitted to the Department of Nephrology, Xiangya Third Hospital, Central South University from January 2013 to January 2019, including 38 males and 18 females. The age ranged from one-year-old to 85 years, with an average age of (37.2±18.4). Information on the etiology, clinical symptoms, laboratory tests, treatment (including blood purification, hormones, antioxidant and alkaline urine) and prognosis of the patients were collected. In three different blood purification groups [continuous veno-venous hemofiltration (CVVH), and blood perfusion (HP) and CVVH + HP], the prognosis of patients, kidney/creatinine (Crea) and muscle enzymology [creatine phosphate kinase (CK), myoglobin (MB), aspertate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH)] level changes were compared.
Results After the three modes of blood purification, the discharge rate of patients was improved (more than 80%). Compared with that before treatment, the CK, MB, AST, ALT and LDH levels were significantly decreased: CVVH [CK(2 247±572)U/L vs.44 940±17 494)U/L; MB(465±138)U/L vs.(3 323±1 329)U/L; AST(318±109) vs.(837±284)U/L; ALT(201±180)U/L vs.(315±287)U/L; LDH(725±199)U/L vs.(2 591±788)U/L]. HP: [CK(1 265±633)U/L vs.(40 859±16 239)U/L; MB(339±130)U/L vs.(2 612±1 012)U/L; AST(200±68)U/L vs.(666±271)U/L ; ALT(118±82)U/L vs.(190±173)U/L; LDH(435±159)U/L vs.(1 741±722)U/L]. CVVH+ HP: [CK(555±120)U/L vs.(27 749±11 329)U/L ]; MB(220±60)U/L vs.(2 204±1 080)U/L ]; AST(245±87)U/L vs.(1 228±877)U/L; ALT(554±221)U/L vs.(965±853)U/L]; LDH(304±88)U/L vs.(2 028±786)U/L], and the renal function improved [CVVH: Crea(297±124) vs.(309±112) μmoL/L; HP: Crea(150±87)vs.(165±95) μmoL/L; CVVH+ HP: Crea(175±103)vs.(184±65)μmoL/L]; the difference before and after treatment was statistically significant (All P<0.05). CVVH+ HP group showed a more significant decrease in myosinase level. However, there was no statistically significant difference between the three groups (P>0.05).
Conclusion The etiology of RM is varied, and the clinical manifestations are muscle pain, myasthenia and myoproteinuria. AKI is a common complication. CVVH, HP and CVVH+ HP can effectively treat RM and its complications, and improve the prognosis of patients.
Key words:
Rhabdomyolysis,
Acute kidney injury,
Continuous veno-venous hemofiltration,
Blood perfusion
Aiping Chen, Jianwen Wang, Hong Wu. Comparison of different blood purification modes in rhabdomyolysis[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(06): 332-336.