CAJ | 학술논문

目的探讨劳力性热射病致横纹肌溶解症的临床病理特点.方法 8例患者中6例为在高温环境中进行军事训练的士兵,2例为在高温下体育锻炼者,其临床表现符合热射病诊断标准.全部患者均进行了血液生化学检查,3例进行了肌电图检查和肌肉活体组织检查,对其临床病理资料进行了分析.结果 8例患者均为男性,平均年龄27.4岁,表现为肌痛者4例,无力者2例,发热5例,棕色尿3例,1例并发急性肾功能衰竭,2例出现多脏器功能衰竭和播散性血管内凝血.1例发病后第3天肌肉活体组织检查证实存在肌肉坏死而无炎性反应,2例在发病2周后肌肉活体组织检查示肌肉坏死伴炎性吞噬反应.经治疗6例治愈,1例好转,1例死亡.结论劳力性热射病所致横纹肌溶解症以男性较多,临床表现主要为肌痛、无力,血肌酸激酶和肌红蛋白明显升高,肌红蛋白尿.肌肉病理早期可见肌细胞坏死、溶解,后期出现炎性细胞浸润.如能及时诊断和正确治疗,多数患者可获康复,严重者可危及生命.
목적 탐토로력성열사병치횡문기용해증적림상병리특점.방법 8례환자중6례위재고온배경중진행군사훈련적사병,2례위재고온하체육단련자,기림상표현부합열사병진단표준.전부환자균진행료혈액생화학검사,3례진행료기전도검사화기육활체조직검사,대기림상병리자료진행료분석.결과 8례환자균위남성,평균년령27.4세,표현위기통자4례,무력자2례,발열5례,종색뇨3례,1례병발급성신공능쇠갈,2례출현다장기공능쇠갈화파산성혈관내응혈.1례발병후제3천기육활체조직검사증실존재기육배사이무염성반응,2례재발병2주후기육활체조직검사시기육배사반염성탄서반응.경치료6례치유,1례호전,1례사망.결론 로력성열사병소치횡문기용해증이남성교다,림상표현주요위기통、무력,혈기산격매화기홍단백명현승고,기홍단백뇨.기육병리조기가견기세포배사、용해,후기출현염성세포침윤.여능급시진단화정학치료,다수환자가획강복,엄중자가위급생명.
Objective To investigate the clinicopathological features and the pathogenesis of rhabdomyolysis caused by exertional heat stroke.Methods Eight patients including 6 military soldiers and 2 physical exercisers trained under high temperature environment were enrolled into this study.Their clinical manifestations were compatible with the diagnostic standard of exertional heat stroke.Consecutive blood biochemistry tests were performed in all patients,and electromyography and muscle biopsy in 3 cases.Results Eight patients were all male,with average age of 27.4 years old.The main clinical characteristics included myalgia in 4 patients,muscle weakness in 2 patients,fever in 5 patients,and tea-colored urine in 3 patients.One patient had acute renal failure,and 2 patients developed multiple organ failure syndromes and disseminated intravascular coagulation.One muscle biopsy done in the third day after the onset showed obvious muscle necrosis without inflammatory infiltrates,while the other 2 muscle biopsy done 2 weeks after the onset showed muscle necrosis companied by inflammatory phagocytic response.Six patients full recovered,1 patient partially recovered and one patient died.Conclusions Rhabdomyolysis caused by exertional heat stroke predominantly occurred in males.The main clinical features include muscle pain,weakness,significantly elevated serum creatine kinase and myoglobin level and myoglobinuria.Muscle pathology indicated muscle necrosis in the early stage and accompanied inflammatory infiltrates in the late stage.Most patients will get recovered with prompt diagnosis and treatment while the severe cases can be life-threatening.