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挤压相关急性肾损伤(急性肾衰竭)

Authors
Raymond Vanholder, MD, PhD
Mehmet S Sever, MD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
冯韵霖, 主治医师

引言

发生横纹肌溶解后，数种发病机制可引起血红素色素相关急性肾小管坏死(acute tubular necrosis, ATN)，继而引起血清肌酐水平骤升或急性肾损伤(acute kidney injury, AKI)[1-4]。 (参见“急性肾损伤(急性肾衰竭)的定义”)

横纹肌溶解可由创伤性或非创伤性肌肉损伤导致。我们对横纹肌溶解相关ATN的很多认识来源于创伤性横纹肌溶解的观察结果，创伤性横纹肌溶解是大规模自然或人为灾害所致挤压综合征的发生基础[5]。

对灾难后急性和慢性肾病的治疗需要格外注意，因其几乎总是需要复杂的技术和设备。挤压综合征相关AKI是大规模灾难后最常出现的急性肾脏问题[6]。

本文将总结创伤性横纹肌溶解所致AKI的临床特征与预防措施。非创伤性横纹肌溶解和溶血所致ATN，以及横纹肌溶解、溶血和药物诱导性肌病的一般概述将会单独详细讨论。 (参见“血红素所致急性肾损伤(急性肾衰竭)的临床特征及诊断”和“横纹肌溶解的临床表现与诊断”和“成人溶血性贫血的诊断方法”和“药物诱导性肌病”)

定义与流行病学

挤压伤诱发的全身性表现通常称为挤压综合征。挤压综合征见于30%-50%的创伤性横纹肌溶解病例中，常见于灾难性地震之后。有估计灾难性地震的所有伤者中有2%-5%发生挤压综合征[7-10]。应认为所有灾难受伤者发生挤压综合征的风险都增加，不论受伤轻重。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2016-05-09.
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