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透析患者中的肌肉痉挛

Author
Jean L Holley, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
王利华, 教授

引言

肌肉痉挛是血液透析治疗的一个常见并发症，发生在33%-86%的患者中[1,2]；肌肉痉挛常导致血液透析过程提前结束，因而是导致透析不充分的一个重要原因。透析患者肌肉痉挛的确切病因不明确。因为痉挛往往最常在血液透析治疗接近结束时发生，故血浆渗透压和/或细胞外液量改变可能牵涉其中。

本文将总结透析相关肌肉痉挛的病理生理学、临床特征及治疗。肌肉痉挛的总体概述及透析的其他急性并发症参见其他专题。 (参见“夜间腿部痛性痉挛”和“血液透析期间的急性并发症”)

病理生理学

痉挛是一种持续的肌肉不自主收缩，发生于已自主收缩到最短位置的肌肉[3]。休息和夜间时肌肉痉挛发作频率增加可能是由于睡眠时腓肠肌和足底肌肉(通过足部趾屈)被置于最短并最易发生痉挛的位置[3]。

肌电图显示，痉挛始于各个肌肉部分的肌束颤动，随后进展到高频动作电位。因此痉挛的起源是神经性的，而非肌肉性的[3]。

血液透析相关性痉挛的病因可能包含以下一个或多个因素的促发作用[1,3,4]：

                

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-08.
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