Preventing renal failure in patients with rhabdomyolysis: Do bicarbonate and mannitol make a difference?
Preventing renal failure in patients with rhabdomyolysis: Do bicarbonate and mannitol make a difference?
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DOI：
10.1097/01.ta.0000130761.78627.10
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发表时间：
2004-06-01
影响因子：
--
通讯作者：
Velmahos, GC
中科院分区：
文献类型：
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作者：
Brown, CVR;Rhee, P;Velmahos, GC
背景资料：碳酸氢盐和甘露醇（BIC/MAN）的组合通常用于预防横纹肌溶解症患者的肾衰竭（RF），尽管缺乏足够的证据证实其使用。本研究的目的是确定是否大男人是有效的，以防止RF在横纹肌溶解症患者造成的traumatic.Methods：本研究是一个审查所有成人创伤重症监护病房（ICU）入院超过5年（1997年1月至2002年9月）。每天检查肌酸激酶（CK）水平（异常，>520 U/L）。RF定义为肌酐大于2.0 mg/dL。根据外科医生的判断，患者接受BIC/MAN。结果：在2,083例创伤ICU入院患者中，85%的患者CK水平异常。总体而言，RF发生在10%的创伤ICU患者中。CK水平5，000 U/L是与RF相关的最低异常水平; 382例CK高于5，000 U/L的患者中有74例（19%）发生RF，而CK低于5，000 U/L的1，701例患者中有143例（8%）发生RF（p < 0.0001）。在CK大于5，000 U/L的患者中，接受BIC/MAN和未接受BIC/MAN的患者在RF、透析或死亡率方面没有差异。亚组分析与不同水平的CK仍然没有显示任何BIC/MAN的好处。结论：异常CK水平是常见的危重病人，和CK水平大于5,000 U/L与RF。BIC/MAN不能预防肌酸激酶水平大于5，000 U/L的患者的RF、透析或死亡。对创伤后横纹肌溶解症患者BIC/MAN的使用标准应重新评估。
Background: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIG MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma.Methods: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal, >520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion.Results: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels of CK still failed to show any benefit of BIC/MAN.Conclusion: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with post-traumatic rhabdomyolysis should be re-evaluated.