Clearance of myoglobin by high cutoff continuous veno‐venous hemodialysis in a patient with rhabdomyolysis: A case report
Clearance of myoglobin by high cutoff continuous veno‐venous hemodialysis in a patient with rhabdomyolysis: A case report
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高截止值连续静脉-静脉血液透析清除横纹肌溶解症患者的肌红蛋白：病例报告
DOI：
10.1111/hdi.12172
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发表时间：
2015
影响因子：
1.3
通讯作者：
Zhihong Liu
中科院分区：
文献类型：
--
作者：
Buyun Wu;D. Gong;D. Ji;Bin Xu;Zhihong Liu
使用高截留滤过器的连续性静脉-静脉血液透析（HCO‐CVVHD）是一种有前景的技术，可有效降低横纹肌溶解症（RM）患者极高水平的循环肌红蛋白。在这里，我们报告了一例中暑引起的RM患者，该患者通过HCO‐CVVHD成功治疗。1例男性患者接受HCO-CVVHD（4 L/h透析液）5天，然后以4 L/h剂量进行前稀释连续性静脉-静脉血液滤过（CVVH），直至肾功能恢复。计算5分钟、4、12和24小时时肌红蛋白和白蛋白的清除率。血清肌红蛋白水平从入院时的峰值25，400 ng/mL降至出院时的133 ng/mL。HCO‐CVVHD期间，4个时间点血清肌红蛋白的平均清除率为61.3（范围，61.0-61.6），52.3（38.9-65.8）、47.3（46.8-47.9）和43.7（39.5-48.0）mL/min，平均清除率为12.4（范围：11.8-13.1）、3.1（2.5-3.8）、1.2（1.0-1.4）和0.8（0.6-1.0）mL/min。CVVH期间，5分钟和24小时肌红蛋白的清除率分别为17.0和3.8 mL/min，白蛋白的清除率可忽略不计。HCO‐CVVHD可有效降低RM患者的血清肌红蛋白，因为其肌红蛋白清除率远高于CVVH。但是，应注意HCO‐CVVHD期间的白蛋白丢失。
Continuous veno‐venous hemodialysis using high cutoff filters (HCO‐CVVHD) is a promising technique, which may be effective to decrease the extremely high level of circulating myoglobin in patients with rhabdomyolysis (RM). Here, we report a patient with RM caused by heat stroke who was successfully treated by HCO‐CVVHD. A male patient received HCO‐CVVHD with 4 L/h dialysate for 5 days and then pre‐dilution continuous veno‐venous hemofiltration (CVVH) at a dose of 4 L/h until recovery of renal function. The clearance of myoglobin and albumin at 5 minutes, and at 4, 12, and 24 hours were calculated. The serum myoglobin level decreased from a peak of 25,400 ng/mL on admission to 133 ng/mL at discharge. During HCO‐CVVHD, the mean clearances of serum myoglobin at four timepoints were 61.3 (range, 61.0–61.6), 52.3 (38.9–65.8), 47.3 (46.8–47.9), and 43.7 (39.5–48.0) mL/min, respectively, and the mean clearances of albumin were 12.4 (range, 11.8–13.1), 3.1 (2.5–3.8), 1.2 (1.0–1.4), and 0.8 (0.6–1.0) mL/min, respectively. During CVVH, the clearance rates of myoglobin at 5 minutes and 24 hours were 17.0 and 3.8 mL/min, respectively, with a negligible clearance of albumin. HCO‐CVVHD can effectively decrease serum myoglobin in patients with RM because of much higher clearance of myoglobin than CVVH. However, attention should be paid to albumin loss during HCO‐CVVHD.
影响因子：
15.1
作者：
Naka, T;Jones, D;Baldwin, I;Fealy, N;Bates, S;Goehl, H;Morgera, S;Neumayer, HH;Bellomo, R
通讯作者：
Bellomo, R