橫紋肌溶解症－個案報告

「橫紋肌溶解症」是指骨骼肌因受創或過度使用、藥物、毒品，以及遺傳性、代謝性肌肉疾病或自體免疫疾病等，而產生肌肉急速損傷與壞死，導致肌細胞之內容物及肌紅蛋白(myoglobin)滲漏至血液中。臨床表徵上會出現肌肉疼痛等非特定症狀，但深棕色尿常是最早被注意而就醫的徵兆，嚴重時可能會導致急性腎衰竭、高血鉀、高血磷、低血鈣等，而併發心律不整或心跳停止之情形，具有潛在的生命危險性。橫紋肌溶解症的治療主要以支持性療法為主，但對於所造成的急性腎衰竭，在處理上除給予大量點滴輸液外，亦可適時給予重碳酸鹽以鹼化尿液，減少肌紅蛋白沉積於腎小管中；必要時，緊急透析治療可作為一優先考量。本案例為一位31歲男性，因一次激烈的壘球運動導致全身肌肉疼痛，隨後出現深棕色尿液而前來求診，經由詳細的病史、理學及實驗室檢查後，發現其肌氨酸激脢(creatine kinase, CK)高達80742 IU/L併肝功能指數異常，尿液潛血亦呈現陽性反應，診斷為橫紋肌溶解症並收住院治療。希望藉此案例，提醒基層醫師對激烈運動所造成的橫紋肌溶解症能多加警覺，將有助於臨床的早期診斷及治療。

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並列摘要

Rhabdomyolysis is a potentially life-threatening syndrome resulting from the acute damage and the breakdown of skeletal muscle fibers with leakage of muscle contents and myoglobin into the circulation. The most common causes are crush injury, overexertion, alcohol abuse, certain medications, and toxic substances. Several genetic and autoimmune diseases are predisposing factors for the syndrome. Clinical features are often nonspecific, but coca-cola like urine is usually the first manifestation of the syndrome. Multiple complications, such as acute renal failure or electrolyte imbalance, can occur and may result in cardiac arrhythmia or arrest. The treatment of the rhabdomyolysis is primarily directed at preserving renal function by adequate intravenous hydration as early as possible. To alkalinize urine by sodium bicarbonate can decrease the toxicity of myoglobin to the tubules of the kidney. Emergent hemodialysis may be a therapeutic modality. This is the report of exercise-induced rhabdomyolysis in a young adult. He visited our outpatient department because of generalized muscle-ache and coca-cola like urine. Laboratory data revealed that he had extremely high level of creatine kinase of up to 80742 IU/L, impaired liver function tests, and positive urine occult blood test. Under the impression of rhabdomyolysis, he was admitted for further evaluation and treatment. We suggest that the primary care physician should be alert to the presence of rhabdomyolysis in order to prevent the severe complications may develop later on.

並列關鍵字

rhabdomyolysis ； myoglobin ； creatine kinase ； acute renal failure ； hyperkalemia

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橫紋肌溶解症－個案報告

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