Rhabdomyolysis in a Restraint Patient at the Emergency Department: A Case Report

急診病患約束後之橫紋肌溶解症：病例報告

蘇君明(Kwan-Ming Soo) ； 蕭志彥(Chih-Yen Hsiao) ； 李維哲(Wei-Che Lee) ； 鄭淵家 (Yuan-Chia Cheng) ； 陳昭文(Chao-Wen Chen) ； 林杏麟(Hsing-Lin Lin)

《南臺灣醫學雜誌》 8卷1期 (2012/06) Pp. 34-38

https://doi.org/10.6726/MJST.201206_8(1).0005

摘要

在急診，約束病患並非不常見，尤其當面對的是意識不清或精神異常的病患，或是在幫病患放置氣管內管的時候。大部分的病患在藥物治療後會解除約束並且沒有明顯的併發症。我們報告一位病患，有精神分裂的病史，到院後有燥鬱及暴力的行為。當考慮到病患可能會自傷及危及醫護人員時，他就被約束並進一步評估。在24小時後，他冷靜下來並覺得胸口悶痛。因為胸痛，所以就抽血檢驗生化檢查包括肌氨酸激酶的情況，然而，檢驗發現病患發生橫紋肌溶解症。於是在給予輸液、仔細的觀察及注意腎功能的情況下，他3天後復原出院。這位病患，在約束的情況下，劇烈的燥動是造成病患橫紋肌溶解症的主要原因。因此，在病患如果在治療前需要約束，醫護人員應該要注意約束後造成橫紋肌溶解症的危險，並進一步評估病患的腎功能及尿量。

關鍵字

橫紋肌溶解症 ； 精神分裂症 ； 肌氨酸激酶 ； 身體約束

並列摘要

Physical restraint is not uncommon in the emergency department when encountering consciousness disturbance or mentally disordered patients, even during the procedure of intubation. Most patients would be relieved after medical therapies without obvious consequences. We report a patient with a medical history of schizophrenia who was brought to our hospital with agitated and violent behaviors. With the concern of self-harm and jeopardy to the health providers, he was restrained for further evaluation. After 24 hours, he calmed down and complained about chest tightness. Laboratory data, including creatine kinase, were collected for further evaluation of his chest tightness; however, acute rhabdomyolysis was found. Hydration was given with close observation of his urine output and renal function. He was discharged after 3 days. In this patient, strenuous exertion after restraint for a period of time was the main cause of rhabdomyolysis. Therefore, in patients who need restraining for a while before treatment, physicians should be aware of the risk of rhabdomyolysis and further evaluation of renal function and urine output should be performed after restraint.

並列關鍵字

rhabdomyolysis ； schizophrenia ； creatine kinase ； physical restrain