運動後橫紋肌溶解症急診住院之危險因子與預防策畧

Risk Factors and Preventive Strategies of Exertional Rhabdomyolysis Patients with Emergency Admission

連楚明(Aming Chor-Ming Lin)

指導教授 ： 蔡行瀚

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00043

摘要

目的: 探討體適能運動造成橫紋肌溶解症與住院間之關聯性及分析其危險因子。
方法: 本研究係一回溯性研究，共225名高中生於同一天舉行體適能肌耐力測驗，結果造成119名學生出現延遲性肌肉酸痛及小便呈現茶的顏色，到某醫學中心求治。本研究分析病人之基本資料，臨床症狀，住院發生率及相關危險因子，其中危險因子包括運動前是否有平日之訓練、運動前之休息、是否空腹運動、運動後是否喝水、是否休息、及是否完成肌耐力測驗等，加上血液檢查，作為評估病人因橫紋肌溶解症住院指標及預防方法。
結果: 所有到急診室119名病人都被診斷橫紋肌溶解症，有78名男性，41名女性（年齡範圍 17-18歲，平均17.6歲），其中99名病人在急診室留觀治療後出院，另外20名病人檢查後因病情需要住院治療。沒有平日訓練者發生橫紋肌溶解症需要住院的機會是有平日訓練者的7.03倍﹔空腹運動者，其發生橫紋肌溶解症需要住院的機會是沒有空腹者的5.3倍﹔運動後若沒喝水者，其發生橫紋肌溶解症需要住院的機會是有喝水者的5.9倍﹔發生橫紋肌溶解症後有全身發炎反應之病人，需要住院的機會是沒有全身發炎反應之病人的10.6倍﹔血清麩胺酸苯醋酸轉氨基酶大於250 IU/L者需要住院的機會是少於250 IU/L的5.25倍。病人血清肌酸激酶值高低跟需要住院的機會並沒有統計學上的意義。
結論: 運動前有平日訓練，避免空腹，運動後多喝水，可減少因橫紋肌溶解症住院之發生率。出現橫紋肌溶解症後，若血清麩胺酸苯醋酸轉氨基酶大於250 IU/L及出現全身性發炎反應，兩項臨床指標其需要住院之發生率高，可以作為橫紋肌溶解症住院之預防方法及急診住院指標。

關鍵字

體適能，橫紋肌溶解症 ； 全身性發炎反應 ； 住院指標 ； 預防方法

並列摘要

Objective: To examine the association between exertional rhabdomyolysis and risk factors for hospitalization of exertional rhabdomyolysis.
Methods: A retrospective study was conducted in adolescents diagnosed with exertional rhabdomyolysis in the emergency department of a medical center hospital for an episode of endurance test in a high school in Taipei city, Taiwan. Total 225 adolescents had been told to perform repetitive squat-jumps of physical fitness. We enrolled 119 patients who had presented to the emergency department after onset of generalized muscle aches and dark urine. The clinical presentation, sex, risk factors, distribution of serum creatine kinase and glutamic oxaloacetic transaminase levels were compared. We evaluated the incidence and risk factors of hospitalization for exertional rhabdomyolysis.
Results: Of the 119 patients visited to the emergency department with a diagnosis of exertional rhabdomyolysis. There were 78 male and 41 female patients (age range 17-18 years, mean 17.6). Serum creatine kinase activity was 55-174260 U/L (mean 36512 U/L) (normal range 50-450). The mean GOT levels in patients was 250±456 U/L (normal range 10-35). Ninety nine adolescents were discharged after tolerance with oral hydration. Twenty required hospital admission. Poor appetite, general malaise, muscle pain, tea urine and systemic inflammatory response syndrome were the most common symptoms and signs. The risk factors for hospitalization of exertional rhabdomyolysis were statistically significant differences in proper traning (OR, 7.03; 95% CI, 1.62-30.56), fasting (OR, 5.3; 95% CI, 1.42-19.67), without oral hydration (OR, 5.90; 95% CI 1.67-20.84) and systemic inflammatory response syndrome (OR, 10.6; 95% CI 2.3-26.6).
Conclusions: The findings suggest that adolescents with fasting before exercise , no traing before exercise, no oral hydration after exercise and systemic inflammatory response syndrome are at increased risk of admission. We can propose the guideline for admission and serve as a resource for developing and implementing prevention plans of exertional rhabdomyolysis.

並列關鍵字

Admission ； physical fitness ； prevention ； rhabdomyolysis ； systemic inflammatory response syndrome (SIRS)

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