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1 病例介绍 患者,女,57岁,确诊多发性骨髓瘤,定期化疗已半年。间歇期出现右大腿部及右膝关节肿痛5天,伴功能障碍入院。入院第2天24小时尿量<50ml。出现全身浮肿。无尿持续4天。血生化检查:尿素氮9.1～42.9mmol/L,二氧化碳结合率15.7mmol/L,肌酐580～829μmol/L。血尿酸1264μmol/L尿pH5,蛋白卅。血气分析代谢性酸中毒。X片示右股骨小粗隆骨质结构较乱,有小的透光区,股骨上段骨膜可见数个透光区。诊断:多发性骨髓瘤并急性尿酸盐肾病肾功衰竭。治疗:别嘌呤醇0.3,3/d,速尿600～1000mg/d,5％NaHCO_3400ml/d,每日静点多巴胺40mg、酚妥拉明20mg和地塞米松20～10mg。2天后因血压升高而停用多巴胺,继续其它药物治疗。抢救7天尿量恢复正常,进入多尿期,血尿酸降至750μmol/L。第8天停用酚妥拉明、速尿、碳酸氢钠液和地塞米松,继续服别嘌呤醇至15天后血尿酸降至
1 Case Introduction Patients and women, 57 years old, were diagnosed with multiple myeloma and had had regular chemotherapy for half a year. The right thigh and right knee joints were swollen and painful for 5 days during intermittent periods and were admitted to hospital with dysfunction. On the second day of admission, 24-hour urine output was <50 ml. Systemic edema appeared. No urine lasted 4 days. Blood biochemical tests: urea nitrogen 9.1 ~ 42.9mmol / L, carbon dioxide binding rate of 15.7mmol / L, creatinine 580 ~ 829μmol / L. Blood uric acid 1264 μmol/L urine pH5, peptone. Blood gas analysis of metabolic acidosis. The X-ray shows that the bone structure of the right femoral small trochanter is disordered, with a small translucent area, and several translucent areas can be seen in the periosteum of the femur. Diagnosis: Multiple myeloma with acute urate nephropathy renal failure. Treatment: allopurinol 0.3, 3 / d, furosemide 600 ~ 1000mg / d, 5% NaHCO 3 400ml / d daily dopamine 40mg, phentolamine 20mg and dexamethasone 20 ~ 10mg. Two days later, dopamine was stopped due to elevated blood pressure and other medications were continued. The urine output returned to normal in 7 days and entered the polyuria stage. Uric acid decreased to 750 μmol/L. On the 8th day, phentolamine, furosemide, sodium bicarbonate solution, and dexamethasone were discontinued, and all purine alcohols continued to be consumed after 15 days.