汶川地震致挤压综合征患者的临床流行病学特点分析

英文篇名：Epidemiological analysis of the victims with crush syndrome of Wenchuan earthquake
中文刊名：中国现代医学杂志
英文刊名：China Journal of Modern Medicine
作者：王威 ; 杨静 ; 陶笙 ; 殷秀梅 ; 王岩
英文作者：WANG Wei1 ; YANG Jing2 ; TAO Sheng1 ; YIN Xiu-mei3 ; WANG Yan (1.Department of Orthopaedics ; 2.Department of Anesthesiology ; PLA General Hospital ; Beijing 100853 ; P.R.China ; 3.Department of Hepatobiliary Surgery ; Chengdu PLA General Hospital ; Chengdu ; Sichuan 610083 ; P.R.China)
中文关键词：地震 ; 挤压综合征 ; 急性肾功能不全 ; 流行病学
英文关键词：earthquake ; crush syndrome ; acute renal failure ; epidemiology characteristics
出版日期：2008-11-30
机构：中国人民解放军总医院骨科;中国人民解放军总医院麻醉科;成都军区总医院肝胆外科;中国人民解放军总医院;
年：2008
期：22
出版单位：中国现代医学杂志

摘要

目的总结分析成都军区总院收治的汶川地震致挤压综合征患者的临床流行病学特点、治疗方法及其预后,总结救治经验。方法通过调查问卷对成都军区总院收治的汶川地震致挤压综合征患者进行调查研究,了解其临床流行病学特点、治疗时机、治疗方式、转归及并发症等。结果成都军区总院在2008年5月12～30日共收治地震伤员1070人,其中挤压综合征患者17例,发生率为1.6%。挤压综合征患者无明显性别差异,有明显的年龄分布特点,94.1%的患者集中于20～59岁。52.9%的患者接受了1次或1次以上的筋膜切开术,47.1%的患者直接进行了截肢术,最终的保肢率为17.6%。8例患者出现少尿型肾功能障碍,其中4例接受透析治疗,2例出现急性呼吸窘迫综合征(ARDS),1例出现弥散性血管内凝血(DIC)和多器官功能障碍(MODS)并死亡。结论挤压综合征患者应尽早被送至非震区的综合性医院救治。早期恰当的内、外科干预可有效降低此征的死亡率及致残率。
【Objective】To analyze the epidemiological characteristics of the crush syndrome victims of Wenchuan earthquake who treated in Chengdu PLA general hospital,and to assess the treatment and outcome of these patients.【Methods】In order to analyze the clinical characteristics,treatment and outcome,special questionnaires were sent out to all crush syndrome victims of Wenchuan earthquake admitted in Chengdu PLA general hospital.【Results】 From 14th to 30th May 2008,of the 1070 hospitalized patients in Chengdu PLA general hospital,17 (1.6%) patients suffered from crushing syndrome.There was no significant difference between mobidity of male and female.And 94.1% patients were adults within the range of 20～59 years.52.9% patients underwent fasciotomy and 47.1% had amputations directly.Oliguria and renal dysfunction were seen in 8 patients and 4 of them underwent dialysis,two of them suffered acute respiratory distress syndrome (ARDS),and one patient died of diffuse intravascular coagulation (DIC) and multiple organ dysfunction (MODS).【Conclusion】In case of severe earthquake,Crush syndrome victims should be rapidly transferred to undamaged general hospital.The proper measurements such as fasciotomy,amputation together with dialysis would reduce the mortality of crushing syndrome.

引文

[1]HIRAIDE A,OHNISHI M,TANAKA H,et al.Abdominal and lower extremity crush syndrome[J].Injury,1997,28(9-10):685-686.
    [2]SLATER MS,MULLINS RJ.Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients:a review[J].J Am Coll Surg,1998,186(6):693-716.
    [3]SEVER MS,EREK E,VANHOLDER R,et al.The Marmara earthquake:Epidemiological analysis of the victims with nephro-logical problems[J].Kidney Int,2001,60(3):1114-1123.
    [4]BETTER OS.The crush syndrome revisited(1940-1990)[J].Nephron,1990,55(2):97-103.
    [5]KAZANCIOGLU R,CAGATAY A,CALANGU S,et al.The characteristics of infections in crush syndrome[J].Clin Microbiol Infec,2002,8(4):202-206.
    [6]WOODROW G,TURNEY JH.Cause of death in acute renal failure[J].Nephrol Dial Transplant,1992,7:230-234.
    [7]ROBERT N.REDDIX JR.*,ROBERT A.Probe Crush syndrome presenting three days after injury[J].Injury Extra,2004,35:73-75.
    [8]JOHANSEN OS,STEIN JH.Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis[J].N Engl J Med,1990,322:825-829.
    [9]RICHARDS NT,TATTERSALL J,MCCANN M,et al.Dailysis for acute renal failure due to crush injuries after the Armenian earthquake[J].BMJ,1989,298:443-445.
    [10]SANTANGELLO ML,USBERTI M,DI SALVO E,et al.A study of pathology of the crush syndrome[J].Surg Gynecol Ob-stet,1982,154:372-374.
    [11]BETTER OS.The crush syndrome revisited(1940-1990)[J].Nephron,1990,55:97-103.
    [12]O DEMIRKIRAN,Y DIKMEN,T UTKU,et al.Crush syndrome patients after the Marmara earthquake[J].Emerg Med J,2003,20:247-250.