加强对地震伤挤压综合征救治的作用和意义
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摘要
目的:探讨加强治疗对玉树地震伤挤压综合征(crush syndrome,CS)作用及意义。方法:分析3例严重CS致急性肾功能衰竭(acute renal fail,ARF)患者的临床及实验室特征,治疗体会。结果:3例均出现了骨筋膜室综合征合并ARF,均为藏族,男2例,女1例,年龄(39.67±9.30)岁,地震伤后获救时间为(6.83±1.60)h,入院时尿素氮(BUN)为(32.02±6.94)mmol/L,血肌酐(Scr)(634.67±146.20)μmol/L,血清磷酸肌酸激酶(CK)(14279.67±4636.87)IU/L,血清钾(K+)(6.67±0.76)mmol/L,急性生理与慢性健康评分(APACHEⅡ)(25.33±1.53)分,入院后首次进行血液透析时间(92.67±3.06)h,共血透或血滤时间为(256.67±124.23)h,少尿期为(17.00±2.65)d,机械通气时间为(14.00±19.29)h。3例患者均存活,痊愈出院。结论:严重的CS易致ARF,早期积极液体复苏、实施有效清创和截肢术、血液净化治疗、有效抗感染会明显提高抢救成活率。
Objective:To investigate the role and significance of strengthening treatment on crush syndrome(CS) of Yushu earthquake injuries. Methods:Three patients,Tibetan (2 men and 1 women,mean age,39.67 ± 9.30 years),with severe CS associated with acute renal failure (ARF) because injury of Yushu earthquake,were hospitalized to our hospital,and the emergency treatment was conducted. Results:The three patients were examined clinically with blood test after hospital immediately; finding they suffered from bone compartment syndrome and ARF with blood urea nitrogen (BUN) of (32.02 ± 6.94) mmol /L,serum creatinine (Scr) of (634.67±146.20)μmol /L,serum creatine kinase (CK) of (14 279.67 ± 4 636.87) IU / L and serum potassium (K+) of (6.67 ± 0.76) mmol / L. Their acute physiology and chronic health score (APACHE Ⅱ) was 25.33 ± 1.53 points. The first treatment was performed with hemodialysis for (92.67 ± 3.06) hours. General time of hemodialysis or hemofiltration was (256.67 ± 124.23) hours. Duration of oliguria reached (17.00±2.65)days and mechanical ventilation for(14.00±19.29)hours. Beneficial effect was obtained in 3 patients,and they are discharged because survival and complete recovery. Conclusions:In strengthening treatment of patient with severe CS associated with ARF following earthquake injury,the aggressive fluid resuscitation,effective debridement and amputation,blood purification,and effective anti-infection easily can significantly improve the survival rate of rescue patients.
Objective:To investigate the role and significance of strengthening treatment on crush syndrome(CS) of Yushu earthquake injuries. Methods:Three patients,Tibetan (2 men and 1 women,mean age,39.67 ± 9.30 years),with severe CS associated with acute renal failure (ARF) because injury of Yushu earthquake,were hospitalized to our hospital,and the emergency treatment was conducted. Results:The three patients were examined clinically with blood test after hospital immediately; finding they suffered from bone compartment syndrome and ARF with blood urea nitrogen (BUN) of (32.02 ± 6.94) mmol /L,serum creatinine (Scr) of (634.67±146.20)μmol /L,serum creatine kinase (CK) of (14 279.67 ± 4 636.87) IU / L and serum potassium (K+) of (6.67 ± 0.76) mmol / L. Their acute physiology and chronic health score (APACHE Ⅱ) was 25.33 ± 1.53 points. The first treatment was performed with hemodialysis for (92.67 ± 3.06) hours. General time of hemodialysis or hemofiltration was (256.67 ± 124.23) hours. Duration of oliguria reached (17.00±2.65)days and mechanical ventilation for(14.00±19.29)hours. Beneficial effect was obtained in 3 patients,and they are discharged because survival and complete recovery. Conclusions:In strengthening treatment of patient with severe CS associated with ARF following earthquake injury,the aggressive fluid resuscitation,effective debridement and amputation,blood purification,and effective anti-infection easily can significantly improve the survival rate of rescue patients.
引文
1赵景洪,张静波,王卫东,等.地震挤压综合征所致急性肾功能衰竭的临床特点和救治方案.第三军医大学学报,2009,3(18):1802~1805.
2Wiedemann HP,Wheeler AP,Hayden D.Comparison of Two Fluid-Management Stategies in Acute Lung Injury.NEJM,2006,354:2564~2575.
3袁发焕,程悦.地震伤致急性肾功能衰竭的救治.西部医学,2009,21(3):345~347.
2Wiedemann HP,Wheeler AP,Hayden D.Comparison of Two Fluid-Management Stategies in Acute Lung Injury.NEJM,2006,354:2564~2575.
3袁发焕,程悦.地震伤致急性肾功能衰竭的救治.西部医学,2009,21(3):345~347.
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