5·12汶川大地震挤压综合征伤员电解质紊乱特点分析
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摘要
目的探讨汶川地震挤压综合征伤员电解质紊乱的特点。方法对149例地震挤压综合征伤员的临床特点,尤其是电解质紊乱的特点进行分析。结果与非挤压综合征伤员比较,149例(8.2%)挤压综合征伤员有更严重的肾功能损害,血钾及血磷水平更高,血钙水平更低(P<0.05);同时表现出血清天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)和肌酸激酶(CK)水平显著升高(P<0.05);电解质紊乱表现多种多样,包括高钾血症、低钾血症、低钠血症、低钙血症、高磷血症、低磷血症以及代谢性酸中毒,尤其是高钾血症,不但严重而且顽固,需要尽早积极治疗。结论地震后挤压综合征伤员表现出严重而且复杂的电解质紊乱,高钾血症是最严重的表现,需要密切监测和积极治疗。
Objective In catastrophic earthquakes,many victims suffered from crush syndrome (CS). There were many kinds of complications and the electrolyte imbalance was the most severe complication in these patients with CS. Here we reported the clinical characteristics of the patients with CS in the Wenchuan earthquake. Methods The questionnaires containing 96 clinical and laboratory items were completed in 1827 patients with seismic injury. We evaluated the clinical features of CS and electrolyte disorders in CS patients and non-CS patients. Results Totally 149 patients (8.2%) were diagnosed as crush syndrome. The patients with CS had many severe complications. They had various kinds electrolyte disturbances,including hyperkalemia,hypokalemia,hyponatremia,hypocalcemia,hyperphosphatemia,hypophosphatemia,and acidosis. The hyperkalemia,a life-threatening and refractory complication,needed intensive treatment. Conclusions The patients with CS often have severe and complicated electrolyte disturbances. The hyperkalemia is a life-threatening complication which should be treated intensively.
Objective In catastrophic earthquakes,many victims suffered from crush syndrome (CS). There were many kinds of complications and the electrolyte imbalance was the most severe complication in these patients with CS. Here we reported the clinical characteristics of the patients with CS in the Wenchuan earthquake. Methods The questionnaires containing 96 clinical and laboratory items were completed in 1827 patients with seismic injury. We evaluated the clinical features of CS and electrolyte disorders in CS patients and non-CS patients. Results Totally 149 patients (8.2%) were diagnosed as crush syndrome. The patients with CS had many severe complications. They had various kinds electrolyte disturbances,including hyperkalemia,hypokalemia,hyponatremia,hypocalcemia,hyperphosphatemia,hypophosphatemia,and acidosis. The hyperkalemia,a life-threatening and refractory complication,needed intensive treatment. Conclusions The patients with CS often have severe and complicated electrolyte disturbances. The hyperkalemia is a life-threatening complication which should be treated intensively.
引文
[1]Vanholder R,Sever MS,Erek E,et al.Acute renal failure related to the crush syndrome:towards an era of seismo-nephrology[J].Nephrol Dial Transplant,2000,15(10):1517-1521.
[2]Sever MS,Vanholder R,Lameire N.Management of crush-related injuries after disasters[J].N Engl J Med,2006,354(10):1052-1063.
[3]Vanholder R,Van der Tol A,De Smet M,et al.Earthquakes and crush syndrome casualties:lessons learned from the Kashmir disaster[J].Kid-ney Int,2007,71(1):17-23.
[4]王莉,何强,李贵森,等.地震后挤压综合征的内科防治[J].中华内科杂志,2008,47(9):711-714.
[5]Greaves I,Porter K,Smith JE.Consensus statement on the early manage-ment of crush injury and prevention of crush syndrome[J].J R ArmyMed Corps,2003,149(4):255-259.
[6]Gonzalez D.Crush syndrome[J].Crit Care Med,2005,33(1Suppl):S34-41.
[7]Mehta RL,Kellum JA,Shah SV,et al.Acute Kidney Injury Network:re-port of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):R31.
[8]Eknoyan G.Acute renal failure in the Armenian earthquake[J].Ren Fail,1992,14(3):241-244.
[9]Bosch X,Poch E,Grau JM.Rhabdomyolysis and acute kidney injury[J].N Engl J Med,2009,361(1):62-72.
[10]Newton,EJ.Acute complications of extremity trauma[J].Emerg Med Clin North Am,2007,25(3):751-761.
[11]Malinoski DJ,Slater MS,Mullins RJ.Crush injury and rhabdomyolysis[J].Crit Care Clin,2004,20(1):171-192.
[12]Sever MS,Erek E,Vanholder R,et al.Serumpotassiumin the crush syn-drome victims of the Marmara disaster[J].Clin Nephrol,2003,59(5):326-333.
[13]Vanholder R,Sever MS,Erek E,et al.Rhabdomyolysis[J].J Am Soc Nephrol,2000,11(8):1553-1561.
[14]Llach F,Felsenfeld AJ,Haussler MR.The pathophysiology of altered cal-cium metabolism in rhabdomyolysis-induced acute renal failure.Interac-tions of parathyroid hormone,25-hydroxycholecalciferol,and1,25-di-hydroxycholecalciferol[J].N Engl J Med,1981,305(3):117-123.
[2]Sever MS,Vanholder R,Lameire N.Management of crush-related injuries after disasters[J].N Engl J Med,2006,354(10):1052-1063.
[3]Vanholder R,Van der Tol A,De Smet M,et al.Earthquakes and crush syndrome casualties:lessons learned from the Kashmir disaster[J].Kid-ney Int,2007,71(1):17-23.
[4]王莉,何强,李贵森,等.地震后挤压综合征的内科防治[J].中华内科杂志,2008,47(9):711-714.
[5]Greaves I,Porter K,Smith JE.Consensus statement on the early manage-ment of crush injury and prevention of crush syndrome[J].J R ArmyMed Corps,2003,149(4):255-259.
[6]Gonzalez D.Crush syndrome[J].Crit Care Med,2005,33(1Suppl):S34-41.
[7]Mehta RL,Kellum JA,Shah SV,et al.Acute Kidney Injury Network:re-port of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):R31.
[8]Eknoyan G.Acute renal failure in the Armenian earthquake[J].Ren Fail,1992,14(3):241-244.
[9]Bosch X,Poch E,Grau JM.Rhabdomyolysis and acute kidney injury[J].N Engl J Med,2009,361(1):62-72.
[10]Newton,EJ.Acute complications of extremity trauma[J].Emerg Med Clin North Am,2007,25(3):751-761.
[11]Malinoski DJ,Slater MS,Mullins RJ.Crush injury and rhabdomyolysis[J].Crit Care Clin,2004,20(1):171-192.
[12]Sever MS,Erek E,Vanholder R,et al.Serumpotassiumin the crush syn-drome victims of the Marmara disaster[J].Clin Nephrol,2003,59(5):326-333.
[13]Vanholder R,Sever MS,Erek E,et al.Rhabdomyolysis[J].J Am Soc Nephrol,2000,11(8):1553-1561.
[14]Llach F,Felsenfeld AJ,Haussler MR.The pathophysiology of altered cal-cium metabolism in rhabdomyolysis-induced acute renal failure.Interac-tions of parathyroid hormone,25-hydroxycholecalciferol,and1,25-di-hydroxycholecalciferol[J].N Engl J Med,1981,305(3):117-123.
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