肾脏替代治疗对挤压综合征伤口的影响分析:汶川地震经验总结
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摘要
[目的]分析肾脏替代治疗对挤压综合征患者伤口的影响,为今后治疗挤压综合征以及制定治疗策略提供更好的临床依据。[方法]收集汶川地震中本院收治的挤压综合征患者临床资料和相关治疗结果,将入选的患者分成肾脏替代治疗组和非肾脏替代治疗组,对比分析伤口感染率、伤口活动性动脉出血发生率、小腿减压切口渗液量的差异。[结果]肾脏替代治疗组和非肾脏替代治疗的伤口感染率差异有统计学意义(P=0.006)。肾脏替代治疗组培养出的致病菌前3位依次是不动杆菌属、铜绿假单胞菌和肠杆菌属,为多重耐药菌株。肾脏替代治疗组创面渗液量显著高于非肾脏替代治疗组(P=0.000)。[结论]肾脏替代治疗易导致挤压综合征患者开放创面渗液量增多、感染率高以及多重耐药菌株混合感染。
[Objective]To analyze the effect of renal replacement therapy on the wound of crush syndrome patients,and to provide better clinic evidence for scheduling the therapy strategy of crush syndrome.[Method]The clinic data of patients suffering from crush syndrome during Wenchuan earthquake were collected and classified into Group A treated by renal replacement therapy and Group B theraped by other treatments except renal replacement therapy.Wound infection rate,wound active artery bleeding occurrence,and the volume of oozes in fasciotomy wound between these two groups were compared.[Result]There was statistically significant difference in the rate of wound infection between Group A and Group B(P=0.006).The most common pathogens were acinetobacter spp,pseudomonas aeruginosa,and enterobacter spp in Group A,and these pathogens were all multi drug-resistant.There was statistically significant difference in the volume of oozes in incisive wound between these two groups(P=0.000).[Conclusion]Renal replacement therapy would increase the volume of oozes,raise the rate of wound infection,and be susceptiblely infected by multi drug-resistant pathogen.
[Objective]To analyze the effect of renal replacement therapy on the wound of crush syndrome patients,and to provide better clinic evidence for scheduling the therapy strategy of crush syndrome.[Method]The clinic data of patients suffering from crush syndrome during Wenchuan earthquake were collected and classified into Group A treated by renal replacement therapy and Group B theraped by other treatments except renal replacement therapy.Wound infection rate,wound active artery bleeding occurrence,and the volume of oozes in fasciotomy wound between these two groups were compared.[Result]There was statistically significant difference in the rate of wound infection between Group A and Group B(P=0.006).The most common pathogens were acinetobacter spp,pseudomonas aeruginosa,and enterobacter spp in Group A,and these pathogens were all multi drug-resistant.There was statistically significant difference in the volume of oozes in incisive wound between these two groups(P=0.000).[Conclusion]Renal replacement therapy would increase the volume of oozes,raise the rate of wound infection,and be susceptiblely infected by multi drug-resistant pathogen.
引文
[1]徐卫东,张春才,李明.地震灾害伤员的挤压伤早期处理[J].中国矫形外科杂志,2008,20:1532-1535.
[2]Hussain A,Kwak HC,Pallister I.Crush syndrome:a comprehen-sive surgical strategy improves outcome[J].Injury,2006,12:53-55.
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[5]裴福兴.1410名地震伤员早期救治体会[J].中国矫形外科杂志,2008,20:1523-1524.
[6]Chuang CK,Lin SP,Chen HH,et al.Plasma free amino acids andtheir metabolites in taiwanese patients on hemodialysis and continuousambulatory peritoneal dialysis[J].Clin Chim Acta,2006,1-2:209-216.
[7]Bakaeen FG,Walkes JC,Reardon MJ.Heparin-induced thrombocy-topenia associated with bilateral adrenal hemorrhage after coronary ar-tery bypass surgery[J].Ann Thorac Surg,2005,4:1388-1390.
[8]Tsai HC,Yen HC,Hsu JC,et al.Heparin-induced thrombocytope-nia associated with intra-tumour haemorrhage in cavernous sinus aftercardiac myxoma surgery[J].Br J Neurosurg,2009,1:95-96.
[9]Charif R,Davenport A.Heparin-induced thrombocytopenia:an un-common but serious complication of heparin use in renal replacementtherapy[J].Hemodial Int,2006,3:235-240.
[10]Gitau MM,Arora N.Heparin-induced thrombocytopenia[J].MoMed,2009,1:50-54.
[2]Hussain A,Kwak HC,Pallister I.Crush syndrome:a comprehen-sive surgical strategy improves outcome[J].Injury,2006,12:53-55.
[3]Ersoy A,Yavuz M,Usta M,et al.Survival analysis of the factors af-fecting in mortality in injured patients requiring dialysis due to acuterenal failure during the Marmara earthquake:survivors vs non-survi-vors[J].Clin Nephrol,2003,5:334-340.
[4]Keven K,Ates K,Sever MS,et al.Infectious complications aftermass disasters:the Marmara earthquake experience[J].Scand J In-fect Dis,2003,2:110-113.
[5]裴福兴.1410名地震伤员早期救治体会[J].中国矫形外科杂志,2008,20:1523-1524.
[6]Chuang CK,Lin SP,Chen HH,et al.Plasma free amino acids andtheir metabolites in taiwanese patients on hemodialysis and continuousambulatory peritoneal dialysis[J].Clin Chim Acta,2006,1-2:209-216.
[7]Bakaeen FG,Walkes JC,Reardon MJ.Heparin-induced thrombocy-topenia associated with bilateral adrenal hemorrhage after coronary ar-tery bypass surgery[J].Ann Thorac Surg,2005,4:1388-1390.
[8]Tsai HC,Yen HC,Hsu JC,et al.Heparin-induced thrombocytope-nia associated with intra-tumour haemorrhage in cavernous sinus aftercardiac myxoma surgery[J].Br J Neurosurg,2009,1:95-96.
[9]Charif R,Davenport A.Heparin-induced thrombocytopenia:an un-common but serious complication of heparin use in renal replacementtherapy[J].Hemodial Int,2006,3:235-240.
[10]Gitau MM,Arora N.Heparin-induced thrombocytopenia[J].MoMed,2009,1:50-54.
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