地震伤高钾血症骨折患者保肢的影响因素分析
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摘要
目的:对地震伤高钾血症骨折患者的临床表现以及保肢情况进行相关性研究,探讨相应的救治方案,提高临床诊治水平。方法:对"5.12"汶川地震收治的37例高钾血症患者的临床表现及药物治疗、患肢切开减压、血液透析、截肢等治疗情况进行多因素Logistic回归分析。结果:37例高钾血症患者全部接受药物辅助治疗,单纯切开减压9例,单纯血液透析8例,切开减压合并血液透析20例。所有患者治疗后血钾浓度均恢复正常,血钾浓度由治疗前的(6.25±0.91)mmol/L降低为治疗后的(4.47±0.65)mmol/L(P<0.05)。5例患者进行了截肢术,均为GustiloIII开放性损伤,血钾浓度为(6.13±0.78)mmol/L,未截肢患者32例,血钾浓度为(6.25±0.31)mmol/L,二者比较差异没有统计学意义(P>0.05)。Logistic回归分析发现,影响保肢的因素有肢体受压时间、伤后开始血液透析时间以及伤后切开减压时间(OR值分别为4.394,3.793和5.432;P值分别为0.013,0.047和0.015)。结论:对地震伤高钾血症患者,缩短肢体受压时间、及时切开减压和血液透析治疗是降低血钾、保存肢体的重要因素。
Objective To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake,to discuss the clinical symptom and to improve the clinical treatment.Methods The clinical symptom,drug therapy,limb incision decompression,hemodialysis,and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression.Results All the 37 patients received drug therapy:9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously.The concentration of potassium decreased from(6.25 ± 0.91)mmol/L to(4.47±0.65)mmol/L,with significant difference(P<0.05).Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of(6.13±0.78)mmol/L,while the concentration of potassium for the other 32 patients was(6.25±0.31)mmol/L.There was no significant difference between them(P>0.05).Logistic regression analysis found the time of compression,the time before incision and decompression,and the time before hemodialysis were the main factors to affect limb salvage.The OR value of these factors was 4.394,3.793 and 5.432;while the P value was 0.013,0.047,and 0.015,respectively.Conclusion Decreasing the time of compression,appropriate incision and decompression,and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.
Objective To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake,to discuss the clinical symptom and to improve the clinical treatment.Methods The clinical symptom,drug therapy,limb incision decompression,hemodialysis,and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression.Results All the 37 patients received drug therapy:9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously.The concentration of potassium decreased from(6.25 ± 0.91)mmol/L to(4.47±0.65)mmol/L,with significant difference(P<0.05).Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of(6.13±0.78)mmol/L,while the concentration of potassium for the other 32 patients was(6.25±0.31)mmol/L.There was no significant difference between them(P>0.05).Logistic regression analysis found the time of compression,the time before incision and decompression,and the time before hemodialysis were the main factors to affect limb salvage.The OR value of these factors was 4.394,3.793 and 5.432;while the P value was 0.013,0.047,and 0.015,respectively.Conclusion Decreasing the time of compression,appropriate incision and decompression,and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.
引文
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[9]Demirkiran O,Dikmen Y,Utku T,et al.Crush syndrome patients after the Marmara earthquake[J].Emerg Med J,2003,20(2):247-250.
[10]Simth J,Greaves I.Crush injury and crush sundrome:a re-view[J].J Trauma,2003,54(1):226-230.
[11]Roy N,Shah H,Pate l V,et al.The Gujarat erathquake ex-perience in aseismically unprepared area:community hospital medical response[J].Prehosp Disaster Med,2002,17(1):186-195.
[2]LinksAltintepe L,Guney I,Tonbul Z,et al.Early and in-tensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apart-ment in Konya[J].Ren Fail,2007,29(6):737-744.
[3]Kes P.Slow continuous renal replacement therapies:an up-date[J].Acta Med Croatica,2000,54(2):69-84.
[4]Robert N,Reddix J R,Robert A.Probe Crush syndrome presenting three days after injury[J].Injury Extra,2004,35(1):73-75.
[5]Yazar S,Lin C H,Wei F C.One stage reconstruction of composite bone and soft-tissue defects in traumatic lower ex-tremities[J].Plast Reconstr Surg,2004,114(6):1457-1466.
[6]Vinsonneau C,Camus C,Combes A,et al.Continuous veno-venous haemodiafiltration versus intermittent haemodialysisfor acute renal failure in patients with multiple-organ dysfunction syndrome:a multicentre randomised trial[J].Lancet,2006,368(9):379-384.
[7]Vanholder R,van der Tol A,De Smet M,et al.Earthquakes and crush syndrome casualties:lessons learned from the Kash-mir disaster[J].Kidney Int,2007,71(1):17-23.
[8]Malinoski D J,Slater M S,Mullins R J.Crush injury and rhabdomyolysis[J].Crit Care Clin,2004,20(1):171-176.
[9]Demirkiran O,Dikmen Y,Utku T,et al.Crush syndrome patients after the Marmara earthquake[J].Emerg Med J,2003,20(2):247-250.
[10]Simth J,Greaves I.Crush injury and crush sundrome:a re-view[J].J Trauma,2003,54(1):226-230.
[11]Roy N,Shah H,Pate l V,et al.The Gujarat erathquake ex-perience in aseismically unprepared area:community hospital medical response[J].Prehosp Disaster Med,2002,17(1):186-195.
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