多学科合作模式治疗66例挤压综合征汶川地震伤员的效果分析
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摘要
[目的]分析研究多学科合作模式在治疗地震所致66例挤压综合症伤员中的临床效果,为疑难重症处理和以后可能发生的灾难重症救治提供参考。[方法]分析医院收治的66例汶川地震挤压综合症伤员的疾病特点、处理措施以及伤员的治疗效果,并与既往地震所致挤压伤伤员的治疗效果进行比较分析。[结果]伤员骨科住院期间无1例死亡,1例合并急性呼吸窘迫综合征(ARDS)和多器官功能衰竭者(MODF)病情稳定进入康复治疗阶段。13例肾功能轻度不全伤员肾功能逐步恢复正常,共49例伤员接受血液透析治疗(CRRT),其中37例伤员肾功能明显改善停止透析治疗,12例继续接受透析治疗伤员4例肾功能改善不明显且全身状况差,创面尚未愈合。截肢创面中5处创面因创面感染或创面过大尚未愈合,切开减压创面中3处因感染未愈合。其余创面均Ⅰ期或Ⅱ期愈合。[结论]多学科协作合作模式能够从整体角度制定综合的治疗方案,提高救治水平,最大限度地防止或减少并发症的发生,降低伤员的病死率,是一种值得提倡的临床工作模式.
[Objective]To study and analyze the clinical effects of multidisciplinary treatment on 66 patients with crush syndrome, provide referral for critical care and disaster relief work. [Methods] Analyzed the clinical features, treatment and outcome of 66 patients with crush syndrome, and compared with them with those of patients injured in past earthquake. [Results] The mortality was 0 during the hospital stay. One patient developed ARDS and MODF, but her condition improved and was very stable now. 13 patients with slightly impaired renal function recovered. There were totally 49 patients undergoing continuous renal replacement treatment (CRRT). The treatment ceased in 37 patients because of obvious improvement in renal function, and it continued in 12 patients, but the renal function improvement in 4 patients was not apparent and their holistic condition was poor, and wounded hadn't healed so far. Of the entire amputation wound, 5 wounds didn't heal because of infection or big tissue lost. Of the fasciotomy wounds, 3 wounds didn't heal due to infection. The others developed Ⅰhealing or Ⅱ healing. [Conclusion] Multidisciplinary treatment can make integrated determination on the whole, help to elevate the treatment level, prevent or lower incidence of complications to the biggest extent, and decrease the mortality. It is a good work pattern in the clinical setting and worthwhile to be advocated.
[Objective]To study and analyze the clinical effects of multidisciplinary treatment on 66 patients with crush syndrome, provide referral for critical care and disaster relief work. [Methods] Analyzed the clinical features, treatment and outcome of 66 patients with crush syndrome, and compared with them with those of patients injured in past earthquake. [Results] The mortality was 0 during the hospital stay. One patient developed ARDS and MODF, but her condition improved and was very stable now. 13 patients with slightly impaired renal function recovered. There were totally 49 patients undergoing continuous renal replacement treatment (CRRT). The treatment ceased in 37 patients because of obvious improvement in renal function, and it continued in 12 patients, but the renal function improvement in 4 patients was not apparent and their holistic condition was poor, and wounded hadn't healed so far. Of the entire amputation wound, 5 wounds didn't heal because of infection or big tissue lost. Of the fasciotomy wounds, 3 wounds didn't heal due to infection. The others developed Ⅰhealing or Ⅱ healing. [Conclusion] Multidisciplinary treatment can make integrated determination on the whole, help to elevate the treatment level, prevent or lower incidence of complications to the biggest extent, and decrease the mortality. It is a good work pattern in the clinical setting and worthwhile to be advocated.
引文
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Shaw AD,Sjolin SU,Mcqueen MM,Crush syndrome following unconsciousness:need for urgent orthopaedic referral[J].BMJ,1994,309(6958):857-859.
Ward M.Factors predictive of acute renal failure in rhabdomyolysis[J].Arch Inter Med,1988,148(7):1553-1557.
Sever MS,Erek E,Vanholder R,et al.The Marmara earthquake:epidemiological analysis of the victims with nephrological problems[J].Kidney Int2001,60(3):1114-1123.
Noji EK.Acute renal failure in natural disasters[J].Ren Fail 1992,14(3):245～249,
Better OS.The crush syndrome revisited(1940～1990)[J].Nephron 1990,55(2):97-103.
Vanholder R,Sever MS,Erek E,et al.Rhabdomyolysis[J].J Am Soc Nephrol 2000,11(8),1553-1561.
Sever MS,Erek E,Vanholder R,et al.Lessons learned from the catastrophic Marmara earthquake:factors influencing the final out-come of renal victims[J].Clin Nephrol.2004,61(6):413-421.
Oda J,Tanaka H,Yoshioka T,et al.Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake[J].Journal of Trauma-injury Infection&Critical Care1997,42(3):470-476..
Shimazu T,Yoshioka T,Nakata Y,et al.Fluid resuscitation and systemic complications in crush syndrome:14Hanshin-Awaji earthquake patients[J].Journal of Trauma-injury Infection&Criti-cal Care1997,42(4):641-646.
Ersoy A,Yavuz M,Usta M,et al.Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to a-cute renal failure during the Marmara earthquake:survivors VS non survivors[J].Clin Nephrol.2003,59(5):334-340.
Ekek E,Mehmet S,Serdengencti S,et al.An over view of mor-bidity and mortality in patients with acute failure due to crush syn-drome:the Marmara earthquake experience[J].Nephrol Dial Transplant,2002,17(1):33-40.
Keven,Ates,Sever,et al.Infectious complications after mass disasters:The marama earthquake experience[J].Scandinavavian Journal of Infectious Disasters,2003,35(2):110-113.
Peek-Asa C,Kraus JF,Bourque LB,et al.Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake[J].Int JEpidemiol 1998,27(3):459-465.
Leborits AH.多学科协作处理慢性疼痛[J].国外医学,麻醉学与复苏分册,1992,13(4):243-244.
吴跃煌,祁永发,唐平章,等.多学科合作外科处理头颈部复杂肿瘤[J].中华外科杂志,2002,40(6):434-436.
Finlay A,McAlister MC,Simon S,et al.Multidisciplinary strate-gies for the management of heart failure patients at high risk at ad-mission:a systematic review of randomized trials[J].Journal of the American College of Cardiology,2004,44(4):810-819.
付平,唐万欣.连续性肾脏替代治疗与多学科协助治疗危重疾病[J].西部医学,2006,18(2):129～130.
Kikta M J,Meyer JP,Bishara RA,et al.Crush syndrome due to limb compression[J].Arch Surg1987,122(9):1078-1081.
Bywaters EG.50years on:The crush syndrome[J].BMJ,1990,301(6766):1412-1415.
Shaw AD,Sjolin SU,Mcqueen MM,Crush syndrome following unconsciousness:need for urgent orthopaedic referral[J].BMJ,1994,309(6958):857-859.
Ward M.Factors predictive of acute renal failure in rhabdomyolysis[J].Arch Inter Med,1988,148(7):1553-1557.
Sever MS,Erek E,Vanholder R,et al.The Marmara earthquake:epidemiological analysis of the victims with nephrological problems[J].Kidney Int2001,60(3):1114-1123.
Noji EK.Acute renal failure in natural disasters[J].Ren Fail 1992,14(3):245～249,
Better OS.The crush syndrome revisited(1940～1990)[J].Nephron 1990,55(2):97-103.
Vanholder R,Sever MS,Erek E,et al.Rhabdomyolysis[J].J Am Soc Nephrol 2000,11(8),1553-1561.
Sever MS,Erek E,Vanholder R,et al.Lessons learned from the catastrophic Marmara earthquake:factors influencing the final out-come of renal victims[J].Clin Nephrol.2004,61(6):413-421.
Oda J,Tanaka H,Yoshioka T,et al.Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake[J].Journal of Trauma-injury Infection&Critical Care1997,42(3):470-476..
Shimazu T,Yoshioka T,Nakata Y,et al.Fluid resuscitation and systemic complications in crush syndrome:14Hanshin-Awaji earthquake patients[J].Journal of Trauma-injury Infection&Criti-cal Care1997,42(4):641-646.
Ersoy A,Yavuz M,Usta M,et al.Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to a-cute renal failure during the Marmara earthquake:survivors VS non survivors[J].Clin Nephrol.2003,59(5):334-340.
Ekek E,Mehmet S,Serdengencti S,et al.An over view of mor-bidity and mortality in patients with acute failure due to crush syn-drome:the Marmara earthquake experience[J].Nephrol Dial Transplant,2002,17(1):33-40.
Keven,Ates,Sever,et al.Infectious complications after mass disasters:The marama earthquake experience[J].Scandinavavian Journal of Infectious Disasters,2003,35(2):110-113.
Peek-Asa C,Kraus JF,Bourque LB,et al.Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake[J].Int JEpidemiol 1998,27(3):459-465.
Leborits AH.多学科协作处理慢性疼痛[J].国外医学,麻醉学与复苏分册,1992,13(4):243-244.
吴跃煌,祁永发,唐平章,等.多学科合作外科处理头颈部复杂肿瘤[J].中华外科杂志,2002,40(6):434-436.
Finlay A,McAlister MC,Simon S,et al.Multidisciplinary strate-gies for the management of heart failure patients at high risk at ad-mission:a systematic review of randomized trials[J].Journal of the American College of Cardiology,2004,44(4):810-819.
付平,唐万欣.连续性肾脏替代治疗与多学科协助治疗危重疾病[J].西部医学,2006,18(2):129～130.
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