挤压伤病理生理学研究进展
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摘要
近年来,在频发地震、泥石流、矿难、爆炸恐怖袭击等灾难事故中,由于房屋建筑垮塌所引起的挤压伤较为多见,其损伤特点是局部损伤貌似轻微,全身继发性病理变化隐匿,常导致包括肾、心、肺、肝等远隔器官的严重损伤,直至发生创伤性多器官功能不全综合征,伤情危重,预后凶险。该文着重对近10年来挤压伤所致重要远隔脏器损伤的病理生理学特点与发病机制研究新进展进行简要综述。
In recent years,amid frequent accidents such as earthquakes,debris flow,mine disasters,explosion and terrorist attacks,crush injuries caused by collapse of buildings often occur,which are characterized by seemingly minor local damage and dormant systemic secondary pathological changes.Crush injuries often lead to serious damage to remote organs including the kidney,heart,lung,and liver until traumatic multiple organ dysfunction syndrome with critical damage and dangerous prognosis occurs.This paper focused on the pathophysiological characteristics and mechanisms of the crush injury to the important remote organs in recent ten years.
In recent years,amid frequent accidents such as earthquakes,debris flow,mine disasters,explosion and terrorist attacks,crush injuries caused by collapse of buildings often occur,which are characterized by seemingly minor local damage and dormant systemic secondary pathological changes.Crush injuries often lead to serious damage to remote organs including the kidney,heart,lung,and liver until traumatic multiple organ dysfunction syndrome with critical damage and dangerous prognosis occurs.This paper focused on the pathophysiological characteristics and mechanisms of the crush injury to the important remote organs in recent ten years.
引文
[1]Michaelson M,Taitelman U,Bshouty Z,et al.Crush syndrome:experience from the Lebanon War 1982[J].Isr J Med Sci,1984,20(4):305.
[2]王正国.实用创伤外科学[M].福州:福建科学技术出版社,2009:253-255.
[3]辛宇鹏,袁光亚,邵红刚,等.地震伤后154例挤压综合征的诊治体会[J].西部医学,2009,21(2):326-328.
[4]屈纪富,文亮,刘明,等.58例严重挤压伤临床诊治分析[J].创伤外科杂志,2009,11(2):140-144.
[5]Derici U,Ozkaya O,Arinsoy T,et al.Increased plasma nitratelevels in patients with crush syndrome in the Marmara earthquake[J].Clin Chim Acta,2002,322(1-2):99-103.
[6]郭庆山,沈岳,林志国,等.地震伤员严重下肢挤压伤保肢治疗体会[J].创伤外科杂志,2008,10(6):495-497.
[7]Bywaters EGL,Beall D.Crush injuries with impairment of renalfunction[J].Br Med J,1941,1(4185):427.
[8]Bywaters EGL.Ischemic muscle necrosis[J].JAMA,1944,124(16):1103-1109.
[9]Better OS.History of the crush syndrome:from the earthquakesof Messina,Sicily 1909 to Spitak,Amrenia 1988[J].Am JNephrol,1997,17(3-4):392-394.
[10]高彩荣,安峰,王英元,等.挤压伤-挤压综合征的实验病理学研究[J].中国法医学杂志,2001,16(1):26-28.
[11]Vanholder R,Van der Tol A,De Smet M,et al.Earthquakes andcrush syndrome casualties:lesson learned from the Kashmir dis-aster[J].Kidney Int,2007,71(1):17-23.
[12]刘蔓莉,佘宁兰,陈敏,等.地震创伤后急性肾损伤临床分析[J].中国血液净化,2008,7(9):507-509.
[13]李广然,张涤华.挤压伤致急性肾衰竭的治疗[J].新医学,2008,39(11):708-710.
[14]刘水平,刘小山,竞花兰,等.挤压伤大鼠早期心脏损伤的细胞机制[J].中国法医学杂志,2006,22(2):90-92.
[15]马永能,张鹏,彭秀娟,等.地震挤压伤患者部分生化指标特征性改变分析[J].国际检验医学杂志,2010,31(9):941-943.
[16]郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
[17]郭进春,赖小今,廖明松,等.家兔挤压伤后心肌组织与心功能变化的对比研究[J].西南国防医药,2012,22(5):473-476.
[18]赖小今,郭进春,梁燕,等.家兔挤压伤后应变率成像与心肌病理变化对照的实验研究[J].临床超声医学杂志,2011,13(10):656-659.
[19]赖小今,郭进春,邓旦,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].Med J Chin PLA,2012,37(7):699-701.
[20]赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588.
[21]韩业兴,谷振勇,丛斌,等.挤压家兔后肢导致急性肝损伤和抗氧化能力降低[J].法医学杂志,2006,22(4):248-250.
[22]He Q,Wang F,Li G,et al.Crush syndrome and acute kidney in-jury in the Wenchuan earthquake[J].Trauma,2011,70(5):1213-1217.
[23]李学博,莫耀南,陈为刚,等.双手挤压伤后肺脂肪栓塞死亡1例[J].法医学杂志,2008,24(4):304-305.
[24]赵军,马志鹏,金春亭,等.左足挤压伤术后并发深静脉栓塞致急性肺栓塞死亡1例[J].河北北方学院学报(医学版),2010,27(6):65.
[25]王立金,王慧,方玉荣.挤压伤引起多器官功能障碍综合征的实验研究[J].中国工业医学杂志,2010,16(3):152-155.
[26]Abassi Z,Hoffman A,Beller O,et al.Acule renal failure compli-cating,muscle crush injury[J].Semin Nephrol,2005,14(1):89.
[27]靳风烁,梁培禾.挤压伤和挤压综合征的发病与救治[J].创伤外科杂志,2010,12(2):191-193.
[2]王正国.实用创伤外科学[M].福州:福建科学技术出版社,2009:253-255.
[3]辛宇鹏,袁光亚,邵红刚,等.地震伤后154例挤压综合征的诊治体会[J].西部医学,2009,21(2):326-328.
[4]屈纪富,文亮,刘明,等.58例严重挤压伤临床诊治分析[J].创伤外科杂志,2009,11(2):140-144.
[5]Derici U,Ozkaya O,Arinsoy T,et al.Increased plasma nitratelevels in patients with crush syndrome in the Marmara earthquake[J].Clin Chim Acta,2002,322(1-2):99-103.
[6]郭庆山,沈岳,林志国,等.地震伤员严重下肢挤压伤保肢治疗体会[J].创伤外科杂志,2008,10(6):495-497.
[7]Bywaters EGL,Beall D.Crush injuries with impairment of renalfunction[J].Br Med J,1941,1(4185):427.
[8]Bywaters EGL.Ischemic muscle necrosis[J].JAMA,1944,124(16):1103-1109.
[9]Better OS.History of the crush syndrome:from the earthquakesof Messina,Sicily 1909 to Spitak,Amrenia 1988[J].Am JNephrol,1997,17(3-4):392-394.
[10]高彩荣,安峰,王英元,等.挤压伤-挤压综合征的实验病理学研究[J].中国法医学杂志,2001,16(1):26-28.
[11]Vanholder R,Van der Tol A,De Smet M,et al.Earthquakes andcrush syndrome casualties:lesson learned from the Kashmir dis-aster[J].Kidney Int,2007,71(1):17-23.
[12]刘蔓莉,佘宁兰,陈敏,等.地震创伤后急性肾损伤临床分析[J].中国血液净化,2008,7(9):507-509.
[13]李广然,张涤华.挤压伤致急性肾衰竭的治疗[J].新医学,2008,39(11):708-710.
[14]刘水平,刘小山,竞花兰,等.挤压伤大鼠早期心脏损伤的细胞机制[J].中国法医学杂志,2006,22(2):90-92.
[15]马永能,张鹏,彭秀娟,等.地震挤压伤患者部分生化指标特征性改变分析[J].国际检验医学杂志,2010,31(9):941-943.
[16]郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
[17]郭进春,赖小今,廖明松,等.家兔挤压伤后心肌组织与心功能变化的对比研究[J].西南国防医药,2012,22(5):473-476.
[18]赖小今,郭进春,梁燕,等.家兔挤压伤后应变率成像与心肌病理变化对照的实验研究[J].临床超声医学杂志,2011,13(10):656-659.
[19]赖小今,郭进春,邓旦,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].Med J Chin PLA,2012,37(7):699-701.
[20]赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588.
[21]韩业兴,谷振勇,丛斌,等.挤压家兔后肢导致急性肝损伤和抗氧化能力降低[J].法医学杂志,2006,22(4):248-250.
[22]He Q,Wang F,Li G,et al.Crush syndrome and acute kidney in-jury in the Wenchuan earthquake[J].Trauma,2011,70(5):1213-1217.
[23]李学博,莫耀南,陈为刚,等.双手挤压伤后肺脂肪栓塞死亡1例[J].法医学杂志,2008,24(4):304-305.
[24]赵军,马志鹏,金春亭,等.左足挤压伤术后并发深静脉栓塞致急性肺栓塞死亡1例[J].河北北方学院学报(医学版),2010,27(6):65.
[25]王立金,王慧,方玉荣.挤压伤引起多器官功能障碍综合征的实验研究[J].中国工业医学杂志,2010,16(3):152-155.
[26]Abassi Z,Hoffman A,Beller O,et al.Acule renal failure compli-cating,muscle crush injury[J].Semin Nephrol,2005,14(1):89.
[27]靳风烁,梁培禾.挤压伤和挤压综合征的发病与救治[J].创伤外科杂志,2010,12(2):191-193.
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