地震挤压综合征所致急性肾功能衰竭的临床特点和救治方案
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摘要
目的回顾性分析地震挤压综合征致急性肾功能衰竭(acute renal failure,ARF)患者的临床特点,总结合理有效的救治方案。方法分析我校收治的12例在汶川大地震中因挤压综合征致ARF患者的病历资料,对患者的临床表现、实验室检查结果、连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)结果以及治愈时间进行综合评价。结果贫血、发热和肺部感染在此类患者中较多见,发生率分别达到了91.67%、66.67%和58.33%,有41.67%的患者出现了胸腔积液和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)。12例患者均出现低钙、低白蛋白血症以及肌酸激酶(CK)明显升高,并且CK>3000IU/L的患者都进行了CRRT治疗,CK>3000IU/L与CRRT治疗有明显的相关性(r=0.845);另有高达91.67%的患者伴有谷草转氨酶升高。筋膜切开减压和/或截肢术后患者行CRRT的例数虽高于闭合性损伤的患者,但两者之间差异无统计学意义(P=0.5227);创面感染的患者其ARF的恢复时间明显长于无感染的患者(P=0.0255)。结论与其他诱因引发的ARF不同,地震挤压综合征所致的ARF具有一些独特的临床表现,且易合并多脏器功能障碍,在救治过程中要给予积极的对症支持和肾脏替代治疗;彻底清创和有效的感染控制有利于肾功能的快速恢复。
Objective To retrospectively analyze the clinical characteristics of acute renal failure ( ARF) induced by crush syndrome after Wenchuan earthquake,and summarize the rational and effective treatment managements of this kind of ARF. Methods The case histories of 12 patients diagnosed as ARF related to the crush syndrome in Wenchuan earthquake were pigeonholed. In order to evaluate the curative effects of the clinical features,laboratorial examination,continuous renal replacement therapy ( CRRT) and cure time were ana- lyzed. Results Anaemia,fever and lung infection were frequently happened in the patients diagnosed as ARF,and the frequency was 91. 67% ,66. 67% and 58. 33% respectively. Pleural effusion and acute respiratory distress syndrome ( ARDS) were noted in 41. 67% of the patients,and the increase of transaminase was noted as 91. 67% . Hypocalcaemia,hypoproteinemia and marked increase of creatine kinase ( CK) appeared in all patients. The patients with CK value exceeded 3 000 IU/L were received CRRT,and there was marked relativity between these 2 variables ( r =0. 845) for the treatment of ARF. Although the proportion of CRRT practiced highly in patients with oliguria,fasciotomies and amputations,there was no significant difference when compared with closed injury and non-oliguria patients ( P = 0. 522 7) . Compared with patients without infections,wound infections were obviously delayed the cure time of ARF ( P = 0. 025 5) . Conclusion As compared with ARF from other causes,ARF related to the crush syndrome has unique characteristics,and easily complicates with multiple organ dysfunction syndrome. Among the treatments, heteropathy and renalreplacement therapy are frequently used. Thorough debridement and infection control are beneficial to renal function recovery.
Objective To retrospectively analyze the clinical characteristics of acute renal failure ( ARF) induced by crush syndrome after Wenchuan earthquake,and summarize the rational and effective treatment managements of this kind of ARF. Methods The case histories of 12 patients diagnosed as ARF related to the crush syndrome in Wenchuan earthquake were pigeonholed. In order to evaluate the curative effects of the clinical features,laboratorial examination,continuous renal replacement therapy ( CRRT) and cure time were ana- lyzed. Results Anaemia,fever and lung infection were frequently happened in the patients diagnosed as ARF,and the frequency was 91. 67% ,66. 67% and 58. 33% respectively. Pleural effusion and acute respiratory distress syndrome ( ARDS) were noted in 41. 67% of the patients,and the increase of transaminase was noted as 91. 67% . Hypocalcaemia,hypoproteinemia and marked increase of creatine kinase ( CK) appeared in all patients. The patients with CK value exceeded 3 000 IU/L were received CRRT,and there was marked relativity between these 2 variables ( r =0. 845) for the treatment of ARF. Although the proportion of CRRT practiced highly in patients with oliguria,fasciotomies and amputations,there was no significant difference when compared with closed injury and non-oliguria patients ( P = 0. 522 7) . Compared with patients without infections,wound infections were obviously delayed the cure time of ARF ( P = 0. 025 5) . Conclusion As compared with ARF from other causes,ARF related to the crush syndrome has unique characteristics,and easily complicates with multiple organ dysfunction syndrome. Among the treatments, heteropathy and renalreplacement therapy are frequently used. Thorough debridement and infection control are beneficial to renal function recovery.
引文
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[3]Pocan S,Ozkan S,Us M H,et al.Crush syndrome and acute renal failure in the Marmara earthquake[J].Mil Med,2002,167(6):516-518.
[4]Crisis center of the Turkish prime ministry.Earthquakes1999[M].Ankara:Prime ministry,2000:3-15.
[5]Najafi I,Van-Biesen W,Sharifi A,et al.Early detection of patients at high risk for acute kidney injury during disasters:development of a sco-ring system based on the Bam earthquake experience[J].J Nephrol,2008,21(5):776-782.
[6]Vanholder R,Van-Biesen W,Lameire N,et al.The role of the Inter-national Society of Nephrology/Renal Disaster Relief Task Force in the rescue of renal disaster victims[J].Contrib Nephrol,2007,156:325-332.
[7]Gunal A I,Celiker H,Dogukan A,et al.Early and vigorous fluid re-suscitation prevents acute renal failure in the crush victims of cata-strophic earthquakes[J].J Am Soc Nephrol,2004,15(7):1862-1867.
[8]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.
[9]Sever M S,Erek E,Vanholder R,et al.Lessons learned from the cat-astrophic Marmara earthquake:factors influencing the final outcome of renal victims[J].clinical Nephrology,2004,61(6):413-421.
[10]Acierno M J,Maeckelbergh V.Continuous renal replacement therapy[J].Compend Contin Educ Vet,2008,30(5):264-272.
[2]Altintepe L,Guney I,Tonbul Z,et al.Early and intensive fluid re-placement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya[J].Ren Fail,2007,29(6):737-741.
[3]Pocan S,Ozkan S,Us M H,et al.Crush syndrome and acute renal failure in the Marmara earthquake[J].Mil Med,2002,167(6):516-518.
[4]Crisis center of the Turkish prime ministry.Earthquakes1999[M].Ankara:Prime ministry,2000:3-15.
[5]Najafi I,Van-Biesen W,Sharifi A,et al.Early detection of patients at high risk for acute kidney injury during disasters:development of a sco-ring system based on the Bam earthquake experience[J].J Nephrol,2008,21(5):776-782.
[6]Vanholder R,Van-Biesen W,Lameire N,et al.The role of the Inter-national Society of Nephrology/Renal Disaster Relief Task Force in the rescue of renal disaster victims[J].Contrib Nephrol,2007,156:325-332.
[7]Gunal A I,Celiker H,Dogukan A,et al.Early and vigorous fluid re-suscitation prevents acute renal failure in the crush victims of cata-strophic earthquakes[J].J Am Soc Nephrol,2004,15(7):1862-1867.
[8]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.
[9]Sever M S,Erek E,Vanholder R,et al.Lessons learned from the cat-astrophic Marmara earthquake:factors influencing the final outcome of renal victims[J].clinical Nephrology,2004,61(6):413-421.
[10]Acierno M J,Maeckelbergh V.Continuous renal replacement therapy[J].Compend Contin Educ Vet,2008,30(5):264-272.
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