地震转运伤员中挤压伤患者的治疗体会
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摘要
目的探讨汶川地震中转运至医院的挤压伤患者的早期救治和院内治疗,为以后此类患者的救治提供经验。方法挤压综合征患者14例,男2例,女12例,年龄11～35岁,中位年龄21岁。分析其病情特点、早期救援情况和转入院后的诊治情况。结果10例患者患肢功能恢复良好,4例患者因并发气性坏疽而多次清创,患肢功能受损严重。所有患者肾功能指标都恢复至正常水平,伤口均二期闭合。仅有1例患者因肢体毁损严重在转入前已行右下肢截肢。结论对于挤压伤患者,早期液体复苏并及时行筋膜切术开减压清创是预防挤压综合征和筋膜间室综合征的关键;同时应积极防治感染,必要时进行透析治疗。
Objective To explore the early rescue and in-patient treatment of transferring crush injury patients to our hospital in Wenchuan earthquake,and to offer experience for rescuing these patients afterward.Methods Fourteen patients,including 2 males and 12 females,were joined in this study,aging from 11 to 35 years old with an average age of 21 years.The patients information of clinical presentations,early rescuing,diagnosis and treatment after transfer to our hospital was analyzed.Results 10 patients was well restored,except 4 patients that were undergoned debridement to the lesion many times because of concomitance with gas gangrene.Renal function indications were restored to normal level in all patients.All incisions of the patients were closed in a second stage.Only one patient had been undergone amputation before transfer to our hospital because of badly damaged right lower extremity.Conclusion For managing crush injury,early fluid resuscitation and timely fasciotomy is the key to prevent the advent of crush syndrome or compartment syndrome.Meanwhile,prophylactic or essential use of antibiotics should be in time,and dialysis treatment should be commenced when necessary.
Objective To explore the early rescue and in-patient treatment of transferring crush injury patients to our hospital in Wenchuan earthquake,and to offer experience for rescuing these patients afterward.Methods Fourteen patients,including 2 males and 12 females,were joined in this study,aging from 11 to 35 years old with an average age of 21 years.The patients information of clinical presentations,early rescuing,diagnosis and treatment after transfer to our hospital was analyzed.Results 10 patients was well restored,except 4 patients that were undergoned debridement to the lesion many times because of concomitance with gas gangrene.Renal function indications were restored to normal level in all patients.All incisions of the patients were closed in a second stage.Only one patient had been undergone amputation before transfer to our hospital because of badly damaged right lower extremity.Conclusion For managing crush injury,early fluid resuscitation and timely fasciotomy is the key to prevent the advent of crush syndrome or compartment syndrome.Meanwhile,prophylactic or essential use of antibiotics should be in time,and dialysis treatment should be commenced when necessary.
引文
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4Gonzalez D.Crush syndrome[J].Critical Care Medicine,2005,33(1):34-41.
5Fernandez WG,Hung O,Bruno R,et al.Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis[J].Am J Emerg Med,2005,23(1):1-7.
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8Better OS.The crush syndrome revisited(1940-1990)[J].Nephron,1990,55(2):97-103.
9Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syn-drome victims of the Marmara disaster[J].Clin Nephrol,2003,59(5):326-333.
10Michael Sahjian,Michael Frakes.Crush injuries:pathophysiology and current treatment[J].The Nurse Practitioner,2007,9(32):13-17.
11Reis ND,Michaelson M.Crush injury to the lower limbs:treatment of the local injury[J].J Bone Joint Surg[Am],1986,68(3):414-418.
12Sever SM,Erek E,Vanholder R,et al.Clinical findings in the renal vic-tims of a catastrophic disaster:the Marmara earthquake[J].Nephrol Dial Transplant,2002,17(11):1942-1949.
13Better O,Rubinstein I,Winaver JM,et al.Mannitol therapy revisited(1940-1997)[J].Kidney Int,1997,51(10):886-894.
14Nadjafi I,Atef MR,Broumand B,et al.Suggested guidelines for treat-ment of acute renal failure in earthquake victims[J].Ren Fail,1997,19(5):655-664.
15Tetsuya M,Toshiharu Y,Hiroshi T,et al.Long term physical outcome ofpatients who suffered crush syndrome after the1995Hanshin-Awaji earthquake:prognostic indicators in retrospect[J].J Trauma,2002,52(1):33-39.
16Holt S,Moore K.Pathogenesis of renal failure in rhabdomyolysis:the role of myoglobin[J].Exp Nephrol,2000,8(2):72-76.
17Moore KP,Holt SG,Patel RP,et al.Acausative role for redoxcycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure[J].J Biol Chem,1998,273(48):31731-31737.
2Better OS,Stein JH.Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis[J].N Engl J Med,1990,322(12):825-829.
3Kopp JB,Ball LK,Cohen A,et a1.Kidney patient care in disasters:les-sons from the hurricanes and earthquake of2005[J].Clin J Am Soc Nephrol,2007,2(4):814-824.
4Gonzalez D.Crush syndrome[J].Critical Care Medicine,2005,33(1):34-41.
5Fernandez WG,Hung O,Bruno R,et al.Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis[J].Am J Emerg Med,2005,23(1):1-7.
6Malinoski DJ,Slater MS,Mullins RJ.Crush injury and rhabdomyolysis[J].Critical Care Clinics,2004,20(1):171-192.
7Ian Greaves,Keith MP.Consensus statement on crush injury and crush syndrome[J].Accident and Emergency Nursing,2004,12(1):47-52.
8Better OS.The crush syndrome revisited(1940-1990)[J].Nephron,1990,55(2):97-103.
9Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syn-drome victims of the Marmara disaster[J].Clin Nephrol,2003,59(5):326-333.
10Michael Sahjian,Michael Frakes.Crush injuries:pathophysiology and current treatment[J].The Nurse Practitioner,2007,9(32):13-17.
11Reis ND,Michaelson M.Crush injury to the lower limbs:treatment of the local injury[J].J Bone Joint Surg[Am],1986,68(3):414-418.
12Sever SM,Erek E,Vanholder R,et al.Clinical findings in the renal vic-tims of a catastrophic disaster:the Marmara earthquake[J].Nephrol Dial Transplant,2002,17(11):1942-1949.
13Better O,Rubinstein I,Winaver JM,et al.Mannitol therapy revisited(1940-1997)[J].Kidney Int,1997,51(10):886-894.
14Nadjafi I,Atef MR,Broumand B,et al.Suggested guidelines for treat-ment of acute renal failure in earthquake victims[J].Ren Fail,1997,19(5):655-664.
15Tetsuya M,Toshiharu Y,Hiroshi T,et al.Long term physical outcome ofpatients who suffered crush syndrome after the1995Hanshin-Awaji earthquake:prognostic indicators in retrospect[J].J Trauma,2002,52(1):33-39.
16Holt S,Moore K.Pathogenesis of renal failure in rhabdomyolysis:the role of myoglobin[J].Exp Nephrol,2000,8(2):72-76.
17Moore KP,Holt SG,Patel RP,et al.Acausative role for redoxcycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure[J].J Biol Chem,1998,273(48):31731-31737.
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