汶川大地震重症伤员疾病分析
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摘要
目的:分析汶川大地震重症伤员的疾病种类和治疗效果。方法:选加强监护病房(ICU)重症地震伤员21例作为研究对象,比较不同疾病组患者的一般情况、血液学检查结果、急性生理及慢性健康情况评估(APACHE)Ⅱ评分和治疗效果,对部分患者行动态APACHEⅡ评分。结果:挤压伤组患者血钾浓度显著高于骨折伴并发症或者合并症组,血钙浓度显著低于单纯骨折组(P<0.05);挤压伤组的血肌酐和天冬氨酸转氨酶(AST)浓度均高于其余各组,但差异无统计学意义(P>0.05)。两周时继续治疗组的APACHEⅡ评分显著高于转出ICU组,而血钠浓度和血钙浓度显著减低(P<0.05);继续治疗组的血钾和血肌酐浓度明显高于转出ICU组,但差异无统计学意义(P>0.05)。结论:重症地震伤员的疾病主要以骨折和挤压伤为主;血钾浓度和血肌酐浓度可初步判断病情的严重程度;对挤压伤患者在恰当时机选择截肢手术对防治挤压综合征是有效的,连续性肾脏替代治疗(CRRT)治疗是挤压综合征患者治疗的重要手段之一;动态APACHEⅡ评分在一定程度上可反映重症患者的病情变化。
Objective:To investigate the classification of diseases and the effect of severe victims in Wenchuan earthquake. Method: 21 patients in intensive care unit were chosen. General state of health, hematologic datas, the acute physiology and chronic health evaluation (APACHE)Ⅱscore and curative effect were detected, and the APACHEⅡscore were evaluated continously for some patients. Result:The serum potassium of patients with crush injury was significantly higher than that of fracture accompanying complications(P< 0.05), while the serum calcium level was significantly lower than that of simple fracture (P<0.05).Compared with other groups, serum creatinine and aspartate aminotransferase were higher in patients with crush injury, but there is no statistically significant (P >0.05). Compared with patients discharged ICU after two weeks, the APACHEⅡscore was significantly higher than those being continuous treated in ICU. However the serum sodium and calcium were significantly lower (P<0.05). The serum potassium and creatinine were higher in patients being continuous treated in ICU, but there is no statistically significant(P>0.05). Conclusion:Fracture and crush injury take the most percent in the severe lesions in earthquake. The potassium and serum creatinine level could evaluate the severity of diseases initially. Amputated extremity could prevent crush syndrome. Continuous renal replacement therapy (CRRT) was the powerful treatment. Continous APACHEⅡscore could reflect patient's condition in a degree.
Objective:To investigate the classification of diseases and the effect of severe victims in Wenchuan earthquake. Method: 21 patients in intensive care unit were chosen. General state of health, hematologic datas, the acute physiology and chronic health evaluation (APACHE)Ⅱscore and curative effect were detected, and the APACHEⅡscore were evaluated continously for some patients. Result:The serum potassium of patients with crush injury was significantly higher than that of fracture accompanying complications(P< 0.05), while the serum calcium level was significantly lower than that of simple fracture (P<0.05).Compared with other groups, serum creatinine and aspartate aminotransferase were higher in patients with crush injury, but there is no statistically significant (P >0.05). Compared with patients discharged ICU after two weeks, the APACHEⅡscore was significantly higher than those being continuous treated in ICU. However the serum sodium and calcium were significantly lower (P<0.05). The serum potassium and creatinine were higher in patients being continuous treated in ICU, but there is no statistically significant(P>0.05). Conclusion:Fracture and crush injury take the most percent in the severe lesions in earthquake. The potassium and serum creatinine level could evaluate the severity of diseases initially. Amputated extremity could prevent crush syndrome. Continuous renal replacement therapy (CRRT) was the powerful treatment. Continous APACHEⅡscore could reflect patient's condition in a degree.
引文
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[2]Gunal AI,Celiker H,Dogukan A,et al.Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes[J].J Am Soc Nephrol,2004,15:1862-1867
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[4]Oda J.Analysis of372with crush syndrome caused by the Hanhsin-Awaji earthquake[J].J Trauma,1997,42:470-475
[5]Demirkiran O,Dikmen Y,Utku T.Crush syndrome patients after the Marmara earthquake[J].Emerg Med J,2003,20:247-250
[6]Sever MS,Erek E,Vanholder R.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol.,2003,59:326-333
[7]Bywaters EG,Beal D.Crush injuries and renal function[J].BMJ,1941,1:427-432
[8]Shimazu T,Yoshioka T,Nakata Y,et al.Fluid resuscitation and systemic complications in crush syndrome:14Hanshin-Awaji earthquake patients[J].J Trauma,1997,42:641-646
[9]Erek E,Sever MS,Serdengecti K.An overview of morbidity and mortality in patient with acute renal failure due to crush syndrome:the Marmara earthquake experience[J].Nephrol Dial Transplant,2002,17:33-40
[10]Shaw AD,Sjolin SU,McQueen MM.Crush syndrome following unconsciousness:need for urgent orthopaedic referral[J].BMJ,1994,309:857-859
[11]Better OS,Stein JH.Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis[J].N Engl J Med,1990,322:825-829com
[2]Gunal AI,Celiker H,Dogukan A,et al.Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes[J].J Am Soc Nephrol,2004,15:1862-1867
[3]Sheng ZY.Medical support in the tangshan earthquake:a review of the management of mass casualities and certain major injures[J].J trauma,1987,27:1130-1135
[4]Oda J.Analysis of372with crush syndrome caused by the Hanhsin-Awaji earthquake[J].J Trauma,1997,42:470-475
[5]Demirkiran O,Dikmen Y,Utku T.Crush syndrome patients after the Marmara earthquake[J].Emerg Med J,2003,20:247-250
[6]Sever MS,Erek E,Vanholder R.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol.,2003,59:326-333
[7]Bywaters EG,Beal D.Crush injuries and renal function[J].BMJ,1941,1:427-432
[8]Shimazu T,Yoshioka T,Nakata Y,et al.Fluid resuscitation and systemic complications in crush syndrome:14Hanshin-Awaji earthquake patients[J].J Trauma,1997,42:641-646
[9]Erek E,Sever MS,Serdengecti K.An overview of morbidity and mortality in patient with acute renal failure due to crush syndrome:the Marmara earthquake experience[J].Nephrol Dial Transplant,2002,17:33-40
[10]Shaw AD,Sjolin SU,McQueen MM.Crush syndrome following unconsciousness:need for urgent orthopaedic referral[J].BMJ,1994,309:857-859
[11]Better OS,Stein JH.Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis[J].N Engl J Med,1990,322:825-829com
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