CAJ | 학술논문

目的回顾性分析汶川地震挤压综合征(CS)的治疗结果,为指导类似灾难性事件中挤压伤、cs的救治提供理论依据和指导.方法 2008年5月12口汶川地震后所致49例合并急性肾脏功能衰竭(ARF)的cS患者,致伤原因均为地震中被重物砸伤;受挤压时间4～102 h,平均24.7 h.男27例,女22例;年龄6.8～76.0岁,平均31.8岁.平均累计肢体1.5肢.49例存在ARF,血Cr平均365.6μmol/L(169～842 μmol/L),CK平均64 022 U/L(34 571～76 836 U/L),均出现肌红蛋白尿,39例合并有高钾血症(血钾5.23～6.38 mmoL/L).所有患者均予持续肾脏替代疗法(CRRT)治疗,补液、利尿、碱化尿液和纠正电解质紊乱、输血、改善低蛋白血症、预防或治疗创面感染治,扩创换药、扩创缝合.结果 CRRT治疗49例,肾脏功能在11～37 d恢复.高钾血症均在入院后当天纠正.CK在人院后13～45 d恢复正常.无1例死亡.骨筋膜间室切开减压30例52肢,截肢35例45肢.5例因感染、肢体坏死行二次截肢手术.24例创而经换药、扩创或植皮愈合,8处创面(4例)因感染、组织坏死或创面过大等原因未愈合,均为长时间(>20 d)接受CRRT治疗患者,并合并有其他系统、器官损伤.结论及时明确诊断、积极有效的早期局部和全身治疗,是成功治疗CS,降低并发症发生率和病死率的关键.CS时创面愈合与长时间CRRT治疗之间的协调,是目前部分尚存创而患者治疗的难点.
목적 회고성분석문천지진제압종합정(CS)적치료결과,위지도유사재난성사건중제압상、cs적구치제공이론의거화지도.방법 2008년5월12구문천지진후소치49례합병급성신장공능쇠갈(ARF)적cS환자,치상원인균위지진중피중물잡상;수제압시간4～102 h,평균24.7 h.남27례,녀22례;년령6.8～76.0세,평균31.8세.평균루계지체1.5지.49례존재ARF,혈Cr평균365.6μmol/L(169～842 μmol/L),CK평균64 022 U/L(34 571～76 836 U/L),균출현기홍단백뇨,39례합병유고갑혈증(혈갑5.23～6.38 mmoL/L).소유환자균여지속신장체대요법(CRRT)치료,보액、이뇨、감화뇨액화규정전해질문란、수혈、개선저단백혈증、예방혹치료창면감염치,확창환약、확창봉합.결과 CRRT치료49례,신장공능재11～37 d회복.고갑혈증균재입원후당천규정.CK재인원후13～45 d회복정상.무1례사망.골근막간실절개감압30례52지,절지35례45지.5례인감염、지체배사행이차절지수술.24례창이경환약、확창혹식피유합,8처창면(4례)인감염、조직배사혹창면과대등원인미유합,균위장시간(>20 d)접수CRRT치료환자,병합병유기타계통、기관손상.결론 급시명학진단、적겁유효적조기국부화전신치료,시성공치료CS,강저병발증발생솔화병사솔적관건.CS시창면유합여장시간CRRT치료지간적협조,시목전부분상존창이환자치료적난점.
Objective To retrospectively analysis the treatment characteristics of the systemic situation in patients with crush syndrome after Wenchuan earthquake happened in May 12th,2008.Methods Forty-nine patients with crush syndrome and subsequent acute renal failure (ARF) due to the earthquake were treated in West China Hospital. All of patients had been extricated from buildings that collapsed in Wenchuan earthquake.The major associated injuries were in the low extremities and upper extremities.49 patients developed ARF with increased concentrations of serum creatinine (mean 64 022 U/L) had underwent haemodialysis.Hyperkalaemia was seen in 9 patients and four of them underwent haemodialysis.49 patients were administered hemodialysis.Results No patient died.All patients who suffered from the ARF were weaned from hemodialysis after admitted 7 to 35 days. Forty-five extremities underwent amputations and 52 extremities had fasciotomy.Conclusions Crush syndrome requires urgent recognition and prompt surgical treatment with simultaneous measures to control hyperkalemia and ARF.The authors believe that immediate intensive care therapy and multisubjective coordination would have improved the survival rate.