汶川地震伤致挤压综合征合并肾功能衰竭患者的救治  

The crush syndrome patients combined with kidney failure after Wenchuan earthquake

作　　者：康鹏德[1] 裴福兴[1] 屠重棋[1] 王光林[1] 张晖[1] 宋跃明[1] 付平[2] 康焰[3] 孔清泉[1] 刘立岷[1] 杨天府[1] 刘雷[1] 方跃[1] 罗传兴[3] 刘洋[1] 金晓东[3] 陶冶[2] 薛欣盛[3] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院肾内科,成都610041 [3]四川大学华西医院ICU,成都610041

出　　处：《中华外科杂志》2008年第24期1862-1864,共3页Chinese Journal of Surgery

摘　　要：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日汶川地震后所致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—102h，平均24．7h。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（169～842μmol／L），CK平均64022U／L（34571—76836U／L），均出现肌红蛋白尿，39例合并有高钾血症（血钾5．23～6．38mmol／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11～37d恢复。高钾血症均在人院后当天纠正。CK在入院后13～45d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例创面经换药、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（〉20d）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，是日前部分尚存创面患者治疗的难点。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 muhisubjective coordination would have improved the survival rate.

关 键 词：挤压综合征 肾功能衰竭 急性 筋膜间隔综合征 减压术 外科 治疗 

分 类 号：R686[医药卫生—骨科学]