加强对地震伤挤压综合征救治的作用和意义

目的：探讨加强治疗对玉树地震伤挤压综合征（crush syndrome,CS）作用及意义。方法：分析3例严重CS致急性肾功能衰竭（acute renal fail,ARF）患者的临床及实验室特征,治疗体会。结果：3例均出现了骨筋膜室综合征合并ARF,均为藏族,男2例,女1例,年龄（39.67±9.30）岁,地震伤后获救时间为（6.83±1.60）h,入院时尿素氮（BUN）为（32.02±6.94）mmol/L,血肌酐（Scr）（634.67±146.20）μmol/L,血清磷酸肌酸激酶（CK）（14279.67±4636.87）IU/L,血清钾（K＋）（6.67±0.76）mmol/L,急性生理与慢性健康评分（APACHEⅡ）（25.33±1.53）分,入院后首次进行血液透析时间（92.67±3.06）h,共血透或血滤时间为（256.67±124.23）h,少尿期为（17.00±2.65）d,机械通气时间为（14.00±19.29）h。3例患者均存活,痊愈出院。结论：严重的CS易致ARF,早期积极液体复苏、实施有效清创和截肢术、血液净化治疗、有效抗感染会明显提高抢救成活率。

The Effect and its Significance of Strengthening Treatment on Crush Syndrome of Earthquake Injuries

Objective：To investigate the role and significance of strengthening treatment on crush syndrome（CS） of Yushu earthquake injuries. Methods：Three patients,Tibetan （2 men and 1 women,mean age,39.67 ± 9.30 years）,with severe CS associated with acute renal failure （ARF） because injury of Yushu earthquake,were hospitalized to our hospital,and the emergency treatment was conducted. Results：The three patients were examined clinically with blood test after hospital immediately; finding they suffered from bone compartment syndrome and ARF with blood urea nitrogen （BUN） of （32.02 ± 6.94） mmol /L,serum creatinine （Scr） of （634.67±146.20）μmol /L,serum creatine kinase （CK） of （14 279.67 ± 4 636.87） IU / L and serum potassium （K＋） of （6.67 ± 0.76） mmol / L. Their acute physiology and chronic health score （APACHE Ⅱ） was 25.33 ± 1.53 points. The first treatment was performed with hemodialysis for （92.67 ± 3.06） hours. General time of hemodialysis or hemofiltration was （256.67 ± 124.23） hours. Duration of oliguria reached （17.00±2.65）days and mechanical ventilation for（14.00±19.29）hours. Beneficial effect was obtained in 3 patients,and they are discharged because survival and complete recovery. Conclusions：In strengthening treatment of patient with severe CS associated with ARF following earthquake injury,the aggressive fluid resuscitation,effective debridement and amputation,blood purification,and effective anti-infection easily can significantly improve the survival rate of rescue patients.