地震伤员中挤压综合征的医院内早期救治：汶川震区13例分析

目的分析汶川5·12地震收治的挤压综合征伤员的早期救治。方法分析13例从地震废墟救出的挤压综合征伤员[男10例，女3例，年龄31（16～81）岁]的临床资料。结果伤员在废墟中被埋12～96h，平均38h。入住ICU后接受补液、输血及血液制品，使用抗生素、利尿、肾替代、筋膜室切开减压、截肢术等治疗。死亡3例。其中1例在入院5h出现猝死；1例入院时即处于休克昏迷状况，抢救9h死亡；1例81岁女性，发生多器官功能衰竭于伤后25d死亡。10例在病情稳定后转省级医院治疗，转院时7例24h尿量在400ml以上，3例24h尿量分别为302ml、315ml、120ml。跟踪随访，转院后1例于伤后58d死亡，1例转为慢性肾功能不全，8例肾功能恢复正常。结论地震灾区挤压综合征发生率高，很多患者没有合并骨折而发生筋膜室综合征，容易漏诊。挤压综合征病情发展快。及时截肢可以有效改善患者肾功能。

Early treatment of crush syndrome among earthquake victims: analysis of 13 cases in earthquake-stricken area of Wenchuan

Objective To summarize the experience of early treatment of crush syndrome among earthquake victims. Methods The clinical data of 13 patients with crush syndrome, 10 males and 3 females, aged 31 （16-81）, who had been buried in earthquake rubble for 38 （12-96） hours, were analyzed. Results The patients underwent rehydration therapy, transfusion of blood and blood products, use of antibiotics and diuretic, kidney replacement, fasciotomy and compartment decompression, even amputation. Three patients died： one was admitted to hospital and suffered from sudden death 5 hours later, one was in a coma while admitted and died 9 hours later,, and one 81-year-old woman died from multiple organ failure. The rest 10 patients were transferred to other hospitals after their condition became stable, seven of them with the 24 h urine volume of 400 ml and above, and the other 3 with the 24 h urine volumes of 302 ml, 315 ml, and 120 ml respectively. Telephone follow-up showed that one remained in the hospital for 58 days, one suffered from chronic renal insufficiency, and 8 with their renal function returning to normal. Conclusion Crush syndrome is common in earthquake. Many patients may suffer from compartment syndrome without fracture which may cause missed diagnosis. The condition of crush syndrome develops rapidly. Timely amputation may effectively improve the renal function.