汶川地震中挤压综合征所致急性肾损伤

目的 探寻可预见挤压综合征急性肾损伤(AKI)严重程度及需要血液透析(HD)的危险因素.方法研究方法为回顾性分析.参照AKI诊断标准,排除既往罹患肾功能障碍伤员,将2008年5月12日至5月30日绵阳中心医院收治的汶川地震伤者2139名,其中挤压综合征AKI患者63例(男33例,女30例)纳入研究对象.按是否采取血液透析治疗分为两组:(1)透析组,25例,接受了HD治疗,执行HD标准:尿量<250 mL/d;血清钾水平>6 mmol/L;(2)非透析组,38例,没有行HD治疗.回顾性调查如下内容:(1)流行病学:年龄、性别、民族、废墟掩埋时间、解除压迫前补液.(2)临床参数:血压、挤压伤面积、截肢术、室筋膜切开减压术、输血、入院24 h内补液量及尿量.(3)首次实验室检查:血细胞计数、尿液分析、血生化、血气分析.用统计分析软件SPSS 10.0行统计学分析:先按适合定量和定性数据分别采用t检验、χ2检验行两组间变量的差异比较,P<0.05有统计学意义,经组间比较有统计学意义的变量,再纳入多因素logistic回归分析.结果室筋膜切开减压术需要、血浆胱蛋白酶抑制剂(Cys C)、血清肌红蛋白(MB)、血清乳酸值(Lac)的DR值分别为8.641,6.956,5.379,4.833;95%CI分别为3.027～76.479,2.971～54.583,2.764～38.172,2.569～32.764;P<0.05.这些危险因素和挤压综合征AKI严重程度、血液透析需要之间存在统计学联系.结论除尿量、血钾外,有室筋膜切开减压术需要或血浆胱蛋白酶抑制剂(Cys C)、血清肌红蛋白(MB)、血清乳酸值(Lac)异常的挤压综合征患者,他们获得的AKI严重,首诊外科医师有提请透析会诊的必要.

Acute kidney injury related to crush syndrome during Wenchuan earthquake

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.