四肢挤压综合征的抗氧化治疗

目的：探讨抗氧化剂防治挤压综合征（CS）的临床疗效,寻求新的治疗措施。方法：21例男性CS患者,年龄24～48岁,平均36岁。早期应用下列抗氧化剂：①20%甘露醇250ml在30min内滴完,每6或8h进行1次。②七叶皂苷钠20mg、丹参注射液20ml分别加入生理盐水或5%葡萄糖200ml中静脉滴注,每日1次,连续应用5～7d。同时碱化尿液,维持液体轻度负平衡及电解质平衡,预防感染及支持治疗。当骨筋膜室压力〉30mmHg时及时切开深筋膜减压并继续应用上述药物。结果：21例肌红蛋白尿均在2～3d内消失,13例伤肢切开深筋膜减压。因缺血时间较长,减压术后断肢坏死截肢2例,小腿轻度功能障碍2例,手部缺血性肌挛缩1例,足下垂1例。随访8个月～1年,按照评定标准,优8例,良7例,可2例,差4例。结论：四肢长时间挤压伤后尽早应用抗氧化剂可以显著降低CS的发生率及伤残率。

Treatment for crush syndrome of extremities with antioxidants

Objective ：To study the clinical therapeutic effect of antioxidants assistant treatment of extremities crush syndrome（CS）in order to find new therapy. Methods：Twenty-one male patients（aged from 24 to 48 years,mean 36 years） were treated with the next antioxidants in early stage：（1）20% Mannitol 250 ml intravenous drip in 30 minutes（one time per 6 to 8 h）. （2）Sodium aescinate 20 mg,Salvia Mihiorrhiza 20 ml were dissolved respectively in isotonic saline or 5% glucose 200 ml and dripped by intravenous drip （50 to 60 drips per minute）. The drugs were used for 5 to 7 days （one time per day）. Basifying urine ,keeping the nagative liquid banlance and electrolyte banlance ,preventing infection and hold out treatment were done. When the pressure of muscular osteofascial compartment was more than 30 mmHg,deep fasia was cut to decompress timely and the above-mentioned drugs were continuously applied for patients. Results：Myoglobin urine of 21 cases died out after 2 to 3 days,of them, 13 cases were performed to decompress. After open decompression,2 cases suffered from amputation because of long time of ischemia,2 cases took place slight dysfunction of lower limbs ,one hand had ischemia muscular contracture in 1 case and one foot down-vertical in 1 case. After followed-up of 8 months to 1 year,according to the function standard,the result were excellent in 8 cases,good in 7 cases,fair in 2 cases,poor in 4 cases. The excellent and good rate was about 71.4% （15/21）. Conclusion ：After extremities crushed for long time, application of antioxidents as early as possible can decrease significantly the incidence and invalidity rate of CS.