"5.12"汶川大地震伤员挤压综合征的早期诊治

目的 总结汶川大地震后挤压综合征的早期诊断和以外科治疗为主、多科协作下的综合治疗要点及其临床价值.方法 66例挤压综合征患者中,行截肢或关节离断手术22例,行骨筋膜室切开减压38例,因感染或肢体坏死行二次截肢6例;所有患者均予以补液、输血、扩创换药、扩创缝合创面、抗感染、利尿或血液透析、全身支持及并存病的治疗.结果 截肢或关节离断术后创面一期愈合11例,二期扩创缝合6例;筋膜切开减压创面直接缝合14例,游离植皮11例,二期扩创缝合10例;术后感染32例,有8例创面尚未愈合;49例合并急性肾功能衰竭患者中,37例经血液透析肾功能好转并停止透析,继续透析治疗12例,其中4例患者肾功能改善不明显,13例肾功能不全者经补液、利尿、碱化尿液等治疗好转,无1例进展为急性肾功能衰竭,全组无1例死亡.结论 挤压综合征的早期诊断要点是挤压史、受压肢体的症状、体征及实验室检查;早期治疗挤压综合征的关键是补液、纠正低血容量和高钾血症、适时切开筋膜减压或截肢;术后积极有效的创面处理、血液透析、合并症处理和全身营养支持等多科协作下的综合治疗是成功治疗挤压综合征的保障.

Early diagnosis and treatment for patients with crush syndrome in 5.12 Wenchuan megaseism

Objective] To summarize the main points of early diagnosis of crush syndrome originated from Wenchuan megaseism and the comprehensive treatment with characteristic of surgical therapy combined with multi-department cooperation and its clinical value.Methods] 22 of 66 patients with crush syndrome underwent amputation or exarticulation,38 osteofascial compartment open decompression and 6 re-amputation due to infection or limbs necrosis.All the 66 patients received fluid infusion,blood transfusion,enlarged d...