地震伤致严重挤压综合征的救治体会

目的：探讨地震伤挤压综合征的诊断及治疗，为地震伤挤压综合征的救治提供参考。方法：对地震伤致严重挤压综合征35例治疗进行总结回顾，观察全身营养支持、积极局部创面处理辅助血液透析，对挤压综合征患者恢复的作用。结果：经过正确的早期处理，逐步清除局部坏死组织，恢复患者心、肾功能，为后续修复创面打下良好基础。结论：尽早解除压迫，正确处理伤肢，及时对坏死组织清除，减少毒素吸收，辅助人工血液透析治疗，有利于提高挤压综合征患者救治成功率。     

汶川地震所致肢体挤压伤及挤压综合征相关危险因素分析

目的 回顾性分析汶川地震所致肢体挤压伤及挤压综合征的危险因素,为地震挤压伤后的病情判断、挤压综合征的预防、早期诊断及治疗提供理论依据.方法 汶川地震后挤压伤、挤压综合征患者66例,挤压伤18例、挤压综合征48例.致伤原因均为地震中被倒塌房屋及重物压砸伤.对患者年龄、性别、受挤压时间、肢体受累及情况、获救后的心率、尿液颜色、血钾、尿素氮、肌酐、肌酸激酶检查结果,以及肢体治疗情况和最终治疗结果进行统计.结果 (1)挤压伤18例21肢,其中单侧下肢(小腿)11例11肢,单侧上肢(前臂)4例4肢,一侧上肢合并一侧下肢(小腿)2例4肢,双前臂1例2肢;挤压综合征48例76肢,单侧下肢24例24肢,一侧上肢合并一侧下肢7例14肢,双侧下肢11例22肢,双下肢合并一侧上肢4例12肢,双上肢2例4肢.(2)挤压伤患者受挤压时间平均7.6h,挤压综合征患者平均16.4h.(3)2例挤压伤患者出现尿液颜色浅红色,32例挤压综合征患者出现褐色尿.(4)挤压综合征患者肢体累及数量高于挤压伤患者.(5)挤压综合征患者血钾、尿素氮、肌酐、肌酸激酶水平较挤压伤患者高,差异均有统计学意义.结论 现场救援过程中或获救后可以通过对患者受挤压时间、累及肢体数、尿液颜色以及血钾、尿素氮、肌酐、肌酸激酶结果,初步判断患者病情严重程度、预后和帮助制定治疗方案.对指导地震等灾害性突发群体损伤事件的救治和提高患者救治效率、优化医疗资源配置将发挥一定的作用.     

汶川地震伤致严重挤压综合征救治体会——附一例报告

目的 探讨地震伤致挤压综合征的诊断及治疗,为地震伤挤压综合征的救治提供参考.方法 对地震伤致严重挤压综合征1例治疗进行总结回顾,观察全身营养支持、积极局部创面处理辅助血液透析对挤压综合征伤员恢复的作用.结果 经过积极处理,局部坏死组织得到清除.心、肾功能进一步好转,为后续修复创面打下良好基础.结论 清除坏死组织、减少毒素吸收、辅助人工血液透析治疗,有利于提高挤压综合征伤员的救治成功率.     

汶川大地震挤压伤特点与手术方式选择

目的 总结5.12汶川大地震挤压伤特点和手术方式选择.方法 2008年5月12日-6月18日,在汶川大地震救治过程中收治202例四肢软组织挤压伤伤员.男110例,女92例:年龄1岁7个月～16岁25例,17～60岁129例,61岁以上48例.挤压时间30 min～154 h.对60例开放性损伤者行清创包扎或缝合术;16例18侧肢体毁损者及6例8侧肢体因挤压综合征急性肾功能衰竭者行截肢术;32例42侧肢体发生筋膜间隙综合征危象者行筋膜腔切开解压术;15例行坏死肌肉切除术31次;9例挤压综合征急性肾功能衰竭伤员行连续性肾脏替代治疗(continuous renal replacementtherapy,CRRT).结果 2例在GRRT治疗期间因肠道及颅内出血死亡,余200例伤口或创面全部愈合.其中198例于治疗后15～120 d痊愈出院,2例8个月后治愈出院;平均住院53 d.22例26侧肢体截肢术后3～6个月均安装假肢,功能良好.结论 挤压伤治疗原则是"积极减压,慎重截肢",肌肉变硬及肌酸激酶、血钾增高是筋膜腔切开解压术的金指标,难以抉择时宁可早期减压;坏死肌肉切除不尽或坏死界限不清者应行开放性截肢.     

汶川地震伤致挤压综合征合并肾功能衰竭患者的救治

目的 回顾性分析汶川地震挤压综合征(CS)的治疗结果,为指导类似灾难性事件中挤压伤、cs的救治提供理论依据和指导.方法 2008年5月12口汶川地震后所致49例合并急性肾脏功能衰竭(ARF)的cS患者,致伤原因均为地震中被重物砸伤;受挤压时间4～102 h,平均24.7 h.男27例,女22例;年龄6.8～76.0岁,平均31.8岁.平均累计肢体1.5肢.49例存在ARF,血Cr平均365.6μmol/L(169～842 μmol/L),CK平均64 022 U/L(34 571～76 836 U/L),均出现肌红蛋白尿,39例合并有高钾血症(血钾5.23～6.38 mmoL/L).所有患者均予持续肾脏替代疗法(CRRT)治疗,补液、利尿、碱化尿液和纠正电解质紊乱、输血、改善低蛋白血症、预防或治疗创面感染治,扩创换药、扩创缝合.结果 CRRT治疗49例,肾脏功能在11～37 d恢复.高钾血症均在入院后当天纠正.CK在人院后13～45 d恢复正常.无1例死亡.骨筋膜间室切开减压30例52肢,截肢35例45肢.5例因感染、肢体坏死行二次截肢手术.24例创而经换药、扩创或植皮愈合,8处创面(4例)因感染、组织坏死或创面过大等原因未愈合,均为长时间(>20 d)接受CRRT治疗患者,并合并有其他系统、器官损伤.结论 及时明确诊断、积极有效的早期局部和全身治疗,是成功治疗CS,降低并发症发生率和病死率的关键.CS时创面愈合与长时间CRRT治疗之间的协调,是目前部分尚存创而患者治疗的难点.     

汶川地震挤压综合征患者肌肉挤压伤的特点

目的 分析汶川地震挤压综合征患者肌肉挤压伤的特点.方法 回顾性分析2008年5月12日汶川地震后成都军区总医院收治的挤压综合征患者8例,男女各4例;年龄25～45岁,平均35.4岁.压埋时间9～152h,平均52h.均行筋膜切开手术,截肢者6例8肢.8例患者均行连续肾脏替代治疗.2例死于颅脑出血及肠穿孔.术后发生ARDS2例,DIC1例,气性坏疽1例.结果 汶川地震肌肉挤压伤的特点:(1)挤压时间超长,导致急性肾衰;(2)挤压伤因皮肤破损轻微而被误诊,延误病情;(3)受压深层肌肉常比浅层肌肉损伤更严重;(4)肌肉坏死区多发且呈不规律分布;(5)早期坏死组织与正常肌肉混杂造成治疗困难;(6)创面在坏死组织脱落后,可有继发性出血.结论 汶川地震中肌肉挤压伤有其自身特点.治疗中应注意观察,发现肌肉肿胀应行切开减压引流.创面易发生突发性出血及感染.隐匿的肌肉坏死区肌肉溶解、感染是长期发热的主要原因.肢体MR检查有助于发现病灶、及时处理肌肉坏死区.连续肾脏替代治疗是治疗挤压综合征的有效手段.     

地震挤压伤患者的心理干预

目的 减轻或缓解地震挤压伤患者的负性心理.方法 了解患者心理状况,对存在生理、认知、情绪及行为方面问题的40例患者进行针对性心理干预,对患儿采取抚慰、鼓励、讲故事、做游戏及触摸法舒缓紧张情绪,对成年患者采取无言的陪伴、关切地倾听,并鼓励其做力所能力的事情等方法进行心理干预.结果 经过近10 d的心理干预.患者4个方面的心理问题均显著好转.结论 针对性心理干预可有效减轻患者地震灾害所致的心理应激反应.     

地震挤压伤患者的心理干预

目的减轻或缓解地震挤压伤患者的负性心理。方法了解患者心理状况,对存在生理、认知、情绪及行为方面问题的40例患者进行针对性心理干预,对患儿采取抚慰、鼓励、讲故事、做游戏及触摸法舒缓紧张情绪,对成年患者采取无言的陪伴、关切地倾听,并鼓励其做力所能力的事情等方法进行心理干预。结果经过近10d的心理干预,患者4个方面的心理问题均显著好转。结论针对性心理干预可有效减轻患者地震灾害所致的心理应激反应。     

地震伤致严重挤压综合征1例救治体会

挤压综合征(crush syndrome,CS)又称外伤性无尿综合征、缺血性肌坏死综合征、Bywaters氏综合征、外伤性肌红蛋白尿急性肾功能衰竭综合征.1941年Bywaters首次分析16例挤压伤患者,并提出"挤压综合征".CS是指四肢或躯干肌肉丰满的部位被长时间压榨导致广泛的肌肉组织缺血性坏死、横纹肌溶解,而后引起身体一系列的病理改变.临床上主要表现为受压肢体肿胀、肌红蛋白尿、高血钾及少尿甚至无尿的急性肾功能衰竭.在这次四川地震中本院一共收治了34名四川地震伤员,这些伤员都有不同程度的挤压伤,其中1例典型的严重挤压综合征患者,经过积极的内外科综合处理,取得满意疗效,现报告如下.     

汶川、玉树、芦山地震伤员伤情分析与救治比较

目的分析比较汶川、玉树、芦山地震伤员的伤情特点及治疗方法,总结经验,为应急救治提供参考。方法首先对后送的406例伤员进行损伤分类,成立以骨科为主的医疗小组,请专家会诊手术,优先处理急、危重伤员,制定综合治疗措施。结果所有救治的伤员均未死亡,汶川地震中10例(11肢)行截肢术,3例截瘫,无严重并发症发生。结论汶川、玉树、芦山地震因地震强度、地域差异及发生时间的不同导致伤情不同,但治疗策略相同,根据伤员自身特点制定其具体治疗方案,疗效满意。     

A contrast study of the traumatic condition between the wounded in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake

Purpose: 5.12 Wenchuan earthquake and 4.25 Nepal earthquake are of the similar magnitude, but the climate and geographic environment are totally different. Our team carried out medical rescue in both disasters, so we would like to compare the different traumatic conditions of the wounded in two earthquakes. Methods: The clinical data of the wounded respectively in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake rescued by Chengdu Military General Hospital were retrospectively analyzed. Then a contrast study between the wounded was conducted in terms of age, sex, injury mechanisms, traumatic conditions, complications and prognosis. Results: Three days after 5.12 Wenchuan earthquake, 465 cases of the wounded were hospitalized in Chengdu Military General Hospital, including 245 males (52.7%) and 220 females (47.3%) with the average age of (47.6 ± 22.7) years. Our team carried out humanitarian relief in Katmandu after 4.25 Nepal earthquake. Three days after this disaster, 71 cases were treated in our field hospital, including 37 males (52.1%) and 34 females (47.9%) with the mean age of (44.8±22.9) years. There was no obvious difference in sex and mean age between two groups, but the age distribution was a little different: there were more wounded people at the age over 60 years in 4.25 Nepal earthquake (p<0.01) while more wounded people at the age between 21 and 60 years in 5.12 Wenchuan earthquake (p<0.05). The main cause of injury in both disasters was bruise by heavy drops but 5.12 Wenchuan earthquake had a higher rate of bruise injury and crush injury (p<0.05) while 4.25 Nepal earthquake had a higher rate of falling injury (p<0.01). Limb fracture was the most common injury type in both disasters. However, compared with 5.12 Wenchuan earthquake, 4.25 Nepal earthquake has a much higher incidence of limb fractures (p<0.01), lung infection (p<0.01) and malnutrition (p<0.05), but a lower incidence of thoracic injury (p<0.05) and multiple injury (p<0.05). The other complications and death rate showed no significant differences. Conclusion: Major earthquakes of the similar magnitude can cause different injury mechanisms, traumatic conditions and complications in the wounded under different climate and geographic environment. When an earthquake occurs in a poor traffic area of high altitude and large temperature difference, early medical rescue, injury control and wounded evacuation as well as sufficient warmth retention and food supply are of vital significance.     

汶川地震腹部损伤的诊治

After analyzing the clinical data of 5 injured persons diagnosed with delayed spleen or liver rupture combined with fractures after the Wenchuan earthquake, we found that the abdominal injuries in earthquake were rare but usually very severe. Since almost all the injured persons had multiple injuries, mortality was extremely high. First aid service should be applied in the first 6 to 8 hours. Orderly physical examination and peritoneocentesis in multiple sites are in favor of diagnosis. Reducing the missed diagnosis rate of abdominal injuries is important in raising the rate of successful treatment. Therapy for earthquake injuries should be focused on the most deadly injuries after a thorough examination, besides this, precise employment of control surgery, swift transportation of the injured persons, and prevention and dealing with complications are also important.     

汶川地震腹部损伤的救治体会与思考

At 2:28 p.m. local time on 12 May, 2008, the Wenchuan earthquake struck with a magnitude of 8.0. After the earthquake, 1364 injured persons, including 732 women and 632 men, were admitted to Deyang People's Hospital. The ages of the injured persons ranged from 0.2 years to 102 years (mean, 42.5 years). Of all injured persons, 4.65% aged under 7 years, 13.84% between 7 and 18 years, 39.57% between 19 and 45 years, 24.48% between 46 and 65 years, and 17.46% above 65 years. A total of 1713 injuries were found in all the injured persons, and the predominant injuries were found in limbs, body surface, head and chest. The incidence of the multiple injuries was 23.64%. Eighteen persons with abdominal injuries received operation. Prompt, accurate and systematic evaluation of the injury is necessary in raising the rescue efficiency. Treating the injured persons according to a classification optimizes the usage of the limited medical resources. Early definitive operation is crucial in rescuing the lives of the injured persons, and the treatment should be applied within 24 hours after the earthquake, then the emphasis of the rescue work should shift to helping orthopedic surgeons with operation and debridement.     

汶川地震德阳市腹部损伤的调查与分析

A magnitude of 8.0 earthquake struck on Wenchuan on May 12, 2008. Until July 1, 1393 injured persons had been admitted to Deyang People's Hospital. Of all injured persons, 32 were diagnosed with abdominal injury, including 18 men and 14 women. All the abdominal injuries were closed injury, and multiple abdominal viscera were involved in the abdominal injuries after the earthquake. Careful examination is crucial in preventing missed diagnosis. The incidences of the liver and spleen injuries were significantly higher than that of the intestine, and the reason may be that the liver and spleen are the parenchymal viscera. Diagnostic abdominocentesis can timely diagnose the parenchymal viscera with severe blood loss. Diagnostic peritoneal lavage combined with selective CT scan can timely diagnose the abdominal injuries with comparatively low cost.     

肾脏替代治疗对挤压综合征伤口的影响分析:汶川地震经验总结

[目的]分析肾脏替代治疗对挤压综合征患者伤口的影响,为今后治疗挤压综合征以及制定治疗策略提供更好的临床依据。[方法]收集汶川地震中本院收治的挤压综合征患者临床资料和相关治疗结果,将入选的患者分成肾脏替代治疗组和非肾脏替代治疗组,对比分析伤口感染率、伤口活动性动脉出血发生率、小腿减压切口渗液量的差异。[结果]肾脏替代治疗组和非肾脏替代治疗的伤口感染率差异有统计学意义(P=0.006)。肾脏替代治疗组培养出的致病菌前3位依次是不动杆菌属、铜绿假单胞菌和肠杆菌属,为多重耐药菌株。肾脏替代治疗组创面渗液量显著高于非肾脏替代治疗组(P=0.000)。[结论]肾脏替代治疗易导致挤压综合征患者开放创面渗液量增多、感染率高以及多重耐药菌株混合感染。     

"5·12"汶川地震华西医院收治患者上肢伤情分析

[目的]探讨地震上肢伤员的伤情及救治情况.[方法]收集地震期间本院收治 236例上肢患者的基本情况,分析上肢患者的受伤机制、临床表现及处理和预后等情况.[结果]236例上肢患者中骨折208例378例次,其中锁骨骨折35例次,肩胛骨骨折31例次,肱骨骨折113例次,尺骨骨折46例次,桡骨骨折87例次,腕掌指骨骨折66例次.开放性骨折64例次.行清创缝合(含扩创)50例次,骨折复位内固定60例次,外固定支架7例次,截肢(含残端修整)19例次,神经血管修复术8例次,保守治疗(石膏托或卧床等)113例次,仅1例病人因高血钾合并颅脑腹部脏器损伤死亡.[结论]分析本次地震中上肢伤的受伤机制、部位等以及伤后救援、治疗、预后等情况,为以后地震及类似情况上肢伤的救治提供参考.     

Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake.

BACKGROUND: The clinical course of acute renal failure (ARF) related to crush syndrome is very complex, because of co-existing surgical and/or medical complications. After the devastating Marmara earthquake that struck Turkey in August 1999, 639 patients were identified with nephrological problems, whose clinical findings have been the subject of this analysis. METHODS: Specific questionnaires asking about 63 variables were sent to 35 reference hospitals that treated the victims. Clinical findings of the renal victims were analysed. RESULTS: At admission, high fever was noted in 31.8% of the patients; the temperature of non-survivors was higher (P=0.027). Mean blood pressure was higher in survivors (P=0.004) and dialysed victims (P <0.001). Most (61.4%) patients were oligo-anuric; oliguria lasted for 10.8+/-7.2 days. Thoracic and abdominal traumas were associated with a higher risk of mortality. 397 fasciotomies and 121 amputations were performed in 790 traumatized extremities. Fasciotomies were associated with sepsis (P<0.001) and dialysis needs (P<0.0001), while amputations were associated with mortality (P<0.0001). Medical complications, which were associated with dialysis needs (P<0.0001) and mortality (P<0.0001), were observed in 51.5% of patients. In a multivariate analysis model of medical complications, disseminated intravascular coagulation (DIC) (P<0.0001, OR=5.81), and adult respiratory distress syndrome (ARDS) (P=0.0001, OR=4.53) were predictors of mortality. CONCLUSIONS: In the aftermath of catastrophic earthquakes, clinical findings of the renal victims can predict the final outcome. While fasciotomies indicate dialysis needs, extremity amputations, abdominal and thoracic traumas are associated with higher rates of mortality in addition to DIC and ARDS.     

地震中肢体挤压伤的液体治疗

目的 评价静脉补液对预防肢体挤压伤后肾功能衰竭发生的重要性.方法 分析解放军第四五二医院收治的11例汶川地震肢体挤压伤伤员临床资料.结果 伤员被废墟下掩埋平均时间(10.90±4.81)h(2-18h),震后(96.18±26.59)h(24-143h)经直升机转运至中心医院.入院第1天血清肌酸激酶峰值(22327.3±26881.0)U/L(1500-102400U/L).入院24h液体入量可以达到12000mL.无死亡和肾功能衰竭发生.结论 尽早、快速、大量静脉补液可以预防挤压综合征发生肾功能衰竭.     

汶川地震伤员的紧急救治

2008年5月12日汶川地震发生30h后，海军总医院抗震救灾第一医疗队抵达灾区绵阳。截止7月4日，抢救重伤员37人次，开展各类手术125台次，诊治灾民12025人次，先后4次向重庆、昆明、广州、德阳等地远距离转运伤员583名。从战伤救治的角度看，我们经历了全部三级救治过程。在最初的紧急救治基本结束后，对其中的体会和经验进行小结。