Crushsyndrome压迫症候群.PPT

Crush Syndrome(壓碎症候群) Bombings, earthquakes, building collapse, train accidents and mining accidents. Crush injuries may result in fatal injury or severe metabolic abnormalities that may result in death. Careful monitoring of these patients is essential. 定 義 edema (excess fluid), oliguria (abnormally low excretion of urine) symptoms of renal failure. 肌肉承受缺血限度 1.5 小時, 可完全恢復, 4小時, 肌肉結構及功能損害且無法回復 7小時, 肌肉壞死 。 症 狀 limb may be tingling or numb swollen and hard tissue around injured body part bruising and formation of blisters body part may be pale and cool if arteries are compressed victim may feel weak or faint pulse becomes weak and rapid victim may become anxious or restless. 腔室症候群 因為肢體之骨骼肌肉腔室內壓力,高過微血管灌注壓，以致於神經,肌肉缺血，造成肢體的局部症狀。 症狀表現 患肢：腫脹疼痛的肢體；癱瘓無力及麻痺。 全身性：休克、高血鉀、低血鈣、血尿、腎衰竭 致病機轉（1） leaking of Na+, Cl-, water into the sarcoplasm hypovolemic and hemodynamic shock prerenal and later acute renal failure intracompartmental hypertension 致病機轉（2） leaking of Ca2+into the sarcoplasm hypocalcemia (6mg/dl) aggravate hyperkalemic with cardiotoxicity activation of cytotoxic proteases 致病機轉（3） efflux of K+ hyperkalcemia and cardiotoxicity peripheral vasodilation 致病機轉（4） release of purines from affected muscle hyperuricemia (often 20mg/dl) nephrotoxicity 致病機轉（5） Phosphorus hyperphosphatemia aggravate hypocalcemia metastatic calcification, including the kidney 致病機轉（6） Myoglobin Nephrotoxicity, particularly with coexisting oliguria, aciduria and hyperuricosuria 致病機轉（7） Lactic acid metabolic acidosis; ? aciduria Thromboplastin ? D.I.C. Creatine kinase ? extreme elevation Creatinine ?? creatinine/urea ratio 休克機轉 水和電解質持續流入受傷的肌 ?內在體液的喪失 脫水 ? 外在體液的喪失 高血鉀、低血鈣 ? 抑制心臟血管功能及 cytokinase 增加nitric oxides ? 壓傷肌肉內血管擴張 腎衰竭的機轉 hypercoagulation