5·12汶川地震挤压伤患者高钾血症救治及相关因素分析.doc

5·12汶川地震挤压伤患者高钾血症救治及相关因素分析 　 作者：马俊　康鹏德　裴福兴　宋跃明　屠重棋　杨天府　易敏　黄富国 【摘要】 ：［目的］回顾性分析5·12汶川地震挤压伤患者高钾血症的救治情况、预后及相关危险因素，更好地指导类似灾害事件的救治工作。［方法］地震发生后1周内，本院收治挤压伤患者66例，根据患者伤情分3组：（1）单纯挤压伤，无挤压综合征；（2）挤压综合征，血钾浓度正常；（3）挤压综合征，高钾血症。针对性给予补液、利尿及碱化尿液、纠正电解质紊乱、血液透析、防治感染及支持治疗。探讨挤压时间、挤压部位与高钾血症发生的关系。［结果］66例患者中49例发生了挤压综合征，39例患者合并高钾血症。随着受累肢体的增加和受压时间的延长，患者发生挤压综合征、高钾血症的风险显著上升。经过积极有效的治疗，全部高钾血症患者均在入院后1 d内得以控制，3 d内完全纠正高钾。截止至2008年11月28日，66例患者无1例死亡。［结论］灾害现场救治时，通过患者挤压时间及受累部位可以迅速判断患者伤情，预测挤压综合征、高钾血症的发生，尽早采取措施。对于挤压综合征、高钾血症的治疗，应及时快速补液、利尿及碱化尿液、血液透析，适时骨筋膜室切开减压、截肢或关节离断，遵循抢救生命、挽留肢体、促进康复的原则。 【关键词】 汶川地震　挤压伤　挤压综合征　高钾血症　治疗　危险因素 　 Abstract：［Objective］To retrospectively analyze the treatment of hyperpotassemia in patients with crush injury in Wenchuan earthquake disaster.［Method］Sixtysix patients with crush injury in 5.12 Wenchuan earthquake disaster were divided into 3 groups:crush injury,no crush syndrome;crush syndrome,without hyperpotassemia;and with hyperpotassemia.All patients were treated with fluid replacement,diuresis,alkalizing urine,keeping the balance of water and electrolyte,with hematodialysis,antiinfiammatory therapy and nutritional support of total body.The clinical data were collected and analyzed.［Result］Fortynine patients developed into crush syndrome,39 patients had hyperpotassemia,no patient died after treatment.With the involved limbs and squeeze time increased,the risk of hyperpotassemia increased significantly.［Conclusion］Crush syndrome and hyperpotassemia could be discovered and treated quickly by calculating involved limbs and squeeze time in disaster.Fluid replacement,diuresis,alkalizing urine,hematodialysis,open discompression and amputation should be considered if necessary.The principle of saving lives,preserving body limbs and promoting healing should be followed. 　 Key words：Wenchuan earthquake; crush injury; crush syndrome; hyperpotassemia; treatment; risk factor 　　挤压伤(crush injury)是指四肢或躯干等部位长时间受到重物或重力挤压，或身体被动体位的自压，或止血带捆扎时间过长等原因所致的直接损伤。而由于这样的损伤导致肌肉组织缺血坏死，肌细胞破坏，细胞内成分释放入血，呈现的全身性病理生理改变则