地震挤压综合征致急性肾功能衰竭的临床特点和救治原则.DOCVIP

地震挤压综合征所致急性肾功能衰竭的临床特点和救治 赵景宏1 张静波1 王卫东2 徐剑铖2 高加蓉2 杨惠标1* （第三军医大学新桥医院：1肾内科，2新桥医院，重庆400037） 摘要：目的 回顾分析地震挤压综合征致急性肾功能衰竭（acute renal failure，ARF）患者的临床特点，总结合理有效的救治方案。方法 分析我校收治的12例在汶川大地震中因挤压综合征致ARF患者的病历资料，对患者的临床表现，实验室检查结果，连续肾替代治疗（continuous renal replacement therapy，CRRT）（acute respiratory distress syndrome，ARDS）creatine kinase，CK）的明显升高，并且CK＞3000IU/L的患者都进行了CRRT；另有高达91.67%的患者伴有转氨酶升高。筋膜切开减压和/或截肢术后以及少尿型患者的CRRT比例高于闭合性损伤和非少尿型的患者，创面感染与ARF的恢复时间有明显的相关性。结论 与其它诱因引发的ARF不同，地震挤压综合征所致的ARF具有一些独特的临床表现，且易合并多脏器功能障碍，在救治过程中要给予积极的对症支持和肾脏替代治疗，彻底清创和有效的感染控制有利于肾功能的快速恢复。 关键词：地震；挤压综合征；急性肾功能衰竭；血液净化 中图法分类号：R459.7；R594.9 Clinical Characteristics and Treatments of Acute Renal Failure Induced by Crush Syndrome after Earthquake Zhao Jing-hong1, Zhang Jing-bo1 , Wang wei-dong2, Xu Jian-cheng2, gao Jia-rong2, Yang Hui-biao1* (1Department of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China） Abstract：Objective To retrospectively analyze the clinical characteristics of acute renal failure (ARF) induced by crush syndrome after Wen-Chuan earthquake, and summarize the rational and effective treatments of this kind of ARF. Methods The case histories of 12 patients diagnosed as ARF related to the crush syndrome in Wen-Chuan earthquake were pigeonholed. In order to evaluate the curative effects of the clinical features, laboratorial check results, continuous renal replacement therapy (CRRT) and cure time were analyzed. Results At admission, anaemia, fever and lung infection were frequently happened in the patients, especially for anaemia, which was occurred in 91.67% of the patients. Pleural effusion and acute respiratory distress syndrome (ARDS）w noted in 41.67% of the patients, and the increase of transaminase was noted as 91.67%. Hypocalcaemia, hypoproteinemia and marked increase of creatine kinase (CK) appeared in all patients. The patients with CK value exceeded 3000IU/L were received CRRT. Compared with closed injury and non-oliguria patients, the proportion of CR