地震创伤后急性肾损伤临床分析

The clinical analysis on the post-traumatic acute kidney injury after the earthquake

目的总结地震创伤后急性肾损伤(AKI)发病情况和治疗方法及转归。方法21例地震创伤后AKI患者为研究对象,转我院时间为受伤后17～752h,平均(139.3±177.9)h;5例诊断挤压综合征。全部病例检测血常规﹑尿常规﹑血电解质﹑肝功能﹑血清白蛋白﹑肾功能﹑血尿酸﹑血气分析检查。观察其临床转归。结果全部病例均有不同程度的骨折及挤压伤,平均Hb、ALb、Ca2+﹑HCO3-低于正常,平均血UA﹑P3+高于正常;与非挤压综合征患者相比,挤压综合征患者血K+﹑P3﹑BUN升高,更为显著,差异有统计学意义;4例行解压术,1例行截肢术;6例行血液净化,其中1例行血液透析和血液透析滤过,5例行连续性静脉静脉血液滤过(CVVH)。经综合治疗,12例肾功能完全恢复,3例肾功能好转﹑4例肾功能未愈转外省医院继续治疗,1例肾功能未愈在我院继续治疗,1例死亡。结论地震创伤后AKI是多种因素综合作用的结果,早期诊断,及时﹑妥善处理局部挤压伤,及早行血液净化治疗,是治疗抢救成功的重要措施。

Objective Sumarize the clinical manifestation,treatment and resolution of the post-traumatic acute kidney injury（AKI）. Methods 21 post-traumatic acute kidney injury patients（19 male,2 female） aged 10 to 85 （mean：55.8＋25.9） were transferred to our hospital 17 to 752 （mean： 139.3±177.9） hours after the earthquake, with 5 cases of crush syndrome,all patients were check for blood routine,urine routine,serum electrolytes （Na^＋ . K^＋. Cl^-. Ca^2＋, p^3＋. HCO3^-）, liver function,serum albumin,renal function,serum uric acid and arterial blood gas analysis. Results All patients had bony fracture and crush injury of various degree, the average hemoglobin, albumin, serum calcium and bicarbonate level of the patients were lower than normal,the average serum uric acid and phosphorus level were higher than normal,compared with patients without crash syndrome,patients with crash syndrome had elevated serum potassium, phosphorus and BUN level, the differences were statistically significant; 4 patients had decompression surgery,1 patient had amputation,1 patient had undergone hemodialysis （HD） and haemodiafiltration （HDF）, 5 patients had undergone continuous venous venous hemofiltration （CVVH）.After treatment,12 patients had full recovery of their renal function,3 patients had partial recovery of renal function,4 patients had no recovery of renal function and been transferred to other facilities in other provinces to continue their treatment. 1 patient with no recovery of his renal function and continued his treatment in our hospital and 1 patient died. Conclusion The post-traumatic acute kidney injury after the earthquake is the sequel of various pathologic processes,early diagnose, timely and proper manage the local crush trauma and early initiating hemopurification is crucial for the success of the treatment.