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

Analysis of relative risk factors for crush injury and crush syndrome in the patients after Wenchuan earthquake

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。

Objective Respectively cohort study to develop predicitive factors based on clinical date for crush injury patients in the Wenchuan earthquake （May 21, 2008）. Methods Sixty-six crush in- juried patients were admitted to our hospital after Wenchuan earthquake. The medical records of those pa- tients were retrospectively analyzed. Some risk factors were assessed for the outcome of relating crush syn- drome. Risk factors for estimating the risk of crush syndrome including patients＂ characteristics, time for res- cue, number of injured limbs, abnormal urine color, and blood laboratory date including potassium, peak serum creatine kinase. Results No patient died. The major associated injuries were in the low extremities and upper extremities. 48 patients developed acute renal failure with increased concentrations of serum crea- tinine had underwent haemodialysis. Hyperkalaemia was seen in 9 patients and four of them underwent haemodialysis. The pulse rate, delayed rescue, and abnormal urine color the most informative predictors of crush syndrome and renal failure, which relate directly to the pathophysiology of the crush injury. The other major risk factors including blood laboratory date such as potassium, peak serum ereatine kinase. Conclu- sion Our findings may be useful to other disaster experts for distinguishing earthquake victime at high risk of severe crush syndrome from those at lower risk. Application of those risk factors to estimating the risk of syndrome may allow relief workers to better utilize limited medical and transportation resources in the after- math of disaster.