地震伤并发挤压综合征的救治分析

Analysis on the treatment of crush syndrome complicated in earthquake injury

目的探讨地震后发生挤压综合征的危险因素和治疗措施。方法“5·12”汶川大地震发生后四川省人民医院收治的325例地震伤病例中，有35例并发挤压综合征，对其按性别、年龄、伤后就诊时间、治疗过程及预后进行比较分析。结果35例挤压综合征患者中，前臂受伤7例，小腿25例，手掌3例，其中合并急性肾功能衰竭3例。伤后至入院时间6～92h，平均49．3h。35例均进行彻底切开减压处理，其中6例治愈，2例遗留肢体功能受限；27例术后发生肌群广泛坏死并发感染，最后行截肢处理，所有35例无死亡。挤压综合征发生率中，青少年（14岁以下25．8％）与成年人（14—59岁为8．0％）比较，差异具有统计学意义。就诊时间晚者（48h后31．0％）OCS发生率明显高于早期就诊患者（48h内3．5％）。结论获救时间、诊治延误及年龄均是挤压综合征发生的高危因素。对地震伤后挤压综合征伤情高度重视和准确判断，早期诊断，及时充分减压，是对地震伤并发挤压综合征最主要的预防与治疗措施。

Objective To explore the risk factors and treatment of crush syndrome complicated in earthquake injury. Method The demographics and epidemiological characteristics, clinical treatment and the outcome of 35 cases with crush syndrome were reviewed and analyzed.The 35 patients were among 325 victims of ＂5· 12＂ Wenchuan earthquake, who were admitted in Sichuan Provincial People＇ s Hospital, Chengdu. Results Of 35 patients with crush syndrome, 7 eases injured at forearm, 25 eases injured at cruse, and 3 eases injured at palm, and 3 cases were complicated with acute renal failure. The time from the occurrence of injury to transporting patients into the hospital was 6 - 92 hours, with mean time 49.3 hours. All the 35 patients had their wound cut open for decompression, and 6 cases were cured, 2 had dysfunction, and 27 underwent amputation. Young patients under 14 years old had higher rate （25.8%） of crush syndrome than elder patients of 14 - 59 years old with rate of 8.0%. And patients admitted into hospital later （over 48 hour after injury） had higher incidence of crush syndrome （31.0%） than those admitted earlier within 48 hours after injury （3.5%）. Conclusions Attaching great importance to crush syndrome after earthquake injury, early diagnosis and treatment, and timely and complete surgical decompression are key points to the successful treatment and prevention of crush syndrome complicated in earthquake injury. Because the longer interval between injury and rescue, delayed diagnosis and treatment, and the younger age of patients are all the risk factors of crush syndrome.