地震伤患儿挤压综合征及其严重程度的相关因素分析

Risk factors for the occurrence and severity of crush syndrome in pediatric trauma victims after earthquake

目的探讨汶川地震伤后儿童发生CS及其严重程度的相关因素，为临床应对突发灾难事件提供救治方法。方法回顾性分析我院收治的98例汶川地震伤儿童，统计患儿年龄、性别、被困时间、受伤部位、受伤类型、伤121感染、透析治疗等资料，采用T-test／x^2／Fisher精确概率以及Binary logistic回归分析，对各个可能影响CS发生的相关因素及影响CS严重程度的各个危险因素进行统计分析。结果15例CS患儿均来自四肢挤压伤患儿，CS在地震伤儿童发生率达15．3％，在四肢挤压伤发生率达25．4％。CS发生的多个相关因素的Binarylogistic逐步回归分析中，患儿年龄、被困时间、闭合型挤压伤与CS的发生密切相关，其OR值分别为1．049、1．221、0．068（均P〈0．05），而与患儿性别、上或下肢损伤、伤口感染无明显的相关性。各类伤口感染率比较，开放性损伤与CS减张切口感染率明显高于其他切口，但两组间无统计学意义（P=0．754）；在影响CS严重程度的各因素比较发现，CS减张切口感染在影响CS严重程度上有统计学意义（P=0．041）。结论儿童挤压伤后CS的发生主要是四肢损伤为主，与患儿年龄、被困时间以及闭合型挤压伤有关，减张切口感染是影响CS严重度的危险因素。

Objective To analyze the factors affecting the occurrence and severity of crush syndrome（CS） after crush injury （CI） in pediatric trauma victims in the Wenchuan earthquake. Methods Medical records of 98 patients who were transferred to our hospital were retrospectively reviewed. The risk factors, such as age, gender, time being besieged, type of injury, wound infection, hemodialysis, etc. , which were assessed with T-test/x^2/Fisher＇s exact tests and logistic regression analysis for the occurrence of crush syndrome after crush injury. Possible risk factors influencing CS severity were analyzed. Results There were 15 patients with CS, and all these cases were from 59 patients with extremities crush injury. The incidence of CS reached 15.3% in pediatric trauma victims after earthquake and 25.4% in extremities crush injury. Six risk factors were assessed with logistic regression analysis for three outcomes relating to crush syndrome, they are age, time being sieged and closed CI, whose log-odds ratio （log-OR） respectively was 1. 049, 1. 221, and 0. 068（ P 〈0. 05 for all）. And no correlation was found between CS and gender, upper or lower limbs injury or wound infection. There was no significant difference in wounds infection rate between patients with open injury and those who underwent CS fasciotomy （ P = 0. 754 ）, but there was significant difference between those patients who underwent CS fasciotomy and those who underwent other operative incisions （ P 〈0. 05 ）. Wound infection had a significant association with severity of CS （ P = 0. 041 ） as compared with other factors such as age, gender, and time being sieged. Conclusion The occurrence of crush syndrome is mainly because of extremities crush injury and also has significant relations with age, time being sieged and closed crush injury in children. Infection of incisional wound after CS fasciotomy is a risk factor for aggravation of CS.