Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake.
Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake.
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DOI：
10.1046/j.1523-1755.2002.00669.x
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发表时间：
2002-12
影响因子：
19.6
通讯作者：
M. Sever;E. Erek;R. Vanholder;Birsen Yurugen;G. Kantarci;M. Yavuz;H. Ergin;S. Bozfakioğlu;Serran Dalmak;M. Tulbek;H. Kiper;N. Lameire
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文献类型：
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作者：
M. Sever;E. Erek;R. Vanholder;Birsen Yurugen;G. Kantarci;M. Yavuz;H. Ergin;S. Bozfakioğlu;Serran Dalmak;M. Tulbek;H. Kiper;N. Lameire
背景肾替代治疗在挤压综合征患者的治疗中至关重要，这些患者在灾难性地震后经常遇到。1999年8月土耳其西北部发生的马尔马拉地震造成477名受害者需要透析。在灾难发生的第一周内，包含63个临床和实验室变量的问卷被发送到35家治疗受害者的参考医院。提交通过这些问卷获得的考虑透析特征的信息进行分析。结果：总共登记了639名有肾脏并发症的伤员，其中477人（平均年龄32.3 ± 13.7岁，269名男性）需要透析。其中，452人接受单一透析方式治疗（437人接受间歇性血液透析，11人接受连续性肾脏替代疗法，4人接受腹膜透析），25人需要一种以上的透析。总共进行了5137次血液透析（每例患者平均11.1 +/- 8.0次），血液透析支持的平均持续时间为13.4 +/- 9.0天;非幸存者的持续时间较短（7.0 +/- 8.7 vs. 10.0 +/- 9.8天，P = 0.005）。34例接受连续性肾脏替代治疗的患者死亡率较高（41.2% vs.13.7%，P < 0.0001）。只有8名受害者接受了腹膜透析治疗，其中4人还需要血液透析或连续性肾脏替代治疗。透析患者的死亡率为17.2%，与非透析肾脏问题患者的死亡率（9.3%; P = 0.015）相比，死亡率明显较高。结论：大量的透析支持可能是治疗群体性灾难患者合并挤压综合征的必要手段。透析患者的特点是发病率和死亡率较高。
BACKGROUND Renal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis. METHOD Within the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis. RESULTS Overall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 +/- 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 +/- 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 +/- 9.0 days; this duration was shorter in the non-survivors (7.0 +/- 8.7 vs. 10.0 +/- 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015). CONCLUSION Substantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality.