Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya
Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya
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DOI：
10.1080/08860220701460095
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发表时间：
2007-01-01
期刊：
影响因子：
3
通讯作者：
Yeksan, Mehdi
中科院分区：
文献类型：
--
作者：
Altintepe, Luetfullah;Guney, Ibrahim;Yeksan, Mehdi
背景迄今为止，人们已经从多个角度研究了地震和其他自然灾害导致的挤压综合征。然而，有关建筑物自发倒塌的案例的数据很少。本研究介绍了在我们的诊所治疗的7横纹肌溶解症患者的结果，其中9名伤员是在建筑物突然自发倒塌后从Zumrut公寓的废墟中救出的。方法. 2004年2月2日20时15分，科尼亚Zumrut 10层公寓突然自发倒塌，楼内121人中有92人丧生，29人被从废墟中救出。9名住院患者有挤压综合征，入院时开始预防性甘露醇碳酸氢盐鸡尾酒。结果他们被困在瓦砾下的时间平均为11.1 +/- 7.3（5-24小时）。患者的最高CPK水平为79049 +/- 75374 u/L（17478-223600 u/L），在事件发生后中位第1.7 +/- 1.1天（第1-4天）观察到。由于预防性给予甘露醇-碳酸氢盐鸡尾酒以预防ARF，仅2例（28.6%）发生ARF，并且由于高钾血症，对这些患者进行了血液透析（HD）治疗。一名患者需要两次HD，另一名患者需要四次。在接受HD治疗的2例患者中，钾水平超过7 mEq/L。在7例挤压综合征患者中，共对5例（71.4%）进行了8次筋膜切开术。其中5例筋膜切开术（62.5%）是对我们的2例需要HD治疗的患者进行的。我们的挤压综合征患者中没有发生永久性肾损伤，也没有发生死亡。结论据推断，快速液体治疗伴随着预防性给予甘露醇碳酸氢盐在很大程度上有效地防止ARF的发展与挤压综合征的情况下，由灾难。
Background. Crush syndrome developing as a result of earthquake and other natural disasters has been investigated from many angles to date. Data are scarce, however, on cases associated with the spontaneous crash of buildings. This study presents the results on seven rhabdomyolysis patients treated in our clinics out of nine casualties who were rescued from the rubble of Zumrut apartment after the building collapsed suddenly and spontaneously. Methods. As a result of the sudden, spontaneous collapse of the 10-floor Zumrut apartment in Konya at 20:15 hours on February 2, 2004, 92 out of a total of 121 persons who were inside the building lost their lives, and 29 casualties were rescued from the rubble. Nine hospitalized patients had crush syndrome, and a prophylactic mannitol-bicarbonate cocktail was started in all at admission. Results. The time they remained entrapped under the rubble was 11.1 +/- 7.3 (5-24 hours) on average. The highest CPK level of the patients was 79049 +/- 75374 u/L (17478-223600 u/L), observed on the median day 1.7 +/- 1.1 (days 1-4) following the incident. ARF developed in only two cases (28.6%) owing to the prophylactic mannitol-bicarbonate cocktail administered to prevent ARF, and because of hyperpotassemia, hemodialysis (HD) treatment was administered to these patients. One patient required two sessions of HD, and another required four. In both patients who received HD treatment, the level of potassium was in excess of 7 mEq/L. A total of eight fasciotomies were performed on five (71.4%) of the seven patients with crush syndrome. Five of the fasciotomies (62.5%) were performed on two of our patients who required HD treatment. None of our patients with crush syndrome developed permanent kidney damage, and no mortality occurred. Conclusion. It was deduced that rapid fluid therapy accompanied by the prophylactic administration of mannitol-bicarbonate are largely effective in preventing the development of ARF in cases with crush syndrome resulting from disasters.