Management of shock and acute renal failure in casualties suffering from the crush syndrome
Management of shock and acute renal failure in casualties suffering from the crush syndrome
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DOI：
10.3109/08860229709109030
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发表时间：
1997-01-01
期刊：
影响因子：
3
通讯作者：
Rubinstein, I
中科院分区：
文献类型：
--
作者：
Better, OS;Rubinstein, I
广泛的肌肉挤压伤常伴有严重的血液动力学休克和肌红蛋白尿性急性肾功能衰竭（ARF）。休克的主要原因是受伤的肌肉迅速吸收了相当大一部分细胞外液。损伤肌肉的NO依赖性血管舒张以及抑制整个心血管系统的高钾血症和低钙血症加重了休克。治疗包括早期大量容量置换和强制碱性溶质使用该方案可以增加生命和肢体的存活率，并预防肌红蛋白尿性ARF：我们的初步经验表明，静脉注射高渗甘露醇对受伤的肌肉也有保护作用，可以作为一种非侵入性的辅助手段用于治疗人类筋膜室综合征。此外，通过保护肌肉的完整性，甘露醇可以减少肾毒性肌红蛋白和尿酸盐的渗漏，从而进一步保护肾功能。
Widespread muscle crush injury is often associated with profound hemodynamic shock and myoglobinuric acute renal failure (ARF). The main reason for the shock is rapid uptake by the injured muscles of a substantial portion of extracellular fluid. The shock is aggravated by NO-dependent vasodilation in the injured muscles and by hyperkalemia and hypocalcemia, which suppress the entire cardiovascular tree. Treatment consists of early massive volume replacement and forced alkaline solute (mannitol) diuresis.With this regimen it is possible to increase survival of life and limbs, and prevent myoglobinuric ARF: Our preliminary experience suggests that i.v. hypertonic mannitol is protective also to the injured muscle and can be used as a noninvasive adjunct in the management of compartment syndrome in man. Moreover by preserving muscular integrity, mannitol can conceivably reduce leakage of the nephrotoxic myoglobin and urate and thus further defend kidney function.