Ersoy A, Yavuz M, Usta M, Ercan I, Aslanhan I, Güllülü M, Kurt E, Emir G, Dilek K, Yurtkuran M
Department of Nephrology, Uludag University Medical School, Gorukle/Bursa, Turkey.
Clin Nephrol. 2003 May;59(5):334-40. doi: 10.5414/cnp59334.
We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times.
Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions.
APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality.
As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.
我们回顾了马尔马拉地震后入住我院的透析患者的病历，并根据生存时间评估了影响幸存者和非幸存者死亡率的因素。
110例患者被诊断为挤压综合征（CS）。60例患者开始透析治疗；其中21例死亡。患者分为两组，39例幸存者（A组，男25例，女14例，平均年龄：31±2.2岁）和21例非幸存者（B组，男9例，女12例，平均年龄：27±3.0岁）。受害者接受了任何形式的肾脏替代治疗，包括每日或间歇性血液透析和/或连续性静脉-静脉血液透析滤过。定期记录临床和实验室检查结果。采用Kaplan-Meier法、对数秩检验和Cox回归分析对生存函数进行统计分析。
A组急性生理与慢性健康状况评分系统（APACHE II）评分为13.5±0.5，B组为13±0.9。地震后，A组患者平均在2.8±0.2天开始透析支持，B组平均在3.7±0.6天开始透析支持（p>0.05）。A组最常见的创伤部位是下肢（61.5%）和上肢+下肢（23%），B组是下肢（38.1%）和躯干+下肢（23.8%）。B组腹部创伤、骨盆骨折和胸部创伤的发生率分别为23.8%、19%和14.2%。B组多发伤比A组更常见（42.8%对2.5%）。两组筋膜切开术、截肢术和手术率相似。非幸存者中脓毒症的发生率更高。在我们中心，总体死亡率为8%，CS患者死亡率为21%，透析患者死亡率为35%。死亡主要与脓毒症有关。A组的生存期（52.3±4.0天）比B组（17.3±2.5天）长。通过Cox回归分析，入院时收缩期低血压、女性性别、血清肌酸激酶峰值高（>20,000 U/l）以及包括胸部和腹部区域的多发伤等参数是增加死亡风险的因素。
因此，脓毒症、多发伤和严重挤压伤是地震后透析伤者死亡风险增加的主要因素。
