Malinoski Darren J, Slater Matthew S, Mullins Richard J
Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098, USA.
Crit Care Clin. 2004 Jan;20(1):171-92. doi: 10.1016/s0749-0704(03)00091-5.
Crush injuries resulting in traumatic rhabdomyolysis are an important cause of acute renal failure. Ischemia reperfusion is the main mechanism of muscle injury. Intravascular volume depletion and renal hypoperfusion, combined with myoglobinuria, result in renal dysfunction. The infusion of intravenous fluids before extrication or soon after injury may lessen the severity of the crush syndrome. Serum CK levels can be used to screen patients with crush injuries to determine injury severity. Once intravascular volume has been stabilized, and the presence of urine flow has been confirmed, a forced mannitol-alkaline diuresis for prophylaxis against hyperkalemia and acute renal failure should be instituted. If an extremity compartment syndrome is suspected, one should have a low threshold for checking the intracompartmental pressures. Further studies are needed to demonstrate if any treatment regimen is truly superior to early, aggressive crystalloid infusion.
导致创伤性横纹肌溶解的挤压伤是急性肾衰竭的重要原因。缺血再灌注是肌肉损伤的主要机制。血管内容量减少和肾脏灌注不足，再加上肌红蛋白尿，会导致肾功能障碍。在解救前或受伤后不久输注静脉液体可能会减轻挤压综合征的严重程度。血清肌酸激酶（CK）水平可用于筛查挤压伤患者以确定损伤严重程度。一旦血管内容量稳定且确认有尿液生成，应进行强制性甘露醇 - 碱性利尿以预防高钾血症和急性肾衰竭。如果怀疑有肢体骨筋膜室综合征，应降低检查骨筋膜室内压力的阈值。需要进一步研究以证明是否有任何治疗方案确实优于早期积极的晶体液输注。
