Hatamizadeh Parta, Najafi Iraj, Vanholder Raymond, Rashid-Farokhi Farin, Sanadgol Hooshang, Seyrafian Shiva, Mooraki Ahmad, Atabak Shahnaz, Samimagham Hamidreza, Pourfarziani Vahid, Broumand Behrooz, Van Biesen Wim, Lameire Norbert
Nephrology Research Center, Dr Shariati Hospital, Tehran, Iran.
Am J Kidney Dis. 2006 Mar;47(3):428-38. doi: 10.1053/j.ajkd.2005.11.019.
Acute renal failure is a serious, preventable, and potentially reversible midterm complication after mass disasters. In 2003, an earthquake struck Bam, Iran. This article studies the epidemiologic aspects of the earthquake from a nephrologic perspective.
A questionnaire was sent to the reference hospitals. The resulting database of 2,086 traumatized patients hospitalized in the first 10 days was analyzed.
Mean age was 29.0 +/- 15.6 years. Compared with the resident population, the percentage of patients was lower among children and teenagers younger than 15 years and higher among young and middle-aged adults (P < 0.001). There was no significant difference between mean ages of patients with acute renal failure and other patients. Time under the rubble was longer for patients with acute renal failure (6.2 +/- 4.1 versus 2.1 +/- 3.9 hours; P < 0.001). These patients were hospitalized later (3.1 +/- 2.8 versus 1.5 +/- 1.7 days after the disaster; P < 0.001) and longer (16.7 +/- 12.8 versus 12.5 +/- 11.3 days; P < 0.001). Sepsis (11.6% versus 0.5%), disseminated intravascular coagulation (7.3% versus 0.3%), adult respiratory distress syndrome (9.1% versus 1.4%), fasciotomy (38.9% versus 1.9%), amputation (6.1% versus 0.5%), and death (12.7% versus 1.9%) were markedly more frequent among patients with acute renal failure (P < 0.001 for all).
Hospitalized patients were mostly young and middle-aged adults. Patients with acute renal failure were entrapped longer and hospitalized later and for longer periods. Medical complications, surgical procedures, and mortality were greater in the latter group. Early extrication and quick hospitalization with appropriate multidisciplinary care are cornerstones to prevent acute renal failure and its subsequent mortality in earthquake conditions.
急性肾衰竭是大规模灾难后一种严重、可预防且可能逆转的中期并发症。2003年，伊朗巴姆发生地震。本文从肾脏病学角度研究此次地震的流行病学情况。
向各参考医院发送了调查问卷。对最初10天内住院的2086名创伤患者的数据库进行了分析。
平均年龄为29.0±15.6岁。与常住人口相比，15岁以下儿童和青少年患者的比例较低，而中青年成年人患者的比例较高（P<0.001）。急性肾衰竭患者与其他患者的平均年龄无显著差异。急性肾衰竭患者被埋在废墟下的时间更长（6.2±4.1小时对2.1±3.9小时；P<0.001）。这些患者住院时间更晚（灾难发生后3.1±2.8天对1.5±1.7天；P<0.001）且住院时间更长（16.7±12.8天对12.5±11.3天；P<0.001）。脓毒症（11.6%对0.5%）、弥散性血管内凝血（7.3%对0.3%）、成人呼吸窘迫综合征（9.1%对1.4%）、筋膜切开术（38.9%对1.9%）、截肢（6.1%对0.5%）和死亡（12.7%对1.9%）在急性肾衰竭患者中明显更为常见（所有P<0.001）。
住院患者大多为中青年成年人。急性肾衰竭患者被困时间更长，住院更晚且住院时间更长。后一组患者的医疗并发症、外科手术和死亡率更高。在地震情况下，早期解救并迅速住院接受适当的多学科护理是预防急性肾衰竭及其后续死亡率的基石。
