Unit of Nephrology and Dialysis, SS. Annunziata Hospital, University of Chieti-Pescara, Chieti, Italy.
Nephrol Dial Transplant. 2011 Aug;26(8):2595-603. doi: 10.1093/ndt/gfq783. Epub 2011 Jan 19.
In the aftermath of large natural and manmade disasters, the need for continuing maintenance haemodialysis (HD) in end-stage renal disease patients of the disaster area and care including dialysis for patients suffering from acute kidney injury (AKI) due to crush syndrome are the two most important nephrological problems.
We report on how renal patients and renal care personnel faced emergency in the aftermath of the earthquake that struck the Italian town of L'Aquila and a surrounding district, on Monday 6 April 2009, causing 308 deaths, some 1500 injured and 66,000 people to be displaced.
The Dialysis Centre in the town did not collapse but was seriously damaged and out of action, making it necessary to move 88 patients on regular dialysis treatment to the closest available facilities to continue treatment. This was all the more urgent in that 45 patients of the Monday-Wednesday-Friday batch were coming off the long interdialytic interval, with possible medical problems (i.e. high increase in weight gain, blood pressure, etc.). In spite of manifold difficulties (including road interruption and shortage of means of transportation, problems in establishing contact between patients and care personnel due to failure of phone and electronic communication and the limited number of available dialysis posts), no patient missed any scheduled HD session. This was obtained thanks to the transfer of patients to neighbouring functioning units, often with extra dialysis shifts. In 3 days, a provisional Dialysis Centre was set up in an inflatable military-style tent, enabling 780 dialysis sessions to be performed safely on patients who had opted to return to L'Aquila. The tent facility was replaced by a rigid modular structure, insulated as living accommodation, containing 13 dialysis machines (20 from 17 November) functioning in HD or on-line haemodiafiltration. Ten cases of crush-related AKI needing dialysis treatment were recorded, the ratio of dialysed victims to number of deaths (32.4: 10 cases/308 deaths, 1000×) being the highest value yet reported. Fasciotomy was performed in six patients but none of the patients had to be amputated. Intermittent HD was used in most cases as the single modality of renal replacement therapy. All patients survived and recovered renal function on discontinuing dialysis treatment. Serum creatinine returned to normal values upon discharge from hospital or during the follow-up period.
Each earthquake is different and may pose issues that will require unanticipated response efforts. Advance planning and rescue coordination, flexibility and creativity in the emergency situation, as well as the hard work and dedication of the entire dialysis care community, contributed to the remarkably positive outcome of dialysis-needing patients in the aftermath of the Aquila earthquake.
在大型自然灾害和人为灾害之后，灾区终末期肾病患者持续进行维持性血液透析（HD）以及对挤压综合征导致的急性肾损伤（AKI）患者进行透析治疗是两个最重要的肾脏问题。
我们报告了在 2009 年 4 月 6 日星期一意大利拉奎拉镇及其周边地区发生地震后，肾脏患者和肾脏护理人员如何应对紧急情况。这次地震造成 308 人死亡，1500 人受伤，66000 人被迫流离失所。
该镇的透析中心没有倒塌，但严重受损无法使用，因此需要将 88 名定期接受透析治疗的患者转移到最近的可用设施继续治疗。由于 45 名周一至周三至周五班次的患者即将结束长间隔透析期，可能会出现医疗问题（即体重增加、血压升高等），因此情况更加紧急。尽管面临多种困难（包括道路中断和交通工具短缺、由于电话和电子通信故障导致患者和护理人员之间的联系困难以及可用透析岗位数量有限），但没有患者错过任何计划的 HD 治疗。这是通过将患者转移到附近运转的单位，经常进行额外的透析班次来实现的。在 3 天内，在一个充气式军用帐篷中建立了一个临时透析中心，安全地为选择返回拉奎拉的 780 名患者进行了 780 次透析治疗。帐篷设施被一个刚性的模块化结构所取代，该结构被隔热作为居住空间，其中包含 13 台透析机（11 月 17 日起为 20 台），可在 HD 或在线血液透析滤过中运行。记录了 10 例挤压相关 AKI 需要透析治疗的病例，接受透析治疗的患者与死亡人数的比例（32.4:10 例/308 例死亡，1000×）是迄今为止报告的最高值。对 6 名患者进行了筋膜切开术，但没有患者需要截肢。在大多数情况下，间歇性 HD 被用作唯一的肾脏替代治疗方式。所有患者在停止透析治疗后均存活并恢复了肾功能。血清肌酐在出院或随访期间恢复正常。
每次地震都是不同的，可能会带来需要意想不到的应对措施的问题。提前规划和救援协调、在紧急情况下的灵活性和创造力，以及整个透析护理社区的辛勤工作和奉献精神，促成了拉奎拉地震后透析治疗需求患者的显著积极结果。
