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在卡赫拉曼马拉什地震中入住重症监护病房的地震灾民的死亡率预测因子。

Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes.

机构信息

İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey.

İnönü University Medical Faculty Biostatistics and Medical Informatics Department, Turkey.

出版信息

Injury. 2024 Sep;55(9):111632. doi: 10.1016/j.injury.2024.111632. Epub 2024 May 28.

Abstract

BACKGROUND

The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality.

METHODS

The demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients.

RESULTS

Twenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome.

CONCLUSION

Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.

摘要

背景

本研究旨在报告因 2023 年 2 月 6 日土耳其卡赫拉曼马拉什地震而在我们的重症监护病房接受治疗的患者的数据,并研究影响死亡率的因素。

方法

回顾性扫描因地震创伤而在重症监护室接受治疗的患者的人口统计学特征、治疗方法、发生的并发症、住院和重症监护时间以及实验室数据,并记录下来。然后将这些数据与存活和非存活患者进行比较。

结果

共有 26 名患者(13 名男性,占 50%)在我们的重症监护室接受治疗,24 名(92%)因被地震废墟掩埋,2 名(8%)因从高处坠落。序贯器官衰竭评估(SOFA)升高(p=0.027)、初始血清钾升高(p=0.043)、初始和峰值血清磷升高(p=0.035)、初始和峰值血清镁升高(p=0.004 和 p=0.001)、初始和峰值碳酸氢盐降低(p=0.021 和 p=0.012)以及初始和峰值血清碱剩余降低(p=0.012 和 p=0.009)与死亡率相关。在挤压伤亚组中,初始和峰值血清钾升高(p=0.001 和 p=0.025)、初始和峰值血清镁升高(p=0.005 和 p=0.004)、初始和峰值碳酸氢盐降低(p=0.019 和 p=0.021)以及初始和峰值血清碱剩余降低(p=0.017 和 p=0.025)与死亡率相关。9 名患者发生多器官功能衰竭,7 名患者发生脓毒症,4 名患者发生弥散性血管内凝血,2 名患者发生急性呼吸窘迫综合征。2 名(8%)患者接受了筋膜切开术,8 名(31%)患者进行了截肢。最常观察到四肢损伤。12 名(46%)发生急性肾损伤的患者中有 10 名(38.5%)需要肾脏替代治疗。7 名(27%)患者在随访期间死亡。在逻辑回归分析中,较高的 SOFA 评分、较低的初始碳酸氢盐和 BE 水平、较高的血清钾和镁水平是死亡的危险因素。在挤压综合征患者中,较高的 SOFA 评分、较低的初始碳酸氢盐和碱剩余以及较高的初始磷值会影响死亡率。

结论

在 ICU 中,不仅 SOFA 评分升高、血清钾、磷和镁升高,而且碳酸氢盐和碱剩余降低与地震挤压综合征患者的死亡率相关。

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