Comoglu Mustafa, Özdemir Güzelali, Sarıkaya Baran, Acehan Fatih, Bingöl Olgun, Kilic Enver, Bahadır Batuhan, Oruc Mustafa, Demir Burak Furkan, Yılmaz Yusufcan, Sahiner Enes Seyda
Ankara Bilkent Şehir Hastanesi İç Hastalıkları Kliniği, 06800 Çankaya, Ankara, Türkiye.
Jt Dis Relat Surg. 2025 Jan 2;36(1):155-163. doi: 10.52312/jdrs.2025.1971. Epub 2024 Dec 10.
This study aimed to identify predictors of sepsis in earthquake survivors who underwent either amputation or fasciotomy and to compare these two patient groups across many clinical outcomes, including sepsis.
In this retrospective study, a total of 1,608 patients who presented to our hospital following the February 6, 2023, Kahramanmaraş earthquakes were evaluated between February 2023 and March 2023. Of these, 138 patients (65 males, 73 females; median age: 35 years; range, 18 to 74 years) who underwent either fasciotomy or amputation were included in the study. Patients managed solely with fasciotomy were included in the fasciotomy group, while those who underwent amputation in at least one area were included in the amputation group. Sepsis predictors were investigated in this population. Additionally, the two groups were compared in terms of clinical outcomes, including bacteremia, sepsis, septic shock and mortality.
Of the 138 earthquake survivors, 59 (42.8%) were in the amputation group, and 79 (57.2%) were in the fasciotomy group. There were no significant differences between the groups in terms of the development of crush syndrome or the need for renal replacement therapy (p=0.781 and p=0.411, respectively). The duration of entrapment under rubble was higher in the amputation group (p=0.030). While bacteremia was more common in the amputation group, there was no significant difference in relation to sepsis (p=0.002 and p=0.106, respectively). Septic shock and mortality rates were higher in the amputation group (p=0.001 and p=0.009, respectively). Multivariate analysis revealed that the number of traumatized sites (odds ratio [OR]=3.68, 95% confidence interval [CI]: 2.13-6.33, p<0.001), amputation at more than two sites (OR=4.27, 95% CI: 1.15-15.9, p=0.022), and fasciotomy at more than two sites (OR=2.71, 95% CI: 1.10-6.69, p=0.021) were significant predictors of sepsis.
Patients undergoing fasciotomy and amputation should be comprehensively evaluated for potential benefits and risks. Close monitoring for sepsis is particularly recommended for patients who have amputation or fasciotomy procedures at more than two sites.
本研究旨在确定接受截肢或筋膜切开术的地震幸存者中脓毒症的预测因素，并比较这两组患者在包括脓毒症在内的许多临床结局方面的情况。
在这项回顾性研究中，对2023年2月6日卡赫拉曼马拉什地震后到我院就诊的1608例患者在2023年2月至2023年3月期间进行了评估。其中，138例（65例男性，73例女性；中位年龄：35岁；范围18至74岁）接受了筋膜切开术或截肢术的患者被纳入研究。仅接受筋膜切开术治疗的患者被纳入筋膜切开术组，而至少在一个部位接受截肢术的患者被纳入截肢术组。对该人群的脓毒症预测因素进行了研究。此外，还比较了两组在包括菌血症、脓毒症、感染性休克和死亡率等临床结局方面的情况。
在138例地震幸存者中，59例（42.8%）在截肢术组，79例（57.2%）在筋膜切开术组。两组在挤压综合征的发生或肾脏替代治疗的需求方面无显著差异（分别为p = 0.781和p = 0.411）。截肢术组在废墟下被困的时间更长（p = 0.030）。虽然菌血症在截肢术组更常见，但在脓毒症方面无显著差异（分别为p = 0.002和p = 0.106）。截肢术组的感染性休克和死亡率更高（分别为p = 0.001和p = 0.009）。多因素分析显示，受伤部位数量（比值比[OR]=3.68，95%置信区间[CI]：2.13 - 6.33，p<0.001）、两个以上部位截肢（OR = 4.27，95% CI：1.15 - 15.9，p = 0.022）以及两个以上部位筋膜切开术（OR = 2.71，95% CI：1.10 - 6.69，p = 0.021）是脓毒症的显著预测因素。
应对接受筋膜切开术和截肢术的患者进行潜在益处和风险的全面评估。对于在两个以上部位进行截肢或筋膜切开术的患者，尤其建议密切监测脓毒症。
