Atef M R, Nadjatfi I, Boroumand B, Rastegar A
Department of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Iran.
Q J Med. 1994 Jan;87(1):35-40.
The 1990 Iran earthquake affected two provinces with a population of 2.3 million, resulting in at least 13,888 deaths and 43,390 injured, and in 33,615 hospitalizations. Overall mortality among hospitalized patients was 0.17%. Acute renal failure (ARF) requiring dialysis support was diagnosed in 156 patients nationwide, with a mortality rate of 14%. Three teaching hospitals of the Tehran University of Medical Sciences admitted 495 patients, with overall mortality of 7.5%. Of these, 30 (6%) required dialysis support, with mortality of 40%, accounting for one-third of all deaths. On admission, patients with ARF were more severely injured, with significantly higher incidence of multiple trauma, peripheral nerve damage, elevated plasma concentrations of muscle enzymes, potassium and phosphate, and abnormal urinalysis. In one of the three hospitals, patients were treated with a standardized hydration protocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Our limited experience suggests that this standardized approach to prevention and treatment of ARF in earthquake victims may be helpful.
1990年伊朗地震影响了两个省份，受灾人口达230万，造成至少13888人死亡，43390人受伤，33615人住院治疗。住院患者的总死亡率为0.17%。全国有156例患者被诊断为需要透析支持的急性肾衰竭（ARF），死亡率为14%。德黑兰医科大学的三家教学医院收治了495例患者，总死亡率为7.5%。其中，30例（6%）需要透析支持，死亡率为40%，占死亡总数的三分之一。急性肾衰竭患者入院时受伤更严重，多发伤、周围神经损伤、血浆肌酶、钾和磷酸盐浓度升高以及尿液分析异常的发生率显著更高。在这三家医院中的一家，患者接受了标准化的补液方案，并谨慎地进行筋膜切开术。该组急性肾衰竭的发生率、与急性肾衰竭相关的死亡率以及筋膜切开术的发生率较低。我们有限的经验表明，这种针对地震受害者急性肾衰竭的标准化预防和治疗方法可能会有所帮助。
