Better O S
Department of Medicine, Technion, Israel Institute of Technology, Haifa.
Kidney Int Suppl. 1993 Jun;41:S235-6.
Human-made and seismic catastrophes continue to extract a heavy toll in lives. Many survivors with extensive muscle injury succumb to preventable causes such as shock, extreme hyperkalemia or acute renal failure (ARF). Others may lose limbs because of the compartment syndrome. Early treatment of such casualties, starting in the field, may increase salvage of lives and limbs, and prevent ARF. The treatment consists of aggressive volume and bicarbonate replacement followed by forced solute alkaline diuresis. If myoglobinuric ARF has occurred, solute load should not be given, and regular hemodialysis (HD) is indicated. If mass casualties have occurred in remote regions and HD cannot be immediately provided, continuous arteriovenous hemofiltration (CAVH) may temporarily substitute for HD. CAVH has the distinct advantage of simplicity, and does not require electricity, pumps or delivery systems. It is effective in eliminating potassium and relieving circulatory congestion without causing hypotension.
人为灾害和地震灾难仍在造成惨重的人员伤亡。许多肌肉严重受伤的幸存者死于诸如休克、极度高钾血症或急性肾衰竭（ARF）等可预防的原因。其他人可能因骨筋膜室综合征而失去肢体。对此类伤员的早期治疗，从现场就开始，可能会增加生命和肢体的挽救几率，并预防急性肾衰竭。治疗包括积极的容量补充和碳酸氢盐替代，随后进行强制溶质碱性利尿。如果已经发生肌红蛋白尿性急性肾衰竭，则不应给予溶质负荷，并应进行常规血液透析（HD）。如果在偏远地区发生了大规模伤亡且无法立即进行血液透析，则连续性动静脉血液滤过（CAVH）可暂时替代血液透析。连续性动静脉血液滤过具有操作简单的明显优势，不需要电力、泵或输送系统。它在消除钾和缓解循环充血方面有效，且不会导致低血压。
