Better O S, Rubinstein I
Dr. R. Chutick Crush Syndrome Center, Faculty of Medicine, Technion, Israel Institute of Technology, Bat-Galim Haifa, Israel.
Ren Fail. 1997 Sep;19(5):647-53. doi: 10.3109/08860229709109030.
Widespread muscle crush injury is often associated with profound hemodynamic shock and myoglobinuric acute renal failure (ARF). The main reason for the shock is rapid uptake by the injured muscles of a substantial portion of extracellular fluid. The shock is aggravated by NO-dependent vasodilation in the injured muscles and by hyperkalemia and hypocalcemia, which suppress the entire cardiovascular tree. Treatment consists of early massive volume replacement and forced alkaline solute (mannitol) diuresis. With this regimen it is possible to increase survival of life and limbs, and prevent myoglobinuric ARF. Our preliminary experience suggests that i.v. hypertonic mannitol is protective also to the injured muscle and can be used as a noninvasive adjunct in the management of compartment syndrome in man. Moreover, by preserving muscular integrity, mannitol can conceivable reduce leakage of the nephrotoxic myoglobin and urate and thus further defend kidney function.
广泛的肌肉挤压伤常伴有严重的血流动力学休克和肌红蛋白尿性急性肾衰竭（ARF）。休克的主要原因是受伤肌肉迅速摄取大量细胞外液。受伤肌肉中一氧化氮依赖性血管舒张以及高钾血症和低钙血症会加重休克，这些因素会抑制整个心血管系统。治疗包括早期大量补液和强制碱性溶质（甘露醇）利尿。采用这种治疗方案，有可能提高生命和肢体的存活率，并预防肌红蛋白尿性ARF。我们的初步经验表明，静脉注射高渗甘露醇对受伤肌肉也有保护作用，可作为一种非侵入性辅助手段用于治疗人类骨筋膜室综合征。此外，通过保持肌肉完整性，甘露醇可以减少肾毒性肌红蛋白和尿酸盐的泄漏，从而进一步保护肾功能。
