Prevent and cure and push three main points of syndrome

Prevent and cure and push three main points of syndrome
Prevent and cure and push three main points of syndrome
Rock Li Xuemei of Prem Liu of internal medicine department of kidney of BJ Union Hospital The calamities and accidents are " The chief culprit " Earthquake, war, project cave in, traffic accident,etc. last syndrome common reason. It is the second death reason besides direct traumatism after the calamity takes place to push syndrome, often appear after oppressing and removing. Some wounded die during 24 hours because of shock and hyperkalemia disease. Being injured for 7- 12 days, it is declined that the acute kidney happens more. Happen, not only treat and cure difficult, with high costs, but also mortality extremely high, it prevents to be key. It is apt to send the kidney to decline, shock and die suddenly, pinch syndrome, mean four limbs or truck the intersection of muscle and abundant position pinch function and cause the ischemic necrosis of the muscular tissue for a long time by the heavy object of outside, present the depleted syndrome of acute renal function taking swelling of limb, myoglobinuria, hyperkalemia disease as characteristic after pushing and relieving, threaten wounded's life seriously. After it causes and destroys trucks or limbs directly that the kidney declines the wound, ischemic necrosis happen in muscles, and release a large amount of myoglobin, potassium ion, acid supersession product, inflammatory factor,etc., make the pressure that the membrane of muscle separates by the district rise. Damage at this moment and is still limited somely, once remove oppression, after injury resumes blood to transport, the above-mentioned material can enter systemic circulation, cause a series of pathologic physiology to change. Acute kidney decline little the intersection of urine and issue, patient quantity little urine or have no urine; The urine is low in specific gravity, affixed to about 1.010; Urine myoglobin is positive, it is obvious the proteinuria, mirror play hematuria or in charge ofing urine; Urine sodium exceed 60mmol/L, the intersection of urea and nitrogen compare with urea nitrogen in the blood less than 10 in the urine: 1; Urine skin anhydride and proportion of anhydride of the blood skin are smaller than 20: 1. Myoglobinuria behind the pressure, can present brown urine or narrate hematuria in 24 hours in dismember while being wounded. Shock mind is indifferent, four limbs faint coldly, the detailed speed of pulse. Wounded's look of potassium of high blood is in a trance, have the fidgets, slow in reaction to the things, whole body is weak, limbs are numb, the tendon reflects and weakens or disappears, the heartbeat can appear arrhythmically slowly, or die because the heartbeat stop suddenly. In diagnosis, except that blood potassium is determined, the electrocardiogram can present the model and behave. Three is great to prevent and cure and want some on-the-spot first aid to remove the heavy pressure early just as objective condition restricted, it is getting more difficult really if you can't relieve in time, oppress,should supplementing pieces of brine immediately. Fluid infusion and alkalizing the persons who can drink the water of urine to drink the alkaline beverage (dissolve hydrogen sodium 8g carbonic acid into 1000- 2000ml water first, add right amount of sugar and salt) . To the unable to take food one, can use 5% carbonic acid hydrogen sodium 125- 250ml intravenous bit, strengthen fluid infusion at the same time, strive to resume circulating through fluid infusion, so as to avoid shock and and reach the urine amount 1500ml / above day. If the vein supplemented the liquid inside insufficiently or delayed not beginning to treat until more than 6 hours, the acute kidney extremely incident is declined. So push a syndrome patient from what has been rescued live and is decompressed, need to carry on a piece of brine such as being supplementary of vein immediately, 1.5L per hour. Supplement the alkaline medicine after circulating stabilizing and amount of urine had all over, the appropriate diuresis treatment is declined by preventing hyperkalemia disease and acute kidney. Injure the limb and deal with and injure the limb to attend to and injure the limb to apply the brake, in order to reduce the absorption which organizes catabolite; Use the cold water in order to injure the limb and lower the temperature, or will injure the limb to expose to nice and cool air; Forbid massage and give a hot compress to, so as not to aggravate and organize oxygen deficiency; Injuring the limb should not be raised, in case that some blood pressure is reduced, influence the blood circulation, the absorption that can also reduce necrosis to organize; Arrest blood in opening the wound and activity persons who bleed, but should avoid pressurizing and wrap up and use tourniquets. Cut, reduce piece, make the intersection of muscle and membrane separate by district organization pigeonhole, drop, prevent the harmful substance from invade the blood flow in early days, lighten the organism and is poisoned symptom. Remove necrosis to organize at the same time, reduce and infect. Its indication is: 1. There is history of obvious crush injury. 2.More than 1 muscle membrane separating by areas are given much trouble, some tension is high, obvious swelling, there are blister and corresponding movement that feel the obstacle. 3.Myoglobin test masculine gender of the urine. Amputation indication is if necessary: 1. Suffering from the limb has no blood to transport or have serious blood that transport the obstacle. 2.It is serious to be poisoned symptom all over, through cutting reducing one,etc. to deal with and does not see symptom relieve, have already jeopardized the life. 3.Injure the limb and erupt the specific infection, such as temperament gangrene,etc. simultaneously. The kidney substitutes and treats serious hyperkalemia disease and patient of the serious renal failure for happening, should choose the blood first to dialyse and treat, make the patient not have urine one and control hyperkalemia disease to spend, generally need to dialyse for about 2 weeks. How good to push the acute renal tubule necrosis prognosis due to syndrome, patient's renal function can mostly resume. But it needs a large number of dialysis liquids, specialized medical apparatus and personnels to carry on the dialysis of blood, lose electrical power in the disaster area, carry on the blood and have difficulty in taking a step further when being dialysed under the situation of the disconnected water. Can dialyse the peritoneum to the wounded not injured of belly at this moment. Its advantage lies in not needing specialized blood to dialyse apparatus and electricity, the operating technology is simpler; The shortcoming lies in being necessary to dialyse liquid consumption enormously, if the sanitary condition can't be ensured, the abdominal cavity incident is infected with. It is obvious, improve to the understanding which pushes syndrome, take and treat and cure the measure early, can reduce the wounded's death effectively. After Wen's Sichuan earthquake, our government has taken and rescued the measure as soon as possible promptly, Beijing send nearly professional team that one hundred people make up within two days and instrument and equipment reply pinch syndrome alone. We are expecting the survivor of disaster area to recover as soon as possible.


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