Clinical Analysis Of Crush Syndrome Resulted From Non-earthquake Injuries

Objective To analyze the clinical features and treatment of crush syndrome(CS).Method Retrospective analysis of the clinical features and therapies of 15 patients with CS who admitted to the Second Hospital of Shanxi Medical University from 2002 to 2008.Results A total of 15 patients with CS were included.(1)general material①All the patients were male adults with the age of(21-55) years.②Reasons of crush injury:cave-in of mine(10 cases),traffic accident(4 cases),wooden rod(1 case).②Clinical characteristics①Position of crush injury:the lower limb was injured in all patients,and the upper limb,buttock and waist were also involved in 4 cases,4 cases and 6 cases,respectively.②The time of crush injury was within the range of 3 hours to 9 hours which mean was 5.7 hours.③Clinical manifestation:The involved limbs showed ecchymosis,swelling,myasthenia and pain;5 cases had fracture and 8 cases had osteofascial compartment syndrome.Acute renal failure(ARF) was observed in all patients.Renal impairment included anuresis(8 cases),oliguresis(4 cases),dark brown colored urine(15 cases), hypertension(9 cases) and hyposarca(2 cases).Complication included MODS(2 cases),DIC(4 cases),urinary infection(8 cases),infection of fascial incisions(2 cases),left heart failure(3 cases) and pneumonedema(1 case).④Laboratory examination:routine urine of all patients showed different degrees of occult blood and proteinuria and urine erythrocyte of 8 cases were elevated.Serum biochemical indexes:serum creatinine,blood urea nitrogen,creatine phosphokinase,lactate dehydrogenase,hydroxybutyrate dehydrogenase,aspartate aminotransferase,alanine aminotransferase,serum potassium and serum phosphate were elevated.Serum calcium,total protein,albumin,red blood cell and hemoglobin were reduced.Serum uric acid of 9 cases,carbon dioxide combing power of 12 cases and white blood cell of 12 cases were respectively elevated,reduced and increased.⑤There were negative correlations between the time spent on crushing and the timing of ARF,between the number of involved limbs and the timing of ARF.There were positive correlations between the time spent on crushing and serum creatinine level,between the number of involved limbs and serum creatinine level,between the time spent on crushing and serum creatine phosphokinase level, between the number of involved limbs and serum creatine phosphokinase level.The cure rate of patients without fracture was significantly higher than that of patients with fracture.There were significant differences in the mortality between the patients with fracture and the patients without fracture(P<0.05).(3) All patients were given combined treatment which included anti-infection, whole blood(5 cases),plasma(7 cases),concentrated red cell(10 cases),cryoprecipitate(4 cases), fasciotomy(4 cases),amputation(3 cases),fluid resuscitation,alkalizing urine,diuresis,improving renal circulation,hematodialysis(13 cases) and symptomatic treatment.(4)Outcomes:Of 11 cases with abnormal urine volume,4 cases were with normal urine volume,2 cases were in diuretic phase and 5 cases were in oliguresis or anuresis.Of 9 cases with hypertention,5 cases were in normal blood pressure and the other still took antihypertensives.2 cases of hyposarca recoverd.8 cases of urinary infection:7 cases were cured and 1 case were not cured.2 cases with MODS died.Of 4 cases with DIC,coagulation function of only one became normal.2 cases with infection of fascial incisions cured.Heart function of the 3 cases with left heart failure recovered. 1 case with pneumonedema got worse due to DIC.Otherwise,1 case became anuresis because of the deterioration of disease.Renal function,electrolyte,spectrum enzymes and general condition were all improved after treatment.There were significant differences between two groups in the changes of serum creatinine,blood urea nitrogen,serum uric acid,carbon dioxide combing power,serum potassium,serum calcium,serum phosphate,creatine phosphokinase, lactate dehydrogenase,hydroxybutyrate dehydrogenase,aspartate aminotransferase,white blood cell,red blood cell,hemoglobin,total protein and albumin(P<0.05).On discharge 9 patients were cured and 2 patients took a favorable turn,whereas,2 patients were not cured requesting discharge and 2 patients died.Conclusions(1)CS is a rare,acute and severe syndrome. (2)There were negative correlationes between the time spent on crushing and the timing of ARF, between the number of involved limbs and the timing of ARF.There were positive correlationes between the time spent on crushing and serum creatinine level,between the number of involved limbs and serum creatinine level,between the time spent on crushing and serum creatine phosphokinase level,.between the number of involved limbs and serum creatine phosphokinase level(P<0.05).(3)The cure rate of patients without fracture was significantly higher than that of patients with fracture.There were significant differences in the mortality between the patients with fracture and the patients without fracture(P<0.05).(4)Early diagnosis and correct therapy could improve the outcome.