Öz
Objective: One of the vital problems after earthquakes that caused many deaths and injuries is crush syndrome due to traumatic muscle damage. The aim of this study was to determine the clinical course of patients with crush syndrome and identify factors that may be associated with crush syndrome. Methods: After the two earthquakes of 7.7 and 7.6 magnitude affecting 11 provinces with the epicentre in Kahramanmaraş on 6 February 2023, 319 patients over the age of 18 were admitted to our hospital between 6-14 February. 87 of 319 patients received inpatient follow-up and treatment. The age, gender, duration of stay in the rubble, province of residence, operation performed, duration of hospital stay, amount of fluid given in the first 24 hours, amount of urine output in the first 24 hours, body trauma sites, some laboratory parameters at the time of admission and during follow-up were retrospectively evaluated from the hospital records of all 43 patients diagnosed with crush syndrome among the inpatients between 6-28 February. Results: The age of the patients was 39±19.6 years, duration of stay under the cave-in(hours) 22.74±36.32, duration of hospitalization(days) 7.26±5.42, amount of fluid given in the first 24 hours(ml) 4954.18±3142, amount of urine output in the first 24 hours(ml) 2646.42±2262.65, admission creatinine(mg/dl) 1.59±2.25, admission creatine kinase(CK)(U/L) 11716.37±18520. 44.2% of the patients were female, 72.1% came from Kahramanmaraş province, 46.5% underwent surgical intervention, 67.4% had an admission CK above 1000 u/l, 14% received hemodialysis treatment and 51.2% had a duration of hospitalization longer than 21 days. The effect of other parameters on the duration of hospitalization and the time to reach the reference range of CK and correlation with laboratory parameters were analysed. Conclusion: As a result, it is thought that the parameters affecting the time to reach the CK reference range and the duration of hospitalization can be used to calculate and reduce the duration of hospitalization in prospective crush syndrome cases.
Anahtar Kelimeler
Kaynakça
- Kurultak İ. Deprem yaralanmalı erişkin hastada ezilme (crush) sendromu. TOTBİD Dergisi. 2022;21(3):294-303. doi:10.5578/totbid.dergisi.2022.40
- Li N, Wang X, Wang P, Fan H, Hou S, Gong Y. Emerging medical therapies in crush syndrome - progress report from basic sciences and potential future avenues. Ren Fail. 2020;42(1):656-666. doi:10.1080/0886022X.2020.1792928
- Ergünay O. Türkiye’nin Afet Profili. In: TMMOB Afet Sempozyumu Bildiriler Kitabı. Mattek Matbaacılık; 2007.
- Sever MS, Erek E, Vanholder R, et al. Lessons learned from the Marmara disaster: Time period under the rubble. Crit Care Med. 2002;30(11):2443-2449. doi:10.1097/00003246-200211000-00007
- Sever MS, Erek E, Vanholder R, et al. The Marmara earthquake: Epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60(3):1114-1123. doi:10.1046/j.1523-1755.2001.0600031114.x
- Michaelson M. Crush injury and crush syndrome. World J Surg. 1992;16(5):899-903. doi:10.1007/BF02066989
- Sagheb MM, Sharifian M, Roozbeh J, Moini M, Gholami K, Sadeghi H. Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush victims. Ren Fail. 2008;30(9):831-835. doi:10.1080/08860220802353785
- Sever MŞ. Crush (Ezilme) Sendromu ve Marmara Depreminden Çıkarılan Dersler. Vol 1. Lebib Yalkın Yayımları ve Basım İşleri A.Ş; 2002.
- Oda Y, Shindoh M, Yukioka H, Nishi S, Fujimori M, Asada A. Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome. Ann Emerg Med. 1997;30(4):507-512. doi:10.1016/S0196-0644(97)70011-8
- He Q, Wang F, Li G, et al. Crush syndrome and acute kidney injury in the wenchuan earthquake. Journal of Trauma - Injury, Infection and Critical Care. 2011;70(5):1213-1217. doi:10.1097/TA.0B013E3182117B57
- Nadjafi I, Atef MR, Broumand B, Rastegar A. Suggested guidelines for treatment of acute renal failure in earthquake victims. Ren Fail. 1997;19(5):655-664. doi:10.3109/08860229709109031
- Knochel JP. Rhabdomyolysis. Western Journal of Medicine. 1976;125(4):312.
- Sever MS, Erek E, Vanholder R, et al. Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake. Kidney Int. 2002;62(6):2264-2271. doi:10.1046/j.1523-1755.2002.00669.x
- Duman H, Külahçi Y, Nişanci M, et al. Ezilme (Crush) Sendromunda Serum Kreatinin Kinaz, Serum Myoglobin Ve İdrar Myoglobin Düzeylerinin Ezilen Ekstremite Sayısı İle İlişkisi. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi. 2003;11(2).
- Bulut M, Turanoğlu G, Armağan E, Akköse Ş, Özgüç H, Tokyay R. The Analysis of Traumatized Patients Who Admitted To The Uludağ University Medical School Hospital After The Marmara Earthquake. Ulus Travma Derg. 2001;7(4):262-266.
- Sever MS, Erek E, Vanholder R, et al. Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrology Dialysis Transplantation. 2002;17(11):1942-1949. doi:10.1093/NDT/17.11.1942
- Oda J, Tanaka H, Yoshioka T. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470-476.
- Shimawu T, Toshiharu Y, Nakata Y, et al. Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients. J Trauma. 1997;42(4):641-646. doi:10.1097/00005373-199704000-00010
- Hwang SJ, Shu KH, Lain JD, Yang WC. Renal replacement therapy at the time of the Taiwan Chi-Chi earthquake. Nephrology Dialysis Transplantation. 2001;16(suppl 5):78-82. doi:10.1093/ndt/16.suppl_5.78
- Zhang L, Fu P, Wang L, et al. Hyponatraemia in patients with crush syndrome during the Wenchuan earthquake. Emerg Med J. 2013;30(9):745. doi:10.1136/EMERMED-2012-201563
- Westermann I, Dünser MW, Haas T, et al. Endogenous vasopressin and copeptin response in multiple trauma patients. Shock. 2007;28(6):644-649. doi:10.1097/SHK. 0B013E3180CAB33F
Öz
Amaç: Çok sayıda ölüm ve yaralanmaya neden olan depremler sonrasında hayati sorunlardan biri de travmatik kas hasarına bağlı meydana gelen crush(ezilme) sendromudur. Bu çalışmada crush sendromu gelişmiş hastaların klinik seyirlerini ve crush sendromu ile ilişkili olabilecek faktörleri saptanması amaçlandı. Yöntem: 6 Şubat 2023 tarihinde 11 ilde etkili olan Kahramanmaraş merkezli 7.7 ve 7.6 büyüklüğündeki iki depremin ardından 6-14 Şubat tarihleri arasında hastanemize 18 yaş üstü 319 hasta başvurdu. 319 hastanın 87’i yatarak takip ve tedavi aldı. Yatarak tedavi alan hastalardan Crush sendromu tanısı alan 43 hastanın tamamının 6-28 Şubat arasındaki hastane kayıtlarından yaşı, cinsiyeti, geldiği ili, enkazda kalış süresi, yapılan operasyon, hastanede yatış süresi, ilk 24 saate verilen mayii miktarı, ilk 24 saat idrar çıkımı miktarı, travma yerleri, hastaneye başvuru esnasında ve takibindeki bazı laboratuvar parametreleri geriye dönük değerlendirildi. Bulgular: Hastaların yaşı 39±19.6 yıl, enkazda kalış süresi(saat) 22,74±36.32, hastane yatış süresi(gün) 7,26±5,42, ilk 24 saatte aldığı mayi(ml) 4954,18±3142, ilk 24 saat idrar miktarı(ml) 2646,42±2262,65, başvuru kreatinin(mg/dl) 1,59±2,25, başvuru kreatin kinaz(u/l) 11716,37±18520 olarak saptandı. Hastaların %44,2’i kadın, %72,1’i Kahramanmaraş ilinden gelmiş, %46,5’una cerrahi müdahale yapılmış, %67,4’ünün başvuru CK 1000 u/l’nin üzerinde, %14’üne hemodiyaliz tedavisi uygulanmış, %46,5’inde CK referans aralığına gelme süresi 7 günden kısa, %51,2’inde yatış süresi 21 günden uzun saptandı. Yatış gün süresi, CK referans aralığına gelme süresi üzerine diğer parametrelerin etkisi ve laboratuvar parametreleri ile korelasyonu analiz edildi. Sonuç: Sonuç olarak CK referans aralığına gelme süresini ve hastanede yatış süresini ön görmede süreye etkili parametreler değerlendirilerek ileriye dönük crush sendromu olgularında hastanede yatış süresini hesaplamada ve azaltmada kullanılabileceği düşünülmektedir.
Anahtar Kelimeler
Kaynakça
- Kurultak İ. Deprem yaralanmalı erişkin hastada ezilme (crush) sendromu. TOTBİD Dergisi. 2022;21(3):294-303. doi:10.5578/totbid.dergisi.2022.40
- Li N, Wang X, Wang P, Fan H, Hou S, Gong Y. Emerging medical therapies in crush syndrome - progress report from basic sciences and potential future avenues. Ren Fail. 2020;42(1):656-666. doi:10.1080/0886022X.2020.1792928
- Ergünay O. Türkiye’nin Afet Profili. In: TMMOB Afet Sempozyumu Bildiriler Kitabı. Mattek Matbaacılık; 2007.
- Sever MS, Erek E, Vanholder R, et al. Lessons learned from the Marmara disaster: Time period under the rubble. Crit Care Med. 2002;30(11):2443-2449. doi:10.1097/00003246-200211000-00007
- Sever MS, Erek E, Vanholder R, et al. The Marmara earthquake: Epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60(3):1114-1123. doi:10.1046/j.1523-1755.2001.0600031114.x
- Michaelson M. Crush injury and crush syndrome. World J Surg. 1992;16(5):899-903. doi:10.1007/BF02066989
- Sagheb MM, Sharifian M, Roozbeh J, Moini M, Gholami K, Sadeghi H. Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush victims. Ren Fail. 2008;30(9):831-835. doi:10.1080/08860220802353785
- Sever MŞ. Crush (Ezilme) Sendromu ve Marmara Depreminden Çıkarılan Dersler. Vol 1. Lebib Yalkın Yayımları ve Basım İşleri A.Ş; 2002.
- Oda Y, Shindoh M, Yukioka H, Nishi S, Fujimori M, Asada A. Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome. Ann Emerg Med. 1997;30(4):507-512. doi:10.1016/S0196-0644(97)70011-8
- He Q, Wang F, Li G, et al. Crush syndrome and acute kidney injury in the wenchuan earthquake. Journal of Trauma - Injury, Infection and Critical Care. 2011;70(5):1213-1217. doi:10.1097/TA.0B013E3182117B57
- Nadjafi I, Atef MR, Broumand B, Rastegar A. Suggested guidelines for treatment of acute renal failure in earthquake victims. Ren Fail. 1997;19(5):655-664. doi:10.3109/08860229709109031
- Knochel JP. Rhabdomyolysis. Western Journal of Medicine. 1976;125(4):312.
- Sever MS, Erek E, Vanholder R, et al. Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake. Kidney Int. 2002;62(6):2264-2271. doi:10.1046/j.1523-1755.2002.00669.x
- Duman H, Külahçi Y, Nişanci M, et al. Ezilme (Crush) Sendromunda Serum Kreatinin Kinaz, Serum Myoglobin Ve İdrar Myoglobin Düzeylerinin Ezilen Ekstremite Sayısı İle İlişkisi. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi. 2003;11(2).
- Bulut M, Turanoğlu G, Armağan E, Akköse Ş, Özgüç H, Tokyay R. The Analysis of Traumatized Patients Who Admitted To The Uludağ University Medical School Hospital After The Marmara Earthquake. Ulus Travma Derg. 2001;7(4):262-266.
- Sever MS, Erek E, Vanholder R, et al. Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrology Dialysis Transplantation. 2002;17(11):1942-1949. doi:10.1093/NDT/17.11.1942
- Oda J, Tanaka H, Yoshioka T. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470-476.
- Shimawu T, Toshiharu Y, Nakata Y, et al. Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients. J Trauma. 1997;42(4):641-646. doi:10.1097/00005373-199704000-00010
- Hwang SJ, Shu KH, Lain JD, Yang WC. Renal replacement therapy at the time of the Taiwan Chi-Chi earthquake. Nephrology Dialysis Transplantation. 2001;16(suppl 5):78-82. doi:10.1093/ndt/16.suppl_5.78
- Zhang L, Fu P, Wang L, et al. Hyponatraemia in patients with crush syndrome during the Wenchuan earthquake. Emerg Med J. 2013;30(9):745. doi:10.1136/EMERMED-2012-201563
- Westermann I, Dünser MW, Haas T, et al. Endogenous vasopressin and copeptin response in multiple trauma patients. Shock. 2007;28(6):644-649. doi:10.1097/SHK. 0B013E3180CAB33F
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Mart 2024 |
| Kabul Tarihi | 19 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 |