目的 总结5·12汶川大地震期间5例挤压综合征（crush syndrome，CS）患者伤后中期出现迟发性肌肉坏死的可能原因、发病机制及临床治疗措施。
方法 5·12汶川大地震期间收治5例CS患者，男3例，女2例；年龄15～35岁，平均23.4岁。肢体共17个受压部位，受压时间21～72 h，平均36 h。入院时病情危重，均表现为急性肾功能衰竭和肝功能损害，合并多部位、大面积感染创面。伤后中期创面动脉性大出血后出现寒战、高热等全身中毒症状，随后出现迟发性肌肉坏死；伤后晚期坏死肌群与周围正常肌群形成明显界限并自然脱离，当创面肉芽屏障形成后，心率、体温逐渐恢复正常。全身治疗主要为纠正肝、肾功能衰竭，抗感染、支持、输血等，局部早期加强引流、结合手术扩创，中期注意有限扩创，晚期进行创面换药及植皮覆盖创面。
结果 治疗后5例患者创面均愈合，皮肤干燥，无渗液、红肿、坏死、裂开及皮下积脓，愈合时间10～21个月，平均15.2个月。5例获随访13～45个月，平均19.6个月。均康复出院；随访期间无死亡，可佩戴假肢或扶拐活动。
结论 地震CS迟发性肌肉坏死可能是多因素共同作用的结果，具体机制有待进一步研究。
Citation：
钟洲, 刘熹, 张晖, 裴福兴, 黄富国, 屠重棋, 岑石强, 周宗科, 康鹏德, 易敏, 黄强. 地震挤压综合征迟发性肌肉坏死的临床研究. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1317-1319. doi: 10.7507/1002-1892.20140284
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- 4. Keven K, Ates K, Sever MS, et al.Infectious Complications after mass disasters:the marmara earthquake experience.Scand J Infect Dis, 2003, 35(2):110-113.
- 5. Knochel JP.Mechanisms of rhabdomyolysis.Curr Opin Rheumatol, 1993, 5(6):725-731.
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- 7. Iguchi N, Fujino Y, Uchivama A, et al.Rhabdomyolysis induced by Pseudomonas aeruginosa sepsis.J Anesth, 2008, 22(2):173-176.
