Rhabdomyolysis Following Crush Injury in the Taiwan Chi-Chi Earthquake

臺灣集集地震中壓迫性傷害造成的橫紋肌溶解症

吳明儒(Ming-Ju Wu) ； 連榮達(Jong-Da Lian) ； 李明彰(Ming-Chang Lee) ； 張浤榮(Horng-Rong Chang) ； 陳呈旭(Cheng-Hsu Chen) ； 鄭志雄(Chi-Hung Cheng) ； 徐國雄(Kuo-Hsiung Shu)

《Acta Nephrologica》 19卷2期 (2005/04) Pp. 62-67

並列摘要

Background: On September 21, 1999, the Chi-Chi Earthquake, measuring 7.3 on the Richter scale, struck central Taiwan, resulting in 2329 deaths and 8722 casualties. Among the severely injured, rhabdomyolysis was a common occurrence, often resulting in acute renal failure. The purpose of this study was to define the clinical picture of rhabdomyolysis secondary to crush injury in a local area close to the epicenter of a major earthquake.
Methods: We retrospectively identified patients with traumatic rhabdomyolysis, defined as a peak level of serum creatine kinase (CK) over 1000 U/L within 2 weeks of the earthquake, diagnosed at the major medical centers in central Taiwan. Patients with elevated serum CK of etiologies other than crush injury were excluded.
Results: A total of 95 cases were recruited from six hospitals. There were 60 males and 35 females with a mean age of 37.6±17.3 years. The median time from the earthquake to the time of rescue (T-rescue) was 6.0h (range: 0.1 to 31h) and median time to emergency room was 11.0h (range: 2 to 144h). The median peak level of serum CK (pCK) was 20000 U/L (range: 1040 to 351540 U/L). Acute renal failure (ARF), defined as a serum creatinine level over 1.3mg/dl, was found in 52 cases (54.7%). Dialytic therapy was performed in 32 cases (33.7%). Among them, 29 (90.6%) were oliguric with a mean oliguric phase of 11.0±9.5 days (median: 9, range: 1-36 days). Most patients (88 cases, 92.6%) also suffered from at least one of the following associated injuries: fracture (41.5%), neuropathy (29.8%), head injury (10.8%), chest injury (7.5%), abdominal injury (7.4%), and thermal burn (1.1%). Fasciotomy for compartment syndrome was performed in 35 cases (36.8%). Oliguric patients were associated with longer T-rescue (9.85 vs. 5.04 hours, p＜0.01), higher pCK (79204 vs. 30495 U/L, p＜0.01), higher LDH (4110 vs. 1498 U/L, p＜0.02) and lower serum calcium (6.53 vs. 7.46mg/dl, p＜0.001) when compared with nonoliguric patients. The pCK positively correlated with BUN, Cr, AST, LDH, and phosphate (all P＜0.005). Besides, the pCK also negatively correlated with serum calcium, blood pH, and urine volume in the first 48 hours (all p＜0.05). Although the pCK correlated well with the presence of oliguria and the need for dialysis, there was no correlation between pCK and mortality. Those patients with ARF were associated with a higher mortality (17.3% vs. 0%, p＜0.02). Mortality (9 cases, 9.5%) did not correlate well with age, sex, presence of oliguria, need for dialysis, or pCK.
Conclusion: The pCK of patients with rhabdomyolysis following crush injury is a reliable prognostic indicator of renal outcome and correlates well with most biochemical parameters. Renal failure was associated with a significantly higher mortality rate.

並列關鍵字

earthquake ； rhabdomyolysis ； crush injury ； acute renal failure ； serum creatine kinase