The crush syndrome Invited Editor

Yıl 2009, Cilt: 44 Sayı: 2, 43 - 47, 01.06.2009

Lale Sever

Öz

Crush syndrome is a systemic disorder resulting from trauma associated rhabdomyolysis that causes several medical and surgical complications Pathogenesis of crush syndrome related acute renal failure ARF can be studied under two headings: 1 Rhabdomyolysis and 2 ARF on the basis of rhabdomyolysis Compression of the muscles baromyopathy induces rhabdomyolysis The term rhabdomyolysis points out to the disintegration of striated muscles which results in the release of muscular cell contents into the circulation On the other hand sodium chloride water and calcium diffuse into the muscle cell and cellular swelling “compartment syndrome” occurs Various factors contribute to the development of ARF on the basis of rhabdomyolysis Among these the most important one is impairment of renal perfusion as a result of hypovolemia due to compartment syndrome The crush syndrome and ARF do not necessarily develop in all cases who suffer from muscle trauma This syndrome is observed relatively rarely in children The most useful indicator of rhabdomyolysis is an increase in serum creatine phosphokinase level On the other hand the most critical laboratory abnormality is hyperkalemia Considering the medical interventions prophylaxis of ARF is vital Fluid replacement is the most important measure for this goal and intermittent hemodialysis is the most effective modality for the treatment of the crush patients with ARF Turk Arch Ped 2009; 44: 43 7 Key words: Children crush syndrome earthquake

Anahtar Kelimeler

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Ezilme sendromu Çağrılı Editör

Öz

Ezilme sendromu travmaya bağlı rabdomiyoliz sonucunda ortaya çıkan ve pek çok dahili ve cerrahi komplikasyona yol açan sistemik bir hastalıktır Ezilme sendromuna bağlı akut böbrek yetersizliğinin ABY patojenezi iki başlık altında incelenebilir: 1 Rabdomiyoliz ve 2 Rabdomiyoliz zemininde ortaya çıkan ABY Kasların basıya uğraması baromiyopati rabdomiyolize neden olur Rabdomiyoliz terimi çizgili kas hücresinin bütünlüğünün bozulup içindeki maddelerin dolaşıma geçmesini ifade eder Öte yandan sodyum klorür ve su da kas hücresi içine girer ve hücre şişmesi kompartman sendromu ortaya çıkar Rabdomyoliz zemininde ABY nin gelişiminde çeşitli etmenlerin etkisi vardır Bunlar içinde en önemlisi kompartman sendromunun yol açtığı hipovolemi nedeniyle böbrek perfüzyonunun bozulmasıdır Kas travması olan tüm olgularda ezilme sendromu ve ABY ortaya çıkmaz Bu sendrom çocuklarda daha da nadirdir Rabdomiyolizin en önemli belirteci serum kreatin fosfokinaz düzeyinin yükselmesidir Öte yandan en hayati laboratuvar bulgusu hiperkalemidir Tıbbi girişimler açısından ABY’nin önlenmesi çok önemlidir Bu amaçla hastalara uygun sıvı desteğinin yapılması gerekir Akut böbrek yetersizliği olan ezilme sendromlu hastalarda en etkili tedavi seçeneği hemodiyalizdir Türk Ped Arş 2009; 44: 43 7 Anahtar kelimeler: Çocuklar deprem ezilme sendromu

Anahtar Kelimeler

Çocuklar, deprem, ezilme sendromu

Kaynakça

• Zager RA. Rhabdomyolysis and myohemoglobinuric acute re- nal failure. Kidney Int 1996; 49: 314-26. 2. Sever MS. The Crush Syndrome and lessons learned from the Marmara Earthquake. 1st ed. Basel: Karger AG, 2005: 58-75.
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