各种灾害中AKI的防治

M. Sever
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摘要

急性肾损伤(AKI)是一种常见的疾病,在自然灾害(如地震)和人为灾害(如战争)后,其频谱、病因发病机制和治疗策略均有很大差异。地震中AKI最重要的发病机制是与挤压伤相关的低血容量和肌红蛋白尿。因此,最有效的预防措施是早期和有力的液体复苏(特别是等渗盐水,由于医疗和后勤优势),同时避免肾毒性药物。当预防措施失败和肾内急性肾损伤发生时,透析是挽救生命的,由于灾害期间的医疗和后勤优势,首选间歇性血液透析。在战争期间,最重要的人为灾害——肾前、肾内和肾后急性肾损伤可能在战场上以及野战或三级保健医院环境中发生。总的来说,战争受害者AKI的发病机制和治疗策略与一般AKI和自然灾害AKI相似。灾后的后勤规划对于提供最有效的治疗至关重要。如果患者无法在当地得到治疗,要么向其他地区或国家寻求帮助,要么将患者转诊到其他地区或国家。重要的是,灾害易发地区及其周围的肾脏科单位应该为灾害后突然涌入的AKI患者做好准备。
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Prevention and Treatment of AKI during Various Disasters
Acute kidney injury (AKI) is frequent, and shows wide variation with regards to the spectrum, etio-pathogenesis and management strategies after natural (e.g., earthquakes) and man-made disasters (e.g., wars). The most important pathogenetic mechanisms in AKI during earthquakes are crush injury-related hypovolemia and myoglobinuria. Therefore, the most effective preventive measures are early and energetic fluid resuscitation (especially isotonic saline due to medical and logistic advantages) and also avoiding nephrotoxic medications. When preventive measures fail and intrarenal AKI develops, dialysis is lifesaving, with a preference towards intermittent hemodialysis due to medical and logistic advantages during disasters. During wars, the most important man-made disaster, prerenal, intrarenal and postrenal AKI may develop both at the battlefield and also in the field- or tertiary care-hospital setting. Overall, pathogenesis and management strategies of AKI in war victims are similar with those of AKI in general and in natural disasters. Logistic planning after disasters is vital for providing the most effective treatment. If patients cannot be coped with locally, either help should be asked from, or, alternatively, patients should be referred to, other regions or countries. Importantly, nephrology units in and around disaster-prone areas should be prepared for disasters for a sudden influx of AKI victims after disasters.
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