Ezilme (Crush) sendromunda serum kreatinin kinaz, serum myoglobin ve idrar myoglobin düzeylerinin ezilen ekstremite sayısı ile ilişkisi

The relationship between number of crushed extremity and amound of serum creatinin kinase, serum myoglobine and urine myoglobine in crush syndrome

Muhittin SERDAR, Haluk DUMAN, Ayhan ÖZCAN, Mustafa NİŞANCI, Yalçın BAYRAM, Yalçın KÜLAHÇI, Mustafa ŞENGEZER, Mehmet BOZKURT

Özet

Ezilme yaralanmasına maruz kalmış, ezilme sendromu gelişme riski olan hastanın yaralı ekstremitesinin tedavisi halen cerrahlar için büyük bir problemdir. Bu nedenle, sistemik etkiler ile harabiyetin derecesi arasmdaki ilişkiyi ortaya koyabilecek objektif parametreler bu ikilemde cerraha yardımcı olacaktır. Gölcük depreminde Gülhane Askeri Tıp Akademisi Plastik ve Rekonstrüktif Cerrahi Kliniğinde ezilme yaralanması olan 35 olgu takip edildi. Uzun süre ezilme yaralanmasına maruz kalan, ezilme yaralanmasına maruz kalan ekstremitesinde şişlik ya da nörolojik bozukluklar meydana gelen, myoglobinürisi olan ve takip eden dönemlerde akut böbrek yetmezliği gelişen 19 hasta, ezilme sendromu gelişen hastalar olarak tanımlandı. Hastalar klinik takibe alındıktan sonra fizik muayeneleri yapıldı ve serum kreatinin kinaz (CK), serum myoglobin ve idrar myoglobin verileri kaydedildi. Mann-Whitney U testine göre 1-3 (r=0.006, p=0.004) ve 2-3 (r=0.004, p=0.002) ekstremitesi yaralananların serum pik CK düzeyleri arasında, 1-3 (r=0.017, p=0.017) ve 1-2 (r=0.051, p=0.048) ekstremitesi yaralananların serum pik myoglobin düzeyleri arasında, 1-3 (r=0.010, p=0.009) ve 2-3 (r=0.022, p=0.022) ekstremitesi yaralananların idrar pik myoglobin değerleri arasında anlamlı ilişki bulundu. Elde edilen sonuçlar, ezilme sendromunun ciddiyetinin, ezilen ekstremite sayısı ile doğru orantılı olduğunu ve serum pik CK, serum pik myoglobin ve idrar pik myoglobinin değerlerinin altta yatan kas hasarının bir göstergesi olabileceğini göstermektedir.

Abstract

In a patient that is prone to sustain crush syndrome after crush injury, management of the crushed extremity is stili an on going challenge for the surgeons. Thus, objective criteria that can show the correlation between the systemic manifestations and the extent of injury may help to overcome this problem. 35 patients who sustained crush injury after Gölcük earth-quake were treated at Gülhane Military Medical Academy, Department of Plastic and Reconstructive Surgery. Crush syndrome patients were selected when the following criteria were met: l)patients who had sustained a crush injury, 2)patients who manifested swelling and/or neurogical disturbances at the affected limbs, 3) patients who had presence of myoglobinuria, and 4)patients who developed acute renal failure. We identified 19 patients with crush syndrome. On admission and during therapy complete physical examination was performed and laboratory data including serum concentrations of creatinin kinase (CK), serum myoglobine and urine myoglobine were recorded. Mann-Whitney U correlation test was employed to verify the correlation between the number of crushed extremity and laboratory findings. Correlations between the l and 3 crushed extremity (r=0.006,p=0.004) with serum peak CK, 2 and 3 crushed extremity (r=0.004,p=0.002) with serum peak CK, l and 3 crushed extremity (r=0.017, p=0.017) vvith serum peak myoglobine, l and 2 crushed extremity (r=0.051, p=0.048) with serum peak myoglobine, l and 3 crushed extremity (r=0.010, p=0.009) with urine peak myoglobine, 2 and 3 crushed extremity (r=0.022, p=0.022) with urine peak myoglobine werefound to be significant. in conclusion, the severity of crush syndrome is directly proportional to the number of crushed limbs and peak levels of serum CK, serum myoglobine and urine myoglobine may be used to determine the extent of underlying muscle damage.