Развитие полиорганной недостаточности при синдроме длительного сдавления на фоне алкогольной интоксикации тяжелой степени (клинический случай)

Abstract

We consider and analyze a clinical example of a patient with multiple organ failure in crush syndrome of the upper extremities on a hard surface by their own weight in addition to severe damage of ethanol intoxication. We consider etiology, development mechanism, symptoms, diagnosis and treatment of crush syndrome. The main manifestation is muscle breakdown, the breakdown of muscle tissue with subsequent endogenous intoxication by tissue autolysis products, pain syndrome and plasma loss, metabolic and water-electrolyte disorders, thrombosis of the microcirculatory bed. First of all, acute renal damage develops. With severe and extremely severe damage, a shock state with unstable hemodynamics is possible. In unstable hemodynamics, inotropic and vasopressor support is used. The main markers in the diagnosis are creatine phosphokinase, miglobin, an increase in creatinine and urea in the blood serum. Treatment includes intensive therapy in addition to renal replacement therapy – plasmapheresis, hemodialysis, hemodiafiltration. Narcotic analgesics are used to eliminate the pain syndrome. According to the indications, surgical treatment is carried out from necrectomy and fasciotomy to limb amputation. Mortality in crush syndrome reaches from 30 to 70 %. A favorable outcome is possible after a month.