نقش حياتي پزشكان اورژانس در كاهش آسيب كليوي حاد ناشي از تروما

The Vital Role of Emergency Physicians in Reducing Acute Renal Injury due to Trauma

آسيب حاد كليه يكي از دلايل عمده نقص اندام در بيماران ترومائي است كه از جراحات اوليه خود جان سالم به در مي برند و به طور مستقل با نرخ بالاتر مرگ و مير همراه است . بيماران تروما در معرض خطر AKI ناشي از هيپوپرفيوژن كليه (ثانويه به شوك خونريزي دهنده) ، رابدوميوليز ، آسيب مستقيم كليه، سندرم كمپارتمان شكمي يا اثرات نفروتوكسيك درماني هستند. سنين بالاتر ، بيماري هاي همراه از جمله ديابت مليتوس و بيماري مزمن كليه ، شوك يا آسيب شديدتر و انتقال خون ، خطر را افزايش مي دهد. 3 AKI ابتلا به در بيماران ترومايي بستري در بخش مراقبت هاي ويژه AKI بروز تقريباً 20 درصد است ، در اين گروه از بيماران خطر نسبي مرگ 3.6 برابر افزايش مي يابد .

Acute kidney injury (AKI) is one of the leading causes of organ failure in trauma patients who survive their primary injuries and are independently associated with higher mortality rates. Trauma patients are at risk for AKI due to renal hypo perfusion (secondary to hemorrhagic shock), rhabdomyolysis, direct kidney injury, abdominal compartment syndrome, or therapeutic nephrotoxic effects. Older people, comorbidities such as diabetes mellitus and chronic kidney disease, more severe shock or injury, and blood transfusions increase the risk of AKI. The incidence of AKI in trauma patients admitted to the intensive care unit is approximately 20%, and in this group of patients the relative risk of death increases 3.6 times. All the above data indicate that acute renal injury is one of the most important in these patients. The importance of this issue is not only due to the increase in morbidity and mortality, but also the ease ways of prevention of this dangerous complication has added to the importance of paying more attention to this complication. The irreplaceable role of physicians dealing with trauma patients in the early stages is crucial in preventing acute kidney injury. The key to preventing this complication is to control the main elements that cause AKI: (1) to prevent hypovolemia (2) to prevent the administration of nephrotoxic drugs and contrast agents. AKI is a recurrent complication in hospitalized trauma patients and is associated with an increased length of hospital stay and an increased risk of death. In addition, AKI is a common complication that leads to late death from trauma. The role of physicians and nurses in dealing with these patients and taking basic measures to prevent this complication is very important and vital. Planning to hold regular and frequent training and practical workshops for physicians and nurses in roadside emergencies and hospital emergencies can be effective in reducing this deadly complication.