Accumulation of blood stasis
Introduction
Introduction Blood stasis is common in crush syndrome. The toxic intermediate metabolites after the destruction of blood and tissue proteins are absorbed into the blood and cause acute tubular necrosis after trauma and acute renal failure caused by it. This is a common cause of late death in patients with extensive soft tissue contusion. As the flesh is damaged, the blood is separated from the veins, the blood stagnates, the blood stagnates, the meridians are occluded, the local pain occurs, the limbs are swollen, the skin is indented, hardened, the skin is bleeding, the skin tension is increased, and there is blisters around the compressed skin. form.
Cause
Cause
Squeeze syndrome occurs in accidental injuries such as house collapse, project collapse, traffic accidents, etc., and can occur in batches during severe natural disasters such as wartime or strong earthquakes. In addition, occasionally in patients with coma and surgery, the limbs are prolonged by the self-pressure of the fixed position.
Examine
an examination
Related inspection
Urine routine urinary aspartate aminotransferase (GOT) platelet electrophoresis time determination platelet electrophoresis time determination platelet aggregation test (PAgT)
Clinical manifestations:
(1) Local symptoms: blood damage, blood stasis, blood stasis, qi stasis, meridian occlusion, local pain, limb swelling, skin indentation, hardening, subcutaneous blood stasis, skin tension increased, in Blisters are formed around the compressed skin. When examining the blood circulation state of the limb, it is worth noting that if the distal end of the limb does not weaken, there is still a risk of ischemic necrosis in the muscle tissue. Attention should be paid to the examination of the muscles and nerve functions of the limbs. Active activity and passive traction can cause pain, which is helpful for judging the affected muscle compartment of the fascia.
(2) systemic symptoms: due to internal injuries, blood, meridians, viscera, patients with head dizziness, loss of appetite, facelessness, chest tightness, abdominal distension, constipation and other symptoms. The accumulation of heat can express fever, red face, yellow urine, red tongue, yellow greasy moss, pulse frequency and so on. Severe palpitations, shortness of breath, and even pale, cold limbs, sweat out of oil and other symptoms (shock). The main characteristics of the crush syndrome are described as follows:
1 shock: some casualties may not have shock in the early stage, or the shock period is short and not found. Some wounded people have strong nerve stimulation due to crush injury, extensive tissue destruction, and a large amount of blood loss, which can quickly produce shock and increase.
2 myoglobinuria: This is an important condition for the diagnosis of crush syndrome. After the injured person relieves the pressure, brown urine or self-reported hematuria appears within 24 hours, and myoglobinuria should be considered. The concentration of myoglobinuria in the blood and urine reaches a peak 3 to 12 hours after decompression of the injured limb, and then gradually decreases, and can be cleared after 1 to 2 days.
3 Hyperkalemia: Because of muscle necrosis, a large amount of intracellular potassium enters the circulation, and it is difficult to excrete potassium in renal failure. In the oliguria period, potassium can rise 2mmol/L per day, and even rise to a fatal level within 24 hours. Hyperkalemia is accompanied by high blood phosphorus, high blood magnesium and low blood calcium, which can aggravate the effect of blood potassium on myocardial inhibition and toxicity.
4 Acidosis and azotemia: After muscle ischemic necrosis, a large amount of acidic substances such as phosphate and sulfate are released, which lowers the pH value of body fluid and causes metabolic acidosis. After severe trauma, tissue catabolism is vigorous, a large number of intermediate metabolites accumulate in the body, non-protein nitrogen is rapidly increased, clinical manifestations such as unconsciousness, deep breathing, irritability, polydipsia, nausea and other acidosis, uremia, etc. . The daily intake and output should be recorded daily, and the urine specific gravity should be measured frequently. If the urine specific gravity is less than 1.018, it is the main indicator of diagnosis.
Diagnosis
Differential diagnosis
Differential diagnosis of blood stasis:
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2. Moisture retention: After the injury is squeezed, the affected part is stagnation of blood stasis, and if the gas is not available, the fluid can not be returned to the cloth and stopped, and the fluid is wet when it is stopped. Water wet retention is not urinary; Jin does not run the intestines, the stool does not go down; the second will not pass the abdominal fullness; Jin does not go on the mouth and thirst; the heat is blocked in the gastrointestinal tract, the middle focus is not greasy, the greasy and thick Number of strings or slips. This type is more common in renal failure and oliguria.
3. Qi and Yin deficiency: patients have no urine or oliguria for a long time, plus external injury, fever, and poor appetite, resulting in both qi and yin deficiency. Because of kidney qi deficiency, the effect of solid fixation and bladder opening is lost, so there are many symptoms of urinary tract. More urine will further damage the yin, and there will be a series of symptoms such as shortness of breath, fatigue, night sweats, pale complexion, red tongue, no moss or little moss, weak pulse and other qi and yin. This type is more common in renal failure and polyuria.
4. Insufficient blood: The patient's diet and the second stool are basically normal, but the limb muscles are still swollen and painful, pale, and the body is weak, the tongue is reddish and the moss is thin, and the pulse is slow and weak. This disease is seen in patients with recovery from uremia who have been relieved.
