{"id":10323,"date":"2021-05-19T23:20:01","date_gmt":"2021-05-19T20:20:01","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=10323"},"modified":"2021-05-22T21:17:07","modified_gmt":"2021-05-22T18:17:07","slug":"crush-sendromu-enkaz-altindaki-bobrek","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/crush-sendromu-enkaz-altindaki-bobrek\/","title":{"rendered":"Crush Sendromu: Enkaz Alt\u0131ndaki B\u00f6brek"},"content":{"rendered":"\n

Deprem, bulundu\u011fumuz topraklarda ka\u00e7\u0131n\u0131lmaz bir afet. \u00c7ok yak\u0131n zamanda \u0130zmir\u2019de de oldu\u011fu gibi Elaz\u0131\u011f, G\u00f6lc\u00fck ve Van’da b\u00fcy\u00fck depremler ya\u015fand\u0131. B\u00fcy\u00fck can ve mal kayb\u0131 oldu. Mucizevi bir \u015fekilde saatler sonra g\u00f6\u00e7\u00fck alt\u0131ndan kurtar\u0131lan insanlar oldu. Baz\u0131lar\u0131 fel\u00e7 kald\u0131, baz\u0131lar\u0131 ise uzuv kayb\u0131 ya\u015fad\u0131. Ancak kurtar\u0131lanlar\u0131n y\u00fczde 40\u2019\u0131nda uzun s\u00fcre s\u0131v\u0131 azl\u0131\u011f\u0131 ve kas y\u0131k\u0131m\u0131ndan dolay\u0131 b\u00f6brek hastal\u0131klar\u0131 g\u00f6r\u00fcld\u00fc. <\/p>\n\n\n\n

B\u00f6brekte olu\u015fan bu hastal\u0131\u011fa Crush Sendromu<\/em><\/strong> veya Travmatik Rhabdomiyolizis<\/strong><\/em> denilmektedir.  <\/p>\n\n\n\n

\"Arama
Elaz\u0131\u011f Depreminde enkaz alt\u0131ndan sa\u011f kurtar\u0131lan hasta sonras\u0131 sevin\u00e7 Anadolu Ajans\u0131<\/a><\/figcaption><\/figure><\/div>\n\n\n\n

Crush Sendromu Nedir?<\/h2>\n\n\n\n

Crush Sendromu, en \u00e7ok depremde enkaz alt\u0131nda kalmakla g\u00f6r\u00fclmektedir. Bunun yan\u0131nda i\u015f ve trafik kazalar\u0131nda, \u00e7\u0131\u011f d\u00fc\u015fmesinde, ezilme bi\u00e7iminde yaralanma ve hareketsizlikle olu\u015fabilmektedir. Crush Sendromu ilk olarak 1909 y\u0131l\u0131ndaki Messina Depremi’nde tan\u0131mlanm\u0131\u015ft\u0131r. <\/p>\n\n\n\n

Crush Sendromu’nda \u00f6l\u00fcm nedeni ileri derecede hipovolemik \u015fok, hiperkalemi, metabolik asidoz, akut miyoglobulin\u00fcrik b\u00f6brek yetmezli\u011fi, kalp aritmileri ve kompartman sendromudur. \u015eokun temel nedeni h\u00fccre d\u0131\u015f\u0131 s\u0131v\u0131n\u0131n b\u00fcy\u00fck b\u00f6l\u00fcm\u00fcn\u00fcn zedelenen kaslarda birikmesidir. \u015eok geli\u015fimi; zedelenen kaslardaki NO’ya ba\u011fl\u0131 vazodilatasyonun  hipokalemi ile h\u0131zlanarak t\u00fcm dola\u015f\u0131m sistemini olumsuz etkilemesiyle olu\u015fur. <\/p>\n\n\n\n

Kas dokusunda ezilmeye ba\u011fl\u0131 olarak rabdomiyoliz (\u00e7izgili kas\u0131n hasara ba\u011fl\u0131 olarak erimesi) g\u00f6r\u00fclmektedir. Bu sebeple miyoglobin; potasyum, magnezyum, fosfat gibi iyonlar; kreatin fosfokinaz ve laktat dehidrojenaz gibi enzimler a\u00e7\u0131\u011fa \u00e7\u0131kmaktad\u0131r. Bu maddelerin kana kar\u0131\u015fmas\u0131n\u0131 engelleyen fakt\u00f6r\u00fcn (enkaz vb.) kald\u0131r\u0131lmas\u0131yla birlikte bu \u00fcr\u00fcnlerin dola\u015f\u0131ma kat\u0131lmas\u0131 sonucu ani kalp ritmi bozukluklar\u0131 gibi \u00f6l\u00fcmc\u00fcl tablolarla kar\u015f\u0131la\u015f\u0131l\u0131r.  <\/sup> <\/p>\n\n\n\n

Ezilmeyi takiben kaslarda b\u00f6lgesel iskemi ger\u00e7ekle\u015fir; sodyum, kalsiyum ve s\u0131v\u0131lar serbest kal\u0131r, kas hacmi ve gerginli\u011fi artar. Nitrik oksit sistemi aktive olur ve vazodilatasyona yol a\u00e7arak hipotansiyonun \u015fiddetlenmesine katk\u0131da bulunur. <\/sup>Ezilen kaslar b\u00fcy\u00fck \u00f6l\u00e7\u00fcde \u015fi\u015fmi\u015f, sert, so\u011fuk, duyars\u0131z ve nekrotiktir.  <\/p>\n\n\n\n

Crush Sendromu s\u0131ras\u0131nda olu\u015fan doku zedelenmesi ile b\u00f6brek kan ak\u0131m\u0131 azal\u0131r ve e\u011fer bu azalma glomer\u00fcl filtrasyon de\u011ferininde de d\u00fc\u015fme ile sonu\u00e7lan\u0131rsa \u00f6ncelikle prerenal b\u00f6brek yetmezli\u011fi geli\u015fir. E\u011fer b\u00f6brek kan ak\u0131m\u0131nda azalma devam ederse, \u00f6ncelikle medulla kan ak\u0131m\u0131 bozulur, b\u00f6brekte iskemik b\u00f6brek yetmezli\u011fi ortaya \u00e7\u0131kar. <\/p>\n\n\n\n

\"Dosya:
Akut Kortikal Nekroz Wikimedia<\/a> <\/figcaption><\/figure><\/div>\n\n\n\n

Ayr\u0131ca b\u00f6brek iskemisinin s\u00fcrmesi sonucunda ve Hem metabolizmas\u0131 ile ortaya \u00e7\u0131kan demir iyonuna ba\u011fl\u0131 olarak serbest oksijen radikalleri de h\u00fccre zedelenmesine neden olur. Buna toksik zedelenme denilmektedir. B\u00fct\u00fcn bu fizyopatolojik de\u011fi\u015fiklikler bir araya gelince akut t\u00fcb\u00fcler nekroz ve akut b\u00f6brek yetmezli\u011fi ile sonu\u00e7lan\u0131r. Zedelenmi\u015f kas dokusundan \u00e7\u0131kan doku fakt\u00f6rleri ve enfeksiyon nedeniyle yayg\u0131n intravask\u00fcler koag\u00fclopati geli\u015febilir. Bu da akut b\u00f6brek yetmezli\u011finin a\u011f\u0131rl\u0131\u011f\u0131n\u0131 artt\u0131r\u0131r. <\/p>\n\n\n\n

Crush Sendromu Tedavisi<\/h2>\n\n\n\n

Enkaz alt\u0131nda hayatta olan bir insan fark edilip ona ula\u015f\u0131ld\u0131\u011f\u0131nda, enkaz alt\u0131na sa\u011fl\u0131k g\u00f6revlisi de girmi\u015ftir. Hipovolemik \u015fok ve elektrolit bozukluk hasarlar\u0131n\u0131 azaltmak i\u00e7in hemen s\u0131v\u0131 takm\u0131\u015ft\u0131r. <\/p>\n\n\n\n

Y\u0131k\u0131nt\u0131 alt\u0131nda kalm\u0131\u015f bir insan\u0131n serbest bir ekstremitesi g\u00f6r\u00fcld\u00fc\u011f\u00fcnde saatte 1 litre gidecek h\u0131zda izotonik NaCl solusyonu tak\u0131lmal\u0131d\u0131r. Bu uygulama hipovolemik \u015fok ve akut b\u00f6brek yetmezli\u011finin \u00f6nlenmesine yard\u0131mc\u0131d\u0131r. Bilin\u00e7siz bir \u015fekilde ekstremiteler \u00fczerine d\u00fc\u015fenler y\u0131k\u0131nt\u0131lar kald\u0131r\u0131lmamal\u0131d\u0131r. Bu b\u00f6lgesel iskemi sonucu olu\u015fan at\u0131klar\u0131n h\u0131zla kan dola\u015f\u0131m\u0131na kat\u0131lmas\u0131na neden olur.  <\/p>\n\n\n\n

V\u00fccudunun tamamen serbestle\u015ftirilmesi i\u00e7in 45 ile 90 dakika ge\u00e7ebilir. Bu a\u015famada da sol\u00fcsyonu uygulamas\u0131 s\u00fcrd\u00fcr\u00fclmelidir. <\/p>\n\n\n\n

Crush Sendromunda en tehlikeli ve \u00f6l\u00fcmlere yol a\u00e7an bulgular\u0131n\u0131n ba\u015f\u0131nda hiperpotasemi vard\u0131r. Bu nedenle potasyum i\u00e7eren bir sol\u00fcsyon kesinlikle verilmemelidir. <\/p>\n\n\n\n

Hasta enkaz alt\u0131ndan \u00e7\u0131kar\u0131ld\u0131ktan sonra idrar \u00e7\u0131k\u0131\u015f\u0131 mutlaka kontrol edilmelidir. Gerekli muayeneler yap\u0131ktan sonra hastaya sonda tak\u0131lmal\u0131d\u0131r. \u0130drar \u00e7\u0131k\u0131\u015f\u0131 yoksa hipovolemik \u015fok i\u00e7in gerekli sol\u00fcsyonlar verilmelidir.<\/p>\n\n\n\n

\"Dosya:
Sa\u011fl\u0131kl\u0131 Erkek B\u00f6bre\u011fi(solda) ve \u0130skemik Erkek B\u00f6bre\u011fi(sa\u011fda) Wikimedia<\/a><\/figcaption><\/figure><\/div>\n\n\n\n

<\/p>\n\n\n\n

Kaynak\u00e7a<\/strong><\/p>\n\n\n\n

Prof. Dr. Mehmet \u015e\u00fckr\u00fc Sever, K\u0130TLESEL FELAKETLERDE SA\u011eLIK H\u0130ZMETLER\u0130 REHBER\u0130 T\u00fcrk Nefroloji Derne\u011fi<\/a><\/p>\n\n\n\n

Do\u00e7. Dr. S\u00fcheyla G\u00fcven Apayd\u0131n, Crush Sendromu, Mart 2002 pdf<\/a><\/p>\n\n\n\n

Prof. Dr. Mehmet \u015e\u00fckr\u00fc SEVER,EZ\u0130LME (\u201cCRUSH\u201d) SENDROMU pdf<\/a><\/p>\n\n\n\n

Crush Sendromu Wikipedia<\/a><\/p>\n\n\n\n

Crush Sendromu ve Tedavisi TTB<\/a><\/p>\n\n\n\n

T.R\u0131fk\u0131 Evrenkaya , Enes M. Atasoyu , M.Ya\u015far T\u00fclbek, ENKAZ ALTINDA 135 SAAT: G\u00d6LC\u00dcK DEPREM\u0130NDEN B\u0130R TRAVMAT\u0130K RABDOMYOL\u0130Z OLGUSU, 2000.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Deprem, bulundu\u011fumuz topraklarda ka\u00e7\u0131n\u0131lmaz bir afet. \u00c7ok yak\u0131n zamanda \u0130zmir\u2019de de oldu\u011fu gibi Elaz\u0131\u011f, G\u00f6lc\u00fck ve Van’da b\u00fcy\u00fck depremler ya\u015fand\u0131. B\u00fcy\u00fck can ve mal<\/p>\n","protected":false},"author":386,"featured_media":10327,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[2081,2084,2083],"acf":[],"views":854,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10323"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/386"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=10323"}],"version-history":[{"count":14,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10323\/revisions"}],"predecessor-version":[{"id":10532,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10323\/revisions\/10532"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/10327"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=10323"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=10323"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=10323"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}