彩色多普勒超声评价筋膜室综合征供血动脉血流动力学改变
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摘要
目的应用彩色多普勒超声评价严重地震挤压伤患者筋膜室综合征供血动脉血流动力学改变。方法用二维超声成像显示11例"5.12"地震严重挤压伤患者肿胀侧肢体及对侧肢体动脉血管,记录动脉内径、内膜中层厚度,观察腔内有无异常回声和狭窄及伴行静脉声像图,血管搏动性;彩色多普勒超声显示动脉血流充盈状况、血流方向和频谱形态,测量血流动力学参数;同时观察血管周围骨骼肌组织,与对侧肢体比较。结果5例患者受压肿胀肢体血管内径明显变窄,管壁搏动减低;动脉血流频谱呈高阻,流速减低;行切开减压术。3例患者超声查见受压肢体供血动脉狭窄,搏动消失,呈高阻频谱,流速减低或远段动脉、静脉无血流信号;行截肢术。切开减压术后3例,其中1例超声查见受压肢体供血动脉狭窄,呈低速低阻频谱;最终截肢。结论筋膜室综合征是导致地震伤受压患者死亡和致残的重要因素,应用血管超声能够准确检出供血动脉的血流频谱异常,有助于分类和治疗方案确定。
Objective To evaluate the hemodynamics of blood-supply arteries of squeeze patients with fascia compartment syndrome by using color Doppler ultrasound.Methods The arterial vessels of extremities of swelling side and opposite side of 11 survivors with crush injury from the May 12 earthquake in Sichuan were measured by two-dimension ultrasound.The inner diameter of blood vessel and intima-media thickening(IMT) were recorded.Abnormal echo in vessel lumen and theultrasonic image of stenosis accompanying vein vessels were observed.The pulsatility of arterial vessels,the flow direction and filling status of the blood,spectrum morphology of flow and hemodynamic parameter were also measured by color Doppler ultrasound.Observation also included the skeletal muscles tissue around the vessels,which was compared with that of the opposite extremity.Results Obvious stenosis was found in arterial vessels of swelling extremity of 5 cases with crush injury and pulsatility was weakened.Spectrum morphology revealed increased resistance with low velocity.Then fasciotomy was performed.In another 3 cases,obvious stenosis was observed in arterial vessels of swelling extremity,and pulsatility disappeared.Furthermore,high impedance with low velocities,or no flow downstream signal was found.Among 3 cases for which fasciotomy was performed,Doppler showed that arteries stenosis appeared in 1 patient,and spectrum displayed a low-resistance waveform with low velocity.Limb amputation was finally performed for this case.Conclusion Fascia compartment syndrome is an important factor of morality and disability in squeeze patients by earthquake.The abnormal spectrum morphology was exactly identified by color Doppler ultrasound,which could help the classification of the fascia compartment syndrome and development of the treatment scheme.
Objective To evaluate the hemodynamics of blood-supply arteries of squeeze patients with fascia compartment syndrome by using color Doppler ultrasound.Methods The arterial vessels of extremities of swelling side and opposite side of 11 survivors with crush injury from the May 12 earthquake in Sichuan were measured by two-dimension ultrasound.The inner diameter of blood vessel and intima-media thickening(IMT) were recorded.Abnormal echo in vessel lumen and theultrasonic image of stenosis accompanying vein vessels were observed.The pulsatility of arterial vessels,the flow direction and filling status of the blood,spectrum morphology of flow and hemodynamic parameter were also measured by color Doppler ultrasound.Observation also included the skeletal muscles tissue around the vessels,which was compared with that of the opposite extremity.Results Obvious stenosis was found in arterial vessels of swelling extremity of 5 cases with crush injury and pulsatility was weakened.Spectrum morphology revealed increased resistance with low velocity.Then fasciotomy was performed.In another 3 cases,obvious stenosis was observed in arterial vessels of swelling extremity,and pulsatility disappeared.Furthermore,high impedance with low velocities,or no flow downstream signal was found.Among 3 cases for which fasciotomy was performed,Doppler showed that arteries stenosis appeared in 1 patient,and spectrum displayed a low-resistance waveform with low velocity.Limb amputation was finally performed for this case.Conclusion Fascia compartment syndrome is an important factor of morality and disability in squeeze patients by earthquake.The abnormal spectrum morphology was exactly identified by color Doppler ultrasound,which could help the classification of the fascia compartment syndrome and development of the treatment scheme.
引文
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[2]Kuwagata Y,Oda J,Tanaka H,et al.Analysis of 2,702traumatized patients in the 1995 Hanshin-Awaji earthquake[J].J Trauma,1997,43:427-432.
[3]William J.Zwiebel,John S.Pellerito.Introduction to vascularultrasonography fifth edition[J].Elsevier Inc,2005:348.
[4]J.X.Wang,Y.Li.L.K Zhang.Taurine inhibits ische-mia/reperfusion-induced comparment syndrome[J].ActaPharmacologica Sinica 2005,26(7):821-827.
[5]Aliev G.and Burnstock G.Watanabe rabbits with heritablehypercholesterolaemia:a model of atherosclerosis[J].HistolHistopathol 1998,13:797-817.
[6]Aliev G,Obrenovich M.E,Seyidova D.Exploring ischemia-induced vascular lesions and potential pharmacological inter-vention strategies[J].Histol Histopathol,2005,20:261-273.
[7]Turnipseed WD,Hurschler C,Vanderby R JR.The effects ofelevated compartment pressure on tibial arteriovenous flow andrelationship of mechanical and biochemical characteristics offascia to genesis of chronic anterior compartment syndrome[J].J Vasc Surg,1995,21:810-816.
[8]W.Kostler,P.C.Strohm,N.P.Sudkamp.Acute com-partment syndrome of the limb.Injury,Int[J].J Care Injured,2004,35:1221-1227.
[9]McQueen M,Court-Brown C.Compartment monitoring in tibi-al fractures.The presure threshold for decompressions[J].JBone Joint Surg.1996,72BR:99-104.
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