高频彩超诊断上肢高压电烧伤血管损伤的应用价值

目的:探讨高分辨率超声在诊断上肢高压电烧伤血管损伤中的应用价值。方法:15例上肢高压电烧伤患者.术前应用彩色多普勒血流图(CDFI)显示重要血管(肱、桡、尺动静脉)管壁结构和腔内回声,声像图特征与手术、病理对照。脉冲多普勒(PW)测量血流速度与对侧上肢对照。结果:高频超声显示损伤桡、尺动脉节段性狭窄和扩张,管壁增厚,内膜波浪状不平;桡、尺静脉轮廓不清。肱动脉内膜断断续续,肱静脉内径小于动脉,血栓形成。CDFI显示动脉血流中断近段血流束串珠样,收缩期峰值流速(SPV)较正常组明显减慢(P<0.001),伴行静脉血流信号消失。手术及病理证实超声诊断符合率100%。结论:高频超声可实时直观显示损伤血管内膜等细小结构改变,简便、无创、重复性好,结合血流动力学定量指标,可预测截肢高度,值得推广。     

彩色多普勒超声在动脉血管吻合术疗效评估中的应用

目的探讨彩色多普勒超声在评估动脉血管吻合术疗效中的应用价值。方法应用彩色多普勒超声仪对16条桡动脉2、条尺动脉吻合术后疗效进行观察,以动脉吻合术后2周、24周血管吻合口处血管内径和峰值血流速度、血流量作为疗效评估指标,同时以健侧桡、尺动脉相同部位的超声检测值作正常对照。结果术后2周,15条桡动脉吻合口处收缩期峰值血流速度升高,与正常对照组相比两组差异有显著性意义(P<0.05),血流量和血管内径缩小,但与正常对照组无显著性差异,余3条动脉吻合口处血流频谱呈单峰,收缩期峰值血流速度明显增高,吻合口远端血流频谱低平;术后24周吻合口处收缩期峰值血流速度较正常对照组增高,血流量降低,但均无显著性差异。结论彩色多普勒超声可作为评价动脉血管吻合术疗效的一种无创、简便及较为可靠的检查方法。     

高度近视眼彩色多普勒血流显像检测价值

目的　研究高度近视眼的眼血流动力学变化。方法　采用ＨＰＳｏｎｏｓ１０００ 型彩色多普勒血流显像仪, 对２３例高度近视眼患者、２０例轻中度近视眼患者及１８例正常对照者的眼动脉、后睫状短动脉、视网膜中央动脉血流进行彩色多普勒超声测定。结果　高度近视眼组与正常组及轻中度近视眼组血流参数比较： 眼动脉血流参数无显著性差异（Ｐ＞ ０．０５）; 后睫状短动脉舒张末期血流速度低于其它两组, 有显著性差异（Ｐ＜ ０．０５）; 视网膜中央动脉收缩期血流峰值速度、平均血流速度、舒张末期血流速度均降低,有显著性差异（Ｐ＜ ０．０５）, 轻中度近视组与正常组比较无显著性差异（Ｐ＞ ０．０５）。结论　高度近视眼视网膜中央动脉血流速度与后睫状短动脉舒张末期血流速度均明显降低, 彩色多普勒超声有可能应用于研究其病理改变的形成机制。     

彩色多普勒超声诊断上肢动脉栓塞的临床价值

目的 探讨彩色多普勒超声诊断上肢动脉栓塞的临床价值.方法 应用高频彩色多普勒超声对临床疑诊上肢动脉栓塞患者进行检查,结合二维及彩色多普勒血流显像对上肢动脉的连续性、内膜、管腔内部回声及血流充盈情况仔细观察.结果 超声诊断为上肢动脉栓塞7例,男性4例,女性3例.所有病例均经动脉造影和手术证实.结论 应用彩色多普勒超声诊断上肢动脉栓塞具有很高的准确性和敏感性.     

超声检查前臂高压电击伤动脉形态与截肢平面定位标志关系

目的　研究前臂高压电击伤截肢平面动脉形态学定位标志。方法　高频超声与彩色多普勒血流图显示桡、尺动脉血流中断处后 ,在高频二维灰阶模式下检测毗邻段动脉形态学改变 ,声像图特征与手术对照。结果　截肢平面桡、尺动脉声像图特征呈瓶颈样改变 ,根据狭窄近心端超声定位截肢平面 ,经手术验证符合率 10 0 %。血流中断近侧狭窄段长度 :桡动脉 (2 .5 0± 0 .4 6 ) cm,尺动脉 (2 .2 8± 0 .2 8) cm。桡动脉较尺动脉狭窄程度重 ,狭窄段与远心段内径比值有显著性差异 ,P<0 .0 0 1。结论　桡、尺动脉瓶颈征是前臂高压电击伤坏死区与存活区交界的定位征象 ,简便易行 ,是提示截肢部位的重要标志     

彩色多普勒血流显像对肢端硬皮病外周血管的诊断价值

目的 探讨彩色多普勒血流显像（CDFI）对肢端硬皮病外周血管的诊断价值。方法 应用9MHz彩色超声测量肢端硬皮病患者桡动脉、尺动脉各48条,与正常健康人相应动脉30条对照研究,比较血管二维声像图及血流动力学指标,并通过分析与肢端硬皮病患者中皱襞微循环的相关性,评价该方法的可靠性。结果 硬皮病患者桡动脉、尺动脉管腔变小,弹性减低,内膜面不光滑,彩色血流暗淡,血流速度减慢,部分呈单峰型,血管阻力指数明显增高。甲皱襞微循环显示：甲床微血管数目减少,管腔扩大,呈扭曲状,红细胞聚焦,血流呈粒流,有的动脉闭塞,断流。结论 CDFI是肢端硬皮病外周血管血流动力学定性、定量的无创性的检查方法,可作为诊断及评价药物有效性的依据。     

新生儿室管膜下出血早期血流动力学研究

目的 探讨彩色多普勒超声检测新生儿早期室管膜下出血（SHE）血流动力学改变的价值.方法 检测早期SHE患儿25例,共35条大脑前动脉（ACA）的血流动力学指标,与25例（50条ACA）无颅内疾患新生儿相应指标进行对比分析,并对15例单侧SHE患儿患侧与健侧ACA血流动力学指标进行对比.结果 SHE组患侧大脑前动脉收缩期最大血流速度（SPV）及舒张期血流速度（DPV）高于正常新生儿SPV及DPV,差异有统计学意义（P〈0.05）;SHE组中单侧SHE患儿的患侧SPV及DPV高于健侧,差异有统计学意义（P〈0.05）.结论 SHE患儿早期颅内血流动力学改变具有一定特征性,彩色多普勒超声检查可对其进行评价,并可协助临床早期诊断SHE及判断预后.     

CDFI对椎动脉发育不良致椎基底动脉供血不足的诊断价值

目的探讨彩色多普勒超声血流图(colorDopplerflowimaging,CDFI)对椎动脉先天性发育不良所致的椎基底动脉供血不足的诊断价值。方法采用GEVividDimension彩色多普勒显像仪,对80例拟诊为椎基底动脉供血不足患者的椎动脉颅外段的走行,内径、管壁及血流速度、血流量进行观测。结果71例椎动脉发育正常,9例椎动脉发育不良,均为单侧。发育正常组两侧管径比较无显著性差异;发育不良组患侧与健侧管径及血流速度比较均有显著性差异。结论彩色多普勒超声血流图为临床诊断椎动脉发育不良提供了有价值的依据,且简便、快捷、无创,可广泛应用。     

彩色多普勒超声图像评估电烧伤血管损伤的应用价值

目的:探讨彩色多普勒超声图像对电烧伤血管损伤评估的临床应用价值。方法:选择2001-03/2006-02广西医科大学第一附属医院收治的17例上肢高压电烧伤患者的20条尺、桡动脉作为烧伤组,术前应用彩色多普勒超声观察患肢腕部创面及创面近心端8,15cm处尺、桡动脉的管壁厚度、管腔内径、收缩期峰值流速以及血栓形成等情况,并以该病例组正常上肢为对照。术中观察动脉大体改变,出现栓塞或管壁坏死者予以切除并进行组织病理学检查。结果:17例全部进入结果分析。①彩色多普勒超声显示烧伤组18条尺动脉和15条桡动脉出现不同程度的异常,表现为血管内膜水肿,管壁增厚,管腔狭窄或串珠样改变,血流缓慢,甚至血栓形成。②术中所见及组织病理学检查结果与彩色多普勒超声诊断相符。③桡动脉烧伤侧创伤处以及创缘近心端8cm处血管管壁厚度大于对照侧[(0.71±0.02),(0.41±0.08)mm;(0.70±0.02),(0.48±0.12)mm;P=0.000];创缘近心端8,15cm处收缩期峰值流速小于对照侧[(48.363±5.327),(55.304±7.401)cm/s,P=0.003;(52.053±4.797),(63.356±11.237)cm/s;P=0.000]。④尺动脉烧伤侧创伤处以及创缘近心端8cm处血管管壁厚度大于对照侧[(0.68±0.03),(0.40±0.06)mm;(0.59±0.01),(0.48±0.09)mm;P=0.000];创伤处、创缘近心端8,15cm处收缩期峰值流速小于对照侧(P<0.01)。结论:彩色多普勒超声检测技术具有无创性的特点,图像能够准确显示血管的形态学及血液动力学的改变,可为电烧伤患者血管损伤检测中一种理想的检测手段之一。     

彩色多普勒超声在产前诊断单脐动脉的临床价值

目的 评估彩色多普勒超声在产前诊断胎儿单脐动脉的临床价值。方法 在中孕期应用彩色多普勒超声观察单脐动脉的形态结构及多普勒血流信号特征，并与产后结果及病理学检查对照。结果 1．正常三支脐血管螺旋状排列特征消失，单脐动脉畸形时脐带内只有一条脐动脉和一条脐静脉，两支血管呈螺旋状排列或并行走行；2．单脐动脉多合并其它畸形、宫内发育迟缓、早产等情况；3．彩色多普勒可直观显示两支血管的血流方向，并且能够为明确其它畸形提供重要的诊断信息。结论 彩色多普勒超声在中孕期诊断单脐动脉具有重要的临床价值。     

四肢血管损伤的急诊救治体会

目的：探讨四肢血管损伤的早期诊断、急诊处理与手术方法。方法：本组患者共37例,门（急）诊根据外伤史及体征确诊26例,其中7例经彩色多普勒检查确诊,4例经血管造影确诊。接诊后行气囊止血带止血12例,肱动脉损伤压迫腋窝及上臂止血点2例,股动脉损伤压迫腹股沟处止血点4例。以无菌纱布块加压包扎止血3例。对闭合性损伤暂不行止血带止血。所有患者经手术探查均证实为大血管损伤。3例一期行截肢术,其余行血管修复手术。股动脉损伤或伴股静脉损伤5例均行股动静脉修复,腘动脉损伤或伴静脉损伤10例均行腘动脉修复,修复腘静脉4例,胫前后动静脉损伤仅修复动脉。肱动静脉损伤均行肱动脉修复,桡动静脉损伤8例均行桡动脉修复。结果：门诊确诊率70%。气囊止血带使用率在开放性损伤病例中达39%。动静脉损伤（受伤至通血）时间：〈6h15例,6～8h11例,9～12h4例,〉12h3例。未通血4例。术后72h内共5例患者出现血管危象,行局部烤灯照射,热敷后2例消除,3例探查改行静脉移植修复后血供恢复。7例术后2～3周复查超声多普勒探测均提示血流正常。随访6～12个月,均未见肢体缺血表现,远端动脉搏动良好。6例遗留缺血性肌挛缩,4例截肢,截肢率11%。结论：四肢血管损伤的救治原则是早期快速诊断,早期正确止血,早期修复血管,早期治疗并发症。     

以损伤血管束为蒂的前臂逆行岛状皮瓣移植术前超声诊断

目的　探讨通过术前超声检查判断以损伤血管束为蒂的前臂岛状皮瓣移植术的适应症。方法　新鲜成人上肢标本 6例 ,直视下进行解剖观察 ,记录上肢尺动脉和桡动脉的交通支及筋膜血管网。手及腕部尺、桡动脉损伤患者 15名 ,自损伤部位近侧 3cm处作为检查部位 ,彩色超声仪的浅表器官探头检查血管直径及血流速度 ,并计算与健侧的比值。结果　在尺动脉、桡动脉及手部各动脉之间还有大量的、管径不一的动脉直接及间接交通支 ;8例腕部切割伤的损伤血管部位附近的血管直径及血流速均较大 ,而 4例腕部及前臂严重广泛挤压伤及 3例电击伤的上述 2项指标均有明显下降。结论　该术式的适应症为腕部切割伤等损伤范围局限的损伤。电击伤及前臂广泛挤压伤等应慎重采用该术式。     

自体股部大隐静脉移植内瘘临床应用分析

目的探讨自体大隐静脉上肢移植内瘘的建立方法,观察其临床应用价值。方法选择北京市海淀医院肾内科12名终末期肾脏病患者,经超声检查证实上肢无合适血管建立动静脉内瘘,且超声提示股部大隐静脉通畅。吻合动脉采用上肢肱动脉或桡动脉,静脉为肘正中静脉、头静脉或贵要静脉,J形或U形搭桥术式端侧吻合。观察动脉吻合口、静脉吻合口及移植静脉不同时段的内径,观察血液透析泵控血流量并计算透析充分性。结果所有患者内瘘术后全部即刻畅通,术后未见感染、血肿等并发症,1例患者于内瘘术后2.5月血栓形成并堵塞,1例于3月时堵塞。术后15d时动脉吻合口、静脉吻合口的内径分别为0.48±0.06cm、0.52±0.10cm(配对t检验,P=0.045);透析泵控血流量(内瘘使用1月)为270.8±32.0ml/min,尿素清除指数(Kt/V)为1.65±0.19,尿素清除率75.3%±3.3%。手术平均花费为人民币1807元。结论大隐静脉移植上肢内瘘术后并发症少,长期通畅率高,易于护理操作,透析充分性好,总体费用低,可作为难以建立透析通路患者的一种有效的血管通路。     

尿毒症患者动静脉内瘘术前超声评估及标记的价值

目的探讨终末期肾病血液透析患者建立动静脉内瘘术前彩色多普勒超声评估及定位对提高造瘘手术成功率的价值。方法纳入肾脏内科2012年1月-7月尿毒症终末期患者25例,均为多次造瘘失败或为临床建立动静脉造瘘较为困难的患者,术前超声行上肢动静脉及双侧大隐静脉评估,重点观察肱动脉、桡动脉、头静脉、贵要静脉及大隐静脉,寻找肘部及上臂段有无合适搭桥的血管,测量其管径并体表定位。结果14例术前多次造瘘失败患者,9例行再造瘘＋自体大隐静脉移植术,2例行人工血管置人术,1例行左上肢人工血管取栓＋动静脉内瘘成型术,2例放弃手术;11例术前未行动静脉造瘘的患者2例行人工血管置人术,6例行自体大隐静脉移植术,1例因桡动脉管径较细行肱动脉与肘正中静脉高位瘘,2例放弃手术。21例手术患者术后生命指征平稳,瘘口搏动震颤良好。术后～2周内复查彩色多普勒超声示所建通路通畅。结论尿毒症终末期患者动静脉内瘘术前超声评估及定位对提高临床手术成功率有重要价值。     

Comparison of ultrasound assessment of flow‐mediated dilatation in the radial and brachial artery with upper and forearm cuff positions

In the published literature relating to flow‐mediated dilatation (FMD), there are substantial differences between centres in terms of normal FMD amongst healthy subjects. This present study attempts to identify the effect of differing methodologies on FMD. High frequency ultrasound was used to measure blood flow and percentage brachial and radial artery dilatation after reactive hyperaemia induced by forearm or upper arm cuff occlusion in 24 healthy subjects, less than 40 years, without known cardiovascular risk factors. FMD of the brachial artery was significantly higher after upper arm occlusion, compared with forearm occlusion, 6·4 (3·3) and 3·9 (2·6)% (P<0·05), respectively. FMD of the radial artery was significantly higher after forearm occlusion, compared with upper arm occlusion, 10·0 (4·6) and 7·9 (3·5)% (P<0·05), respectively. The percentage blood flow increase in the brachial and radial arteries after forearm and upper arm occlusion were similar. After forearm and upper arm occlusion, the radial artery percentage dilatation was greater than the brachial artery. In conclusion dilatation of the brachial artery, after reactive hyperaemia induced by upper arm occlusion, was significantly more pronounced compared with dilatation of the brachial artery after forearm occlusion, despite a similar percentage blood flow increase. The local ischaemia of the brachial artery with a proximal occlusion may explain why the brachial artery dilated more after upper arm occlusion compared with after forearm occlusion. The study has also shown that FMD of the radial artery could be assessed by B‐mode ultrasound technique. FMD was greater using the radial artery compared with the brachial artery, suggesting that the radial artery may be a useful way to assess FMD in future clinical studies.     

An unexpected case of venous and pulmonary thrombo-embolism in a patient treated with thalidomide for refractory erythema nodosum leprosum: a case report

Background

The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation.

Case report

A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine). From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral), with minimal residual flow to the right and no signal on the humeral and radial left artery.

Results

Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with heparin in continuous intravenous infusion and subsequent anticoagulant therapy allowed the gradual disappearance of the symptoms with the reappearance of peripheral pulses.

Conclusion

Angiography showed regression of vasospasm and the resumption of flow in distal vessels. The patient had regained sensitivity and motility in the upper limbs and bilaterally radial and ulnar were present.     

贵要静脉营养血管远端蒂复合瓣的解剖学特征

背景:前臂皮神经营养血管皮瓣特别适宜手部远端的组织缺损修复,所以了解贵要静脉远端的营养血管及与邻近骨、皮和前臂内侧皮神经的血供关系对临床上前臂皮神经营养血管远端蒂复合瓣的设计有重要意义。目的:研究前臂尺侧缘远端的动脉穿支,为前臂尺侧缘贵要静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计:单一样本实验。单位:解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心。材料:实验于2004-05/10在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。研究材料为30侧动脉灌注红色乳胶成人上肢标本(由南京军区福州总医院军区骨科研究所临床解剖学研究中心提供)。方法:将30侧成人上肢标本,以尺骨茎突为观测标志点进行显微解剖。主要观察指标:重点观察:①前臂尺侧缘远端的动脉穿支来源。②动脉穿支与贵要静脉远端的营养血管。③营养血管与邻近骨、皮和前臂内侧皮神经的血供关系。④贵要静脉的浅深交通支。结果:①前臂尺侧缘远端的动脉穿支来自:尺动脉的皮支5～9支,外径(0.7±0.3)mm,尺动脉腕上皮支1～3支,外径(0.6±0.3)mm。在尺骨茎突上方6.0～16.0cm,骨间前动脉发骨皮穿支二三支,骨间后动脉发骨皮穿支1～3支,二者外径在0.4～1.2mm,分布尺骨中下段骨膜及相应区域的皮肤。②上述动脉穿支均发皮支、筋膜支、骨膜支、贵要静脉和皮神经营养血管支,形成贵要静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂尺侧缘远端的动脉穿支是贵要静脉营养血管的来源,营养血管与邻近的骨、皮和前臂内侧皮神经的营养血管同源,是设计贵要静脉营养血管远端蒂复合瓣的解剖学基础。以尺动脉腕上皮支为蒂的远端蒂复合瓣,旋转轴点可达腕关节平面,用于转位修复手部远处的组织缺损。     

Carotid rupture following electrical injury: a report of two cases

Electrical injuries often result in extensive tissue damage where vascular damage may occur and result in thrombosis and spontaneous rupture of blood vessels. Rupture of the brachial, radial, ulnar, internal mammary, and obturator arteries has been reported in the literature. The authors present two cases of carotid artery rupture following high-voltage electrical injuries. The first case is a 21-year-old man who was climbing a fence near a high-voltage power line when a gold chain he was wearing around his neck caught on the power line, resulting in a 10% circumferential electrical injury to his neck. He presented with visible arterial bleeding from the large neck wound and was taken to the operating room, where a 1-cm laceration to the carotid artery was repaired with a vein patch. On the second postoperative day, the patch dislodged, and a spontaneous rupture of the common carotid artery occurred. The damaged artery was subsequently ligated. The patient recovered with no neurological sequelae. The second case is a 43-year-old man who suffered a high-voltage injury while working on an electrical panel, resulting in a 50% TBSA full-thickness burn to the face, scalp, trunk, and extremities. Four weeks after admission, a latissimus dorsi myocutaneous free flap was used for coverage of exposed outer table of the skull. Intraoperatively, the carotid artery spontaneously ruptured proximal to where the dissection was being carried out. The patient recovered with no neurological sequelae. High-voltage electrical injury results in significant damage to blood vessels via a number of mechanisms. Rupture of a major vessel is a rare, life-threatening sequelae of electrical injury.     

慢性肾衰竭患者血管造瘘后盗血综合征彩色多普勒超声特征

目的 探讨慢性肾衰竭患者血管造瘘后盗血综合征的彩色多普勒超声特征。方法 对87例慢性肾衰竭血管造瘘患者进行彩色多普勒超声检查,观察瘘口及距瘘口5 cm内桡动脉、尺动脉和头静脉血流充盈情况及血流方向,回顾患者前臂中部头静脉血流量。结果 87例患者中,79例(79/87,90.80%)超声示桡动脉远端至瘘口处出现反向血流,其中5例(5/79,6.33%)临床诊断为盗血综合征;5例盗血综合征患者中,3例超声发现桡动脉管腔狭窄。术后1个月时79例反向血流患者前臂中部头静脉平均血流量为(481.24±84.21)ml/min,5例盗血综合征患者血流量分别为900、423、416、461和405 ml/min。结论 动脉狭窄及头静脉的高血流量可能为慢性肾衰竭血管造瘘患者出现盗血综合征的原因,彩色多普勒超声可为此类患者的临床诊断和治疗提供有价值的参考。