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。

The emergency treatment of the great vessel injury in limbs

Objective：To study the early diagnosis,emergency treatment and operation method of the great vessels injury in limbs.Method：This group includes 37cases.26cases were diagnosed by clinic（emergency） according to the traumatic history and physical signs,7cases were diagnosed by color Doppler and 4cases were diagnosed by angiography.Twelve cases were stanched by air tourniquet after the reception,2cases of brachial artery injury were oppressed on the hemostatic point of the armpit and upper arm,4cases of femoral artery injury were oppressed on the hemostatic point of the groin,3cases were stanched by the pressurized sterile gauze.Closed injury was not stanched by air tourniquet for the moment.All cases were confirmed to be great vessels injury after operation.Three patients had to do the one-stage operation of amputation,and the others had the vascular repair operation.Five patients with both femoral artery and femoral vein injury had the femoral artery and femoral vein repair operation all,10patients with popliteal artery and popliteal vein injury all had the artery repair operation,but only 4cases had the popliteal vein repair operation,anterior and posterior tibial artery and vein injury only repair the artery.Patients with brachial artery and vein injury all had the artery repaired,10patients with radial artery and vein all had the artery repair operation.Result：The clinic diagnose rate is 70%.The utilization rate of pneumatic tourniquet in open injury was 39%.The time（t） from the blood vessel injury to repaired：6hin 15cases,6ht8hin 11cases,9ht12in 4cases,t12hin 3cases.The blood vessels of 4cases couldn＇t be repaired.Five patients had vascular crisis in 72hours.2cases became better after local baking lamp irradiation and chliasma.Blood supply came back in the other 3cases after the repair of venous graft.Seven cases were prompted the normal blood flow by color Doppler 2～3weeks after operation.All patients were followed up for 6-12months.There were no limb ischemia,and the distal artery pulsed good.Six patients had ischemic contracture and 4cases had amputation.The amputation rate is 11%.Conclusion：The treatment principle of great vessels injury include early and rapid diagnosis,correct hemostasia,early repair of blood vessels and early treatment of complications.Early diagnosis and correctly hemostasia are the keys for saving the extremity and life.