基于健康人急性骨筋膜室综合征模型的超声监测价值研究

目的:探讨超声在急性骨筋膜室综合征模型早期无创监测中的应用价值，为进一步的临床应用提供参考。方法:为前瞻性自身对照研究。通过袖带加压法建立小腿急性骨筋膜室综合征的健康志愿者模型，随机数字法确定一侧小腿为实验组，袖带依次给予0、20、30、40、50、60、70、80 mmHg (1 mmHg=0.133 kPa)压力，对照组的小腿袖带不加压。实验组每个压力水平持续5 min，期间应用超声测量双侧腘动脉、腘静脉及足背动脉的血流频谱及血管结构指标。采用重复测量方差分析和多变量方差分析进行统计分析。结果:研究共纳入25名健康志愿者，双侧小腿围和胫前筋膜室厚度的差异无统计学意义（ P=0.314、0.678），小腿袖带加压期间心率及血压稳定（ P=0.235、0.358）。实验组腘动脉收缩期最大血流速、最小血流速均随袖带压力的增大而增加，从加压30 mmHg起实验组腘动脉最大血流速明显高于对照组(73±19) cm/s vs (59±14) cm/s, P=0.023)]，从加压20 mmHg起实验组腘动脉最小血流速显著高于对照组(-28±8) cm/s vs (-22±6) cm/s, P=0.012)]。随着压力的增加，实验组腘动脉舒张期反向血流比增加（ P<0.001），加压20 mmHg时即显著大于对照组(0.42±0.14）cm/s vs (0.30±0.12) cm/s, P=0.009)]。实验组足背动脉正向血流比随压力增加而减小（ P=0.024）。 结论:在健康人急性骨筋膜室综合征模型中，随着筋膜室压力的增加，近端动脉的收缩期最大血流速、舒张期反向血流比例明显增加，远端动脉的收缩期正向血流比例明显减少，提示超声可用于急性骨筋膜室综合征的早期监测，值得进一步的临床研究。

Ultrasound evaluation of acute compartment syndrome: Based on healthy volunteers

Objective:To explore the application value of ultrasound in the early noninvasive monitoring of acute compartment syndrome model, and to provide reference for further clinical applications.Methods:This was a prospective self-controlled study. A model of healthy volunteers with acute compartment syndrome was established by cuff compression. The random method was used to determine the experimental side and the control side. The experimental side cuff was given 0, 20, 30, 40, 50, 60, 70, and 80 mmHg pressure in sequence, while the control side cuff was kept uncompressed at all times. Each pressure on the experimental side lasted for 5 min, during which the ultrasound was used to measure the blood flow waveform and vascular structure of the bilateral popliteal artery, popliteal vein and dorsal plantar artery. Statistical analysis was performed using repeated measures analysis of variance and multivariate analysis of variance.Results:The study included 25 healthy volunteers. There was no statistically significant difference in calf circumference and anterior tibial compartment thickness ( P = 0.314 and 0.678). During compression, the volunteers' heart rate and blood pressure were stable ( P = 0.235 and 0.358). On the experimental side, the maximum blood flow velocity of the popliteal artery during systole increased with the increase of pressure ( P<0.001), and the minimum blood flow velocity of the popliteal artery increased with the increase of pressure ( P<0.001). When pressurized by 30 mmHg, the maximum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side (73 ± 19) cm/s vs (59 ± 14) cm/s, P=0.023)]. When pressurized by 20 mmHg, the minimum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side (-28 ± 8) cm/s vs (-22 ± 6) cm/s, P=0.012)]. With the increase of pressure, the diastolic retrograde arterial flow ratio of the experimental side gradually increased ( P <0.001), and when the pressure was increased by 20 mmHg, the diastolic retrograde arterial flow ratio of the experimental side of the popliteal artery increased significantly (0.42 ± 0.14) cm/s vs (0.30 ± 0.12) cm/s, P=0.009)]. The systolic prograde arterial flow ratio of the dorsal artery in the experimental side decreased with the increase of pressure ( P = 0.024). Conclusions:Increased limb compartment pressure can significantly change the arterial flow waveform of the proximal and distal arteries, and ultrasound can be used as an early monitoring tool for acute compartment syndrome.