高频超声对电击伤上肢血液供应的探讨

目的应用高频彩色多普勒超声判断上肢电击伤血供状况。方法采用14MHz高频探头检测上肢电击伤患者肱、桡、尺动脉各26条,与正常人相应动脉12条对照,比较血管二维、彩色血流图及血流动力学指标,并与治疗、病理对照。结果保肢组9只上肢,血管壁规则,血流通畅,动脉收缩期峰值流速(SPV)与正常组比较无显著性差异(P>0.05)。截肢组17只上肢,动脉壁损伤,管腔节段性狭窄和扩张,血流中断,血管闭塞。血流中断近心侧SPV减慢,与正常组和保肢组均有显著性差异(P<0.05)。伴行静脉血流信号消失。超声所见与大体及镜下病理结果十分符合。结论高频彩色多普勒超声可有效评价电击伤上肢血供优劣,为临床选择治疗方案提供定性、定量的科学依据。

Upper Limb Circulation after Electrical Injury Detected with High-frequency Color Doppler Ultrasonography

Objective To explore an effective method in assessing the degree of vascular injury in upper limbs suffered from electrical burns.Methods A 14-MHz high-frequency linear array Doppler transducer was utilized to identify the major blood vessels of the arms in 24 patients suffered from electrical injury,including brachial artery(BA) and brachial vein(BV),ulnar artery(UA) and ulnar vein(UV),radial artery(RA) and radial vein(RV).Their structures were observed and compared with surgery and pathology.The systolic peak velocity(PSV)in the 26 burned regional vessels and 12 coresponding normal vessels in the controls were measured.All data were analyized statistically.Results Nine of 26 wounded arms had no significant vascular abnormality.The arterial PSVs were not significant different from those of the normal group (P>0.05).On the other hand,17 arms were amputated unfortunately,including forearm level amputation in 9 and upper arm level amputation in 8.Ultrasonographic map clearly showed the blood vessel abnormalities of the destroyed arms.For example:arterial segmental stenosis and dilation,endothelial echoic missing,blocked and occlusive arteries:meanwhile,accompanying veins were not visualized,especially in the forearm.The blood flow on the proximal portions interrupted with systolic peak velocity significantly lower than those of the normal group (P<0.05).All these ultrasonographic appearances were closely accordant with those in macro- and microscopic visualization.Conclusions Our study suggest that color Doppler ultrasonography be a useful imaging modality to assess the vascularity and hemodynamics in the upper limbs with electrical injury,and be a qualitative and quantitative basis for clinical treatment.