应用数字减影血管造影与B超判断上肢高压电烧伤患者的血管损伤情况

目的　比较数字减影血管造影 (DSA)与B超在判断上肢高压电烧伤血管损伤中的作用。　方法　选择 19例上肢高压电烧伤患者的尺、桡动脉作为烧伤组 ,术前应用DSA及B超检测技术 ,观察患肢腕部创面及创面近端 5、10、15cm处尺、桡动脉的内膜、管壁厚度、管腔内径、血流量以及血栓形成等情况 ;以 12位正常人的尺、桡动脉作为对照组。术中 :结合DSA和B超检查结果 ,综合分析并判断尺、桡动脉损伤程度 ,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DSA检测显示烧伤组患者 14条尺动脉、11条桡动脉出现异常 ,主要变化有栓塞形成、管腔狭窄、血流缓慢等 ,尺动脉损伤程度重于桡动脉。B超显示烧伤组 19条尺动脉和 16条桡动脉出现异常 ,主要表现为血管内膜粗糙不平、水肿或脱落 ,管壁增厚 ,管腔狭窄或串珠样改变 ,血流量减少 (P <0.0 5～ 0.0 1)其中创缘近端 5cm的尺动脉血流量 (31.6 0± 13.90 )ml/min,明显低于对照组 (47.70± 9.6 0 )ml/min(P <0.0 5)。术中探查及组织病理学检查结果与DSA、B超诊断相符。　结论　判断上肢高压电烧伤后的血管损伤情况可采用B超为主、DSA为辅的方法 ,以提高手术探查的精确度。

Application of digital subtraction angiography and type B ultrasonography in the evaluation of vascular injury in patients with high voltage electrical injury

OBJECTIVE: To compare the difference between digital subtraction angiography (DSA) and type B ultrasonography in the evaluation of vascular injury in patients inflicted with high voltage electrical injury. METHODS: Nineteen patients with high voltage electrical injury of upper limbs were enrolled in the study as burn group, and another 12 healthy volunteers as controls. The endovascular membrane, vascular wall thickness, intra-vascular blood flow and endovascular thrombosis formation of ulnar and radial arteries at wound site and in regions 5, 10 and 15 cm proximal to the wounds were examined by DSA and type B ultrasonography and compared with imagings of healthy volunteers as control. The injury degree of the ulnar and radial arteries was examined during operation for evaluation to corroborate with DSA and ultrasonography findings. Necrotic and/or thrombotic vessels were excised and sent for pathomorphological examination. RESULTS: By DSA images abnormal signs as thrombosis, vascular lumen stenosis and blood flow deceleration were found in 14 ulnar and 11 radial arteries, and the signs were more pronounced in ulnar arteries. By type B ultrasonography, abnormal signs as roughing of tunica intima, swelling or exfoliation, thickening of vascular wall, lumen stenosis, decreased blood flow, even necrosis of vascular wall and thrombosis were identified in 19 ulnar and 16 radial arteries in burn group (P < 0.05 approximately 0.01). The blood flow in ulnar artery 5 cm to the approximal part of the wound edge was obvious lower than that of the control (31.60 +/- 13.90 ml/min vs 47.70 +/- 9.60 ml/min, P < 0.05). CONCLUSION: Type B ultrasonography and DSA could be helpful in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.