闭合性四肢血管损伤的诊断方法探讨.doc

闭合性四肢血管损伤的诊断方法探讨 解葆冬 赵建勇 孙如泉 杜志国 杨波 孙中平 [摘要] 目的 探讨闭合性血管损伤早期诊断方法。方法 120例闭合性血管损伤患者，44例仅采用物理检查判断有无血管损伤，20例采用超声多普勒检查，56例采用急诊动脉造影检查。动脉造影组中20例采用Seldinger技术，36例采用直接穿刺技术。结果 单纯物理检查组10例误诊，其准确率为77％（34／44），超声检查组3例误诊，诊断准确率85％（17／20），动脉造影组准确率100％。结论 单纯的物理检查准确率较低，超声是首选的无创性检查方法，动脉造影检查是最准确的检查方法。 [关键词] 血管损伤； 诊断； 物理检查； 超声； 动脉造影 Evaluation of diagnosis methods in closed extremities vascular injury . XIE Bao-dong, ZHAO Jian-yong, SUN Ru-quan. Department of Orthopaedics Surgery, Cangzhou Traditional Chinese and Westen Medicine Hospital of Hebei Province,Cangzhou 061001, China [Abstract] Objective To evaluation the diagnosis methods of closed extremities vascular injury（ CEVI） in early stage. Methods 120 patients were diagnosised with CEVI , 44 of them undervent physical examination（PE）only , 20 patients were diagnosed through doppler ultrasound examination and 56 patients carried on emergency arteriography examination . Results Ten patients were misdiagnosed in PE , 3 patients in doppler ultrasound examination and none of them was missed in arteriography examination . The accuracy of the three methods metioned above are 77% (34/44) ,35% (17/20)and 100% (56/56) separately . Conclusion PE has a lower accuracy than the other two metheds . Doppler ultrasound examination is the best noninvasive examination and Arteriography examination is the most accurate method in the diagnosis of CEVI. [Key words] vascular injury; diagnosis; physical examination; ultrasound ;arteriography 四肢血管损伤较为常见，损伤分为开放性和闭合性。闭合性血管损伤由于病情隐匿，容易漏诊或误诊而造成延误治疗，重者可导致病人截肢甚至死亡[1,2]。笔者回顾性分析我院收治的120例闭合性血管损伤，旨在对闭合性血管损伤的早期诊断方法进行探讨。 1临床资料 1.1 一般资料 本组男97例，女23例；年龄12～77岁，平均38岁。致伤原因：车祸57例，高处坠落伤31例，挤压伤17例，绞伤4例，硬物击打伤11例。伤后至就诊时间1～22h，平均5h。损伤部位：肱动脉17例，腋动脉7例，锁骨下动脉10例，股动脉31例，腘动脉27例，髂内动脉16例，髂外动脉9例，髂总动脉7例，均为闭合性动脉损伤。合并骨折55例，伴有神经损伤19例，伴静脉损伤49例。 1.2 诊断方法 所有病例均首先进行了物理检查，观察患肢的脉搏、血运、肢体的颜色、温度等。本组单纯物理检查44例。对于临床可疑有血管损伤而物理检查不能确诊的患者，进行了超声检查或动脉造影检查。本组超声检查20例，采用ATL HDI U9型彩色多普勒超声诊断仪，探头频率7.5 MHz 。首先在患肢血管的体表投影部位由近心端向远端扫查，观察血管走行、血管壁状态、管腔内径及腔内有无异常回声和血管