中国修复重建外科杂志

中国修复重建外科杂志

上臂及胸壁挤压综合征的诊断及治疗

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目的探讨上臂及胸壁挤压综合征的发病机制、诊断及治疗方法。方法2010 年 1 月—2015 年 1 月,收治 5 例由于 CO 中毒及饮酒昏迷后自身压迫导致的上臂及胸壁挤压综合征患者。其中男 4 例,女 1 例;年龄 28~46 岁,平均 36.7 岁。左上臂及左胸壁 2 例,右上臂及右胸壁 3 例。受压时间 4~12 h,平均 7 h。 5 例入院后急诊给予筋膜切开减压术联合封闭式负压引流,术后转入 ICU 给予连续性肾替代治疗(continuous renal replacement therapy,CRRT),待患者病情稳定后,肢体创面行游离植皮修复。结果患者住院时间 26~48 d,平均 33 d。1 例植皮术后皮片部分坏死,经扩创后再次植皮成活;其余 4 例植皮顺利成活,创面 Ⅰ 期愈合。治疗期间无 1 例发生感染。5 例患者均获随访,随访时间 12~18 个月,平均 15 个月。末次随访时,根据顾玉东提出的全臂丛功能评定标准,5 例均为优,肌力 Ⅴ 级,完全恢复正常生活与工作。结论CO 中毒、醉酒与自身挤压 3 种因素共同作用,导致上臂及胸壁挤压综合征病情严重、进展快速。确诊后应尽早进行切开减张,同时行 CRRT 以及纠正贫血、电解质紊乱等综合性治疗,可获得良好预后。

ObjectiveTo investigate pathogenesis, diagnosis, and treatment of crush syndrome of chest and arm.MethodsBetween January 2010 and January 2015, 5 cases of crush syndrome of chest and arm caused by pressing oneself in a coma after CO poisoning or alcoholic intoxication were treated. There were 4 males and 1 female with an average age of 36.7 years (range, 28-46 years). Two patients involved left upper limb and chest, while the other three patients involved right upper limb and chest. The crushed time ranged from 4 to 12 hours (mean, 7 hours). All 5 cases received emergency decompression and vacuum sealing drainage (VSD). After surgery, the patients were transferred to Intensive Care Unit to receive continuous renal replacement therapy (CRRT). The wounds were repaired with skin grafts after the patients’ condition were stable.ResultsThe hospitalization time was 26-48 days (mean, 33 days). Necrosis of the skin graft occurred in 1 case, which cured after debridement and skin graft again. The skin graft survived in the other cases and the wounds healed by first intension. Five patients were followed up 12-18 months (mean, 15 months). At last follow-up, the results were excellent in all 5 cases according to the assessment criteria proposed by GU Yudong. The patients got full recovery of their upper limb activities and sensation. All the patients returned to the normal life and work.ConclusionCO poisoning, drunkenness, and pressing oneself together will lead the crush syndrome to severe and rapid progress. The key of the treatment is a comprehensive therapy including a thorough and rapid tension reduction to save the limb function, CRRT, and correction of anemia and electrolyte imbalance.

关键词: 挤压综合征; 上臂; 胸壁; 横纹肌溶解; 筋膜室综合征

Key words: Crush syndrome; upper arm; chest; rhabdomyolysis; compartment syndrome

引用本文: 崔浩杰, 熊革, 张春林, 肖滋润. 上臂及胸壁挤压综合征的诊断及治疗. 中国修复重建外科杂志, 2018, 32(6): 703-706. doi: 10.7507/1002-1892.201711118 复制

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