间室内压监测与症状体征对间室综合征早期诊断的相关性研究  

A study on the correlation of ICP monitoring and signs and symptoms in early diagnosis of compartment syndrome

作　　者：张文玺[1] 方加虎[2] 凌为其[3] 

机构地区：[1]溧阳市人民医院骨科,江苏溧阳213300 [2]江苏省人民医院骨科,南京210029 [3]常州市第一人民医院骨科,江苏常州213003

出　　处：《中国骨与关节外科》2013年第5期442-445,共4页Chinese Journal of Bone and Joint Surgery

基　　金：常州市卫生局计划项目(WZ201128)

摘　　要：背景:间室综合征(CS)临床上偶有发生,根据症状体征结合间室内压(ICP)测定进行判断更安全,对于缺乏ICP测定设备的情况下,症状体征不失为简单且重要的判断方法,但难以量化。目的:分析ICP与症状体征评分在CS早期诊断中的相关性。方法:对符合纳入标准的80例患者进行症状体征评分的同时进行ICP测量,先由专科医师记录症状体征并按评分标准进行评分,记录总分值作为评分组;再采用CYY-1型自动筋膜压测量仪对前臂与小腿肿胀进行ICP测量,计算ΔP(舒张压-ICP)作为测压组。测压组与评分组采用自身对照。采用单因素线性回归分析,判断症状体征评分与ΔP的相关系数是否存在线性相关;采用配对卡方检验,分析通过症状体征评分和ΔP判断发生CS的数量是否存在统计学差异。结果:80例患者符合纳入标准,并进行为期1周的临床观察,其中6例的症状体征评分>10分且ΔP<4 kPa,一致判断为CS,并予以切开减压处理,症状体征评分与ΔP存在线性关系(r=0.822);症状体征评分和ΔP判断发生CS的数量分别为6例和14例,相比较有统计学差异(P=0.008),说明两种判断方法对CS的诊断存在一定区别,以ΔP判断可以发现更多存在潜在危险的患者。结论:采用症状体征评分进行CS判定存在一定风险性;采用ΔP<4 kPa作为切开减压标准极少出现CS未检出的情况。因此,以ΔP<4 kPa作为切开减压标准的同时仍需要结合症状体征进行综合考虑。Background： Compartment syndrome （CS） occurs occasionally in clinics. It is safer to diagnose it according to symptoms and signs with the combination of intra-compartmental pressure （ICP） determination. But if there is a lack of ICP measurement equipment, judging by signs and symptoms may be a simple and important method, but it is difficult to quantify. Objective： To analyze the correlation of ICP and symptom sign scores in early diagnosis of CS. Methods： Symptoms and ICP of 80 patients who satisfied the inclusion criteria were estimated and measured. First, specialists recorded their clinical symptoms and gave them scores according to the scoring standards, and summed their total scores as scoring group; then, they measured the ICP of forearms and lower legs with CYY- 1 auto fascia pressure measuring instru- ment, and calculated the AP （AP=diastolic blood pressure-ICP） as measuring compression group. The two groups were evalu- ated with self-control method. The single factor linear regression analysis was adopted in judging whether there was a linear correlation between symptom sign scores and correlation coefficient of AP; and the paired chi-square test was applied in ana- lyzing whether there was statistical difference in the quantities of CS occurrence judged by symptom sign scores and AP, Results： The 80 patients who met the inclusion criteria received a one-week clinical observation. Six of them whose symp- tom sign scores 〉10 points and AP〈4 kPa were all diagnosed with CS, and were treated with incision decompression. There was a linear relationship between the scoring value and AP （r=0.822）. However, quantities of CS occurance judged by symptom sign scores and AP were 6 cases and 14cases respectively. There was statistical difference between the two meth- ods. Therefore, there was a certain difference between them, and more potential cases can be found with the judgment of AR Conclusions： It is dangerous to judge CS only by symptom sign scores; If AP 〈4 kPa is selected as

关 键 词：间室综合征 骨折 减压 舒张压 

分 类 号：R683[医药卫生—骨科学]