足趾末梢血氧饱和度动态监测在闭合性腘动脉伤早期诊断中的应用  

Application of dynamic monitoring of toe peripheral blood oxygen saturation in early diagnosis of closed popliteal artery injury

作　　者：徐云钦[1] 李强[1] 申屠刚[1] 苏佩华[1] 王刚[1] 姚有榕[1] 邓盼[1] 罗正理[1] 魏强强[1] 邱成斌[1] 陈伟[1] 沈海强[1] 

机构地区：[1]解放军第98医院全军创伤骨科中心骨四科,浙江湖州313000

出　　处：《中国骨与关节损伤杂志》2015年第8期829-832,共4页Chinese Journal of Bone and Joint Injury

基　　金：南京军区重点卫生课题(13ZD03)

摘　　要：目的探讨足趾末梢血氧饱和度动态监测在闭合性腘动脉伤早期诊断中的作用。方法选择自2011-01—2013-10诊治的60例高能量损伤导致的膝关节及其周围骨折和(或)膝关节脱位患者,以心电监护仪的末梢血氧饱和度探头动态监测双下肢足趾末梢血氧饱和度来早期筛查闭合性腘动脉伤。观测记录双下肢足趾末梢血氧饱和度值,以血氧饱和度值<90%或双下肢血氧饱和度值相差≥10%为阳性结果,反之为阴性结果。结果 60例中双下肢足趾末梢血氧饱和度动态监测阳性12例,阴性48例。最后明确9例闭合性腘动脉伤,51例无闭合性腘动脉伤。足趾末梢血氧饱和度动态监测发现腘动脉伤的敏感度为100%,特异度为94.4%,阳性预测值为75.0%,阴性预测值为100%,准确度为95.2%。血管损伤组足趾血氧饱和度值:伤肢(23.5±14.4)%,健肢(95.1±2.7)%,差异有统计学意义(t=14.661,P<0.001)。无血管伤组足趾血氧饱和度值:伤肢(91.6±7.3)%,健肢(92.8±4.3)%,差异无统计学意义(t=0.982,P=0.328)。结论足趾末梢血氧饱和度动态监测在诊断闭合性腘动脉伤时具有较高的敏感度与准确度,且操作简单、费用低廉,可作为闭合性腘动脉伤患者早期筛查的检查项目。Objective To explore the role of dynamic monitoring of toe peripheral blood oxygen satm＇ation in early diagnosis of closed popliteal artery injury. Methods A total of 60 patients with knee joint dislocation and （or） fracture caused by high energy trauma were collected from January 2011 to October 2013. Peripheral blood oxygen saturation probe of ECG monitor was employed to dynamically monitor toe peripheral oxygen saturation of both extremities for early screening of closed popliteal artery injury. The values of both lower extremities toe peripheral oxygen saturation were observed and recorded with blood oxygen saturation value 〈 90% or both lower limbs blood oxygen saturation value difference ≥ 10% as positive results, whereas as the negative results. Results Of all 60 patients with lower extremity toe peripheral oxygen saturation monitoring, there were 12 positive cases and 48 negative cases. Finally, 9 cases were confirmed as closed popliteal artery injury, and there were 51 cases without closed popliteal artery injury. Toe peripheral oxygen saturation dynamic monitoring showed that the sensitivity of popliteal artery injury was 100%, the specificity was 94.4%, the positive predictive value was 75.0%, the negative predictive value was 100%, and the accuracy was 95.2%. The toe oxygen saturation values in the vascular injury group was as followed： the injured limb （23.5±14.4）% and healthy limb （95.1±2.7）%, and the difference was statistically significant （t =14.661, P 〈0.001）. The toe oxygen saturation values in the non-vascular injury group was as followed： the injured limb （91.6±7.3）% and healthy limb （92.8±4.3）%, and the difference was statistically significant（t =0.982, P =0.328）. Conclusion The dynamic monitoring of the peripheral blood oxygen saturation of toe has high sensitivity and accuracy in the diagnosis of closed popliteal artery injury, and the dynamic detection is simple and cost is low, which can be used as examination item of the early stage screening

关 键 词：腘动脉伤 闭合性损伤 足趾末梢血氧饱和度 动态检测 敏感度 特异度 

分 类 号：R683[医药卫生—骨科学]