高压电烧伤合并肢体血管损伤治疗10年回顾性分析  

Treatment of limb vascular injuries after high-voltage electrical burns:a 10-year retrospective analysis

作　　者：贾伟[1] 刘建龙[1] 覃凤均[2] 田轩[1] 蒋鹏[1] 程志远[1] 周也平 王成[2] JIAWei;LIU Jianlong;QIN Fengjun;TIAN Xuan;JIANG Peng;CHENG Zhiyuan;ZHOU Yeping;WANG Cheng(Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Burn Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院血管外科,北京100035 [2]北京积水潭医院烧伤科,北京100035

出　　处：《中国普通外科杂志》2022年第6期760-766,共7页China Journal of General Surgery

摘　　要：背景与目的:高压电烧伤虽然发生率很低,但是潜在的肌肉、神经和血管受损比火焰灼伤更加隐匿,危及肢体的缺血和迟发破裂出血会导致肢体功能丧失、致残甚至致死。高压电烧伤后的肢体血管损伤尚无明确的发生率,也没有诊疗指南的推荐,各个中心的治疗方案也不尽相同。北京积水潭医院作为全国烧伤抢救中心,每年要收治大量的烧伤患者,其中高压电烧伤合并血管损伤的患者屡见不鲜。本文总结了近10年来北京积水潭医院收治的高压电烧伤合并血管损伤的患者诊治方案,试图从中分析出此类患者与创伤性动脉损伤患者的差异,归纳出此类患者的诊疗特点,为今后的临床工作提供有力的证据支持。方法:回顾本中心2010年1月—2020年1月收治的由于高压电烧伤导致肢体血管损伤的患者94例,患者的血管修复方式包括直接局部修补、自体血管重建和人工血管重建。分析术后血管血栓形成、迟发破裂出血、感染、截肢等术后并发症的发生比例,对比数据间的差异。结果:94例患者中,男83例,女11例;平均年龄(30.4±20.1)岁。7例来院时肢体毁损严重,行截肢术。87例完成血管修复,29例行局部修补术,53例采用自体血管重建,5例采用人工血管材料重建,技术成功率100%。局部修补患者术后2周内血栓形成3例,假性动脉瘤2例,均再次手术行自体血管重建。自体血管重建患者中,术后2周内血栓形成7例,切开取栓后血运改善,发生迟发破裂出血4例,切开止血再次重建1例,腔内介入置入覆膜支架3例,术后感染或软组织严重坏死截肢3例。人工血管材料重建患者中,术后2周内血栓形成1例,切开取栓后恢复血运,发生迟发破裂大出血1例,腔内介入置入覆膜支架。75例患者获随访3~6个月,血管通畅率89.3%(67/75)。结论:高压电烧伤后的血管损伤远超肉眼可见的损伤范围,不同于一般创伤导致的相关损伤Background and Aims:Although the incidence of high-voltage electrical burns is very low,its potential damage to the muscle,nerve and blood vessel is more insidious than that of flame burns.The limb-threatening ischemia and delayed rupture/bleeding will lead to loss of limb function,disability and even death.There is no definite incidence number for limb vascular injuries after high-voltage electrical burns,nor is there any recommendation of diagnosis and treatment guidelines,and the treatment schemes of each center are different.As a national burn rescue center,our hospital treats a large number of burn patients every year,including high-voltage electrical burn patients with vascular injuries.This paper summarizes the diagnosis and treatment schemes of patients with high-voltage electrical burn wounds combined with vascular injuries treated in our hospital in recent 10 years,trying to analyze the differences between this category of patients and patients with traumatic arterial injuries,and extracting the diagnosis and treatment characteristics of these patients,so as to provide evidence support for future clinical work.Methods:A total of 94 patients with limb vascular injuries caused by high-voltage electrical burns treated in our center from January 2010 to January 2020 were reviewed.The vascular repair methods included direct local repair,autologous vascular reconstruction and prosthetic vascular reconstruction.The incidence rates of postoperative complications such as thrombosis,delayed rupture/bleeding,infection,amputation were analyzed,and the differences of the data were compared.Results:Of the 94 patients,83 cases were males and 11 cases were females,with an average age of(30.4±20.1)years.Seven patients underwent amputation due to serious limb damage at initial admission.Eighty-seven patients received vascular repair that included local repair in 29 cases,autologous vascular reconstruction in 53 cases,and prosthetic vascular reconstruction in 5 cases.The technical success rate was 100%.Among patients und

关 键 词：血管系统损伤 烧伤 电 血管外科手术 

分 类 号：R654.3[医药卫生—外科学]