超声引导下骨筋膜室穿刺测压用于评估毒蛇咬伤患者骨筋膜室压力的可行性研究  

Feasibility of ultrasound-guided osteofascial chamber puncture manometry in assessing the pressure of osteofascial chamber in patients with venomous snake bites

作　　者：吕林[1] 许树云[1] 唐时元[1] 蒋臻[1] 任艳[1] 鲜晓燕 周越[1] 陈方 柏婷 李雅楠 韩存巧 邓迪[1] LÜLin;XU Shuyun;TANG Shiyuan;JIANG Zhen;REN Yan;XIAN Xiaoyan;ZHOU Yue;CHEN Fang;BAI Ting;LI Yanan;HAN Cunqiao;DENG Di(Department of Emergency Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Emergency Medicine,Chengdu Shangjin Nanfu Hospital,Chengdu,Sichuan 611700,P.R.China)

机构地区：[1]四川大学华西医院急诊科,成都610041 [2]成都上锦南府医院急诊科,成都611700

出　　处：《华西医学》2023年第11期1673-1678,共6页West China Medical Journal

基　　金：四川省科技计划项目(2021YFS0189);四川大学华西医院临床新技术(医临新2020-283号)。

摘　　要：目的 探讨超声引导下骨筋膜室穿刺测压用于毒蛇咬伤患者临床病情评估的效力及该方法的安全性。方法 前瞻性纳入2021年4月—2023年1月四川大学华西医院急诊科收治的毒蛇咬伤患者,收集患者入院时的基本信息、生理指标(心率、血压)、实验室检查指标、患肢体征、治疗方式及预后。以超声引导下骨筋膜室穿刺测患肢压力的患者为测压组,并以1∶1的比例随机抽取同期毒蛇咬伤未穿刺测压患者作为对照组。比较两组患者患肢出血、感染、神经损伤等情况,以及住院时间及远期预后,探索超声引导下骨筋膜室穿刺测压的安全性。将测压组测得的压力与急性中毒严重评分中的代表指标肌酸激酶进行相关性分析,探索超声引导下骨筋膜室穿刺测压评估病情的效力。结果 测压组与对照组在新发或加重感染、出血、神经损伤(如麻木、感觉缺失等)、在院治疗时间、患肢最终消肿时间以及最终不良预后等方面比较,差异均无统计学意义(P>0.05)。测压组患者经超声引导下骨筋膜室穿刺所测压力与肌酸激酶值呈正相关(rs=0.286,P=0.002)。结论 经超声引导下骨筋膜室穿刺测得的压力越高,中毒病情可能越严重。并且,超声引导下骨筋膜室穿刺测压不延长患者住院时间及患肢最终消肿时间,不增加患者出血、感染、神经损伤及最终不良预后事件发生率,具有临床实用性及可行性。Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasoundguided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites.Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included,and their basic information,physiological indicators(heart rate,blood pressure),laboratory examination indicators,physical signs,treatment methods and prognosis were collected.The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group.Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1.The bleeding,infection,nerve injury,length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry.The correlation between the pressure measured in the manometry group and creatine kinase(a representative index of acute poisoning severity score)was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease.Results There was no significant difference between the manometry group and the control group in new or aggravated infection,bleeding,nerve injury(such as numbness and anesthesia),hospital treatment time,final detumescence time of the affected limb,or final adverse prognosis(P>0.05).There was a positive correlation between the measured pressure and creatine kinase(rs=0.286,P=0.002).Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is,the more serious the poisoning condition may be.In addition,ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients

关 键 词：毒蛇咬伤 骨筋膜室综合征 骨筋膜室压力 超声引导 穿刺 可行性 安全性 

分 类 号：R646[医药卫生—外科学] R445.1[医药卫生—临床医学]