筋膜间隔综合征与脂肪栓塞相关性:临床资料分析

目的 为研究脂肪栓塞发病机制,分析筋膜间隔综合征(compartment syndrome,CS)与脂肪栓塞(fat embolism,FE)之间的相关性.方法 对比长骨骨折合并CS组与无CS的长骨骨折组的(亚)临床FE(＜sub-＞CFE)的发病率、高甘油三酯(HTG)合并尿酮体(++)阳性率,分析CS对(sub-)CFE发病的优势比(OR)及积差相关系数(r).结果 两组sub-CFE发病率分别为16.22%、9.68%.差别有非常显著意义(x2=20.71,P＜0.01);CS对(sub-)CFE、HTG的OR分别为1.94、1.97(CI95＞1);r为0.66(tr=4.96,P＜0.01).结论 上述结果均提示,CS是(sub-)CFE发病的危险因子,相关呈中度.     

髂肌筋膜间隔综合征7例诊治体会

目的：探讨髂肌筋膜间隔综合征的诊断和治疗。方法：回顾性分析我院收治的7例病人，1例采用穿刺抽血减压，6例采用手术治疗，切开髂肌筋膜，清除血肿减压，均使股神经和股外侧皮神经获得了减压。结果：7例病人通过12-18个月的随访，股四头肌肌力、下肢的感觉及膝反射均恢复正常。结论：在伤后34小时内就诊者，可试行穿刺抽血减压，在伤后48小时的就诊者，应尽早手术切开减压。     

足部筋膜间隔室综合征

筋膜间室综合征发於足部,临床上并不少见,然而常常不被人们所认识,我院近年来有18例足部外伤病人出现筋膜间室综合征,现报告如下。临床资料一、一般资料　18例病人中,男14例,女4例,年龄17～49岁。致伤原因:砸伤6人,辗轧伤9人,坠落伤4人,骨折类型:足跖骨多处多段骨折11人,足距跟骨骨折2人,小腿内外踝骨折并关节脱位5人。其中2人合并小腿筋膜间室高压症,发生前足坏死1人。二、临床表现及治疗(一)临床表现　伤足肿胀,并逐渐加重,局部皮肤有压痛,皮下瘀血皮肤张力增加并有水泡形成,伤足趾被动活动时疼痛剧烈,趾端麻木,感觉减退,足趾部皮肤发紫或…     

筋膜间隔综合征的中西医结合治疗

本文分析了自１９８６年至１９９３年３１例筋膜间隔综合征。采用中西医结合方法治疗。应用甘露醇和活血化瘀中药有改善局部微循环、减轻水肿及疤痕挛缩的作用，疗效可靠。并对甘露醇和活血化瘀中药的作用机理进行了讨论。     

脂肪栓塞综合征早期诊断与抢救

１９８５～１９９３年对６例骨折并发脂肪栓塞综合征经抢救成功５例,死亡１例,现报告如下。临床资料本组６例中,均为男性,年龄２０～３６岁;双胫腓骨骨折１例,股骨骨折３例,多发性骨折２例;车祸４例,工伤２例;治愈５例,死亡１例。临床表现与抢救１病人早期表...     

Abdominal compartment syndrome: urological aspects

ACS is prevalent in various surgical conditions and in a large percentage of critically ill patients. Measuring the IAP is important in the early diagnosis of ACS and can be easily done by measuring the intravesical pressure. ACS adversely affects many organ systems; the pathogenesis of renal dysfunction is probably multifactorial, from a combination of reduced cardiac output, reduced GFR mediated by secretion of renin and angiotensin, aldosterone-mediated water reabsorption, increased renal parenchymal pressure and direct compression of the renal vein. Successful treatment requires a high index of suspicion, prompt recognition and early surgical abdominal decompression.     

Intra abdominal hypertension and the abdominal compartment syndrome

The patho-physiological significance of raised intra-abdominal pressure, known as Intra Abdominal Hypertension, with subsequent organ dysfunction and failure, known as Abdominal Compartment Syndrome, has recently been demonstrated to occur relatively frequently in mixed populations of critically ill patients. Clinical diagnosis is unreliable, so routine measurement of intra abdominal pressure should be undertaken, particularly in specific groups of patients known to be at high risk. Whilst definitive therapy requires surgical abdominal decompression, less invasive therapies have been investigated and, if initiated early, may help to minimise progression of the condition. Clearly defined indications for surgical intervention remain elusive however and require prospective investigation. This review summarises the patho-physiology of the syndrome, its diagnosis and surveillance, and current management strategies, both medical and surgical.     

Renal allograft compartment syndrome: an underappreciated postoperative complication

PURPOSE: Renal allograft compartment syndrome (RACS) is early graft dysfunction secondary to retroperitoneal hypertension and resultant ischemia. Our purpose was to identify the incidence, therapies and outcomes of patients with RACS. METHODS: All patients who underwent a renal transplant between 2000 and 2005 were reviewed. Patients with signs of acute allograft dysfunction were identified. RACS was diagnosed via visual allograft hypoperfusion and/or with preoperative Doppler ultrasound. RESULTS: Among 458 patients, 11 (2%) were diagnosed with RACS. Characteristics between patient groups were similar. Five (45%) patients displayed adequate initial allograft function after transplantation. Doppler ultrasound was diagnostic. Six (55%) patients displayed poor initial allograft function and were classified as early presenters of RACS. Allograft function improved dramatically upon decompression. CONCLUSIONS: Clinicians must remain aware of RACS as a potential diagnosis when patients display rapid deterioration in kidney performance after good initial allograft function. Doppler ultrasound is useful in diagnosing late presenters.     

严重创伤并发腹腔间室综合征的诊治

目的:总结严重创伤后并发腹腔间室综合征(abdominal compartment syndrome,ACS)的诊治经验。方法:回顾分析近两年半时间内严重创伤后并发ACS病人的临床资料,10例行开腹减压者入组;1例为电击伤致腹壁裂开、腹腔脏器外露,腹壁裂口处组织呈焦痂、挛缩状态,外露小肠肿胀明显,还纳后强行关腹势必会形成腹腔内高压状态,因此亦行腹腔临时关闭,故入组一并讨论。结果:11例均行腹腔开放减压,1例术后死于酸中毒、多脏器功能衰竭,其余病人二期行关腹或皮瓣移植术后出院。结论:腹部严重创伤合并ACS的病人伤情危重、复杂,早期诊断和及时的开腹减压是抢救的关键,遵循损伤控制原则和给予合理的营养支持治疗是改善预后的重要措施。     

Acute compartment syndrome of forearm and hand

The diagnosis and treatment of the acute compartment syndrome is of paramount importance. Unless the viscious cycle is intervened at an appropriately early time it will result in irreversible damage leading to disability. In this review article we are discussing the basic pathophysiological process through which the various aetiological factors causing increased compartmental pressure lead to the progressive death of muscles and nerves. We also discuss the various clinical features that aid in the diagnosis and the role of intracompartmental pressure measurements. Finally we hope to ascertain the basic principles and the surgical techniques for treating this condition effectively.     

Abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment mortality rates approach 70% as multi-organ failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2012 to draw consensus and improve patient outcomes. ACS is the end sequela of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summarizes the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS.     

Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome

Chronic exertional compartment syndrome (CECS) represents the second most-common cause of exertional leg pain with incidence of 27-33%. CECS of the superficial posterior compartment, or soleus syndrome, is rare and has only been discussed briefly in the literature. We discuss the management of two patients with bilateral soleus syndrome or CECS of the superficial posterior compartment.     

再论腹腔间隙综合征

Since we called for the attention of the occurrence of abdominal compartment syndrome in 2002, forty cases of this complication have been recognized and reported by six burn units in this journal, including three cases accompanied with massive pleural effusion (1601 - 3240 mL). Most cases emerged after "aggressive" fluid resuscitation, especially after massive infusion of crystalloid fluid. The idea "more fluid no harm" should be corrected. The goal of early fluid resuscitation in burn is to correct the hypovolemia and cell hypoxia, and circulating fluid just serves as a carrier in bringing O2 to the cells and carrying out CO2 and other metabolites from tissues. In face of "leaking while infusing", heavy accumulation of fluid in the third spaces may worsen the cell hypoxia. Some of the parameters we get from invasive monitoring systems can be misleading. Now, the trend of overloading should be prevented, and it behaves us to study the regime of lower fluid volume with proper contents in burn shock resuscitation.     

骨筋膜室综合征诊断与治疗的研究进展

【摘要】〓骨筋膜室综合征(OCS)是指由各种原因造成的肢体创伤导致筋膜室内压力(ICP)升高,阻断筋膜室内组织微循环而引发的一系列症状和体征。目前其病理、病因已有明确的认识,即缺血4小时以上就可造成不可逆的损伤,早期准确诊断及选择适当的治疗方案就尤为重要。但目前临床上对该病诊断的准确性尚有所不足,治疗方案的选择仍有不同的见解。本文对OCS的早期诊断和动态监测以及治疗方法进行了回顾分析,旨在提高该病诊断的准确性,以及为该病的最佳处理方式提供指导。