筋膜间隔综合征的高压氧治疗与血浆纤粘素变化的关系

本文首次报道采用253kPa的高压氧治疗24例创伤后筋膜间隔综合征(PACS)病人并采用免疫单扩散法检测了治疗前后血浆纤粘素(FN)的变化与预后的关系。30例健康人作为血浆FN的对照组。结果表明:16例早期PACS病人,经3～5次高压氧治疗,症状和体征逐渐好转,无1例作筋膜切开减压。6例筋膜切开减压后行高压氧治疗者,水肿、炎症消退,体温降低,临床症状好转。2例坏死期PACS虽然临床症状好转,但效果差。高压氧治疗后,病人血浆FN显著高于治疗前。分别较治疗前高43(18.9％;P<0.01)、61(24.7％;P<0.01)、49(17.2％;P<0.01)、57(17.4％;P<0.05)和55mg/L(16.6％;P<0.05)。根据本组研究的结果,提示高压氧是治疗早期PACS的有效非手术疗法和筋膜减压后有效辅助疗法。

HYPERBARIC OXYGEN THERAPY OF ACUTE COMPARTMENT SYNDROME AND THE RELATIONSHIP BETWEEN PLASMA FIBRONECTIN CONCENTRATION AND PROGNOSIS

This report describes for the first time the effect of hyperbaric oxygen therapy at 253 kPa on post-trauma acute compartment syndrome in 24 patients and the relationship between the prognosis of the syndrome and the changes of plasma fibronectin.Plasma fibronectin was measured using single radial immunodiffusion before and after the therapy and 30 healthy subjects were used as controls.The results showed that clinical symptoms and signs of 16 patients with acute compartment syndrome at the early stage were significantly improved after 3-5 times of hyperbaric oxygen therapy and recovered without performing fasciotomy; infection, edema and swelling of the injuried limbs and temperature were markedly reduced in 6 patients treated with hyperbaric oxygen after fasciotomy, and no good therapeutic efficacy was obtained in 2 patients at the necrotic stage although their clinical symptoms and signs were partially improved.It was also found that plasma fibronectin concentrations were significantly increased in these patients after hyperbaric oxygen therapy.The mean increase was 47(18.9%, P<0.01), 61(24.7%, P<0.01), 49(17.2%, P<0.01), 57(17.4%, P<0.05)and 55 mg/L(16.6%, P<0.05)at the 1st, 2nd, 3rd, 4th and 5th time, respectively. The results suggest that hyperbaric oxygen therapy is an effective non-surgical treatment for PACS at the early stage, and a good adjuntive therapy after fasciotomy.