四肢主干动脉伤外科处理后并发症防治的临床观察
血管损伤,,四肢；血管损伤；外科治疗；并发症,临床资料,1一般资料,2治疗方法,3统计学处理,结果,讨论,1重视筋膜室的早期切开减压,2手术选择,3
摘要：目的 分析62例四肢主干血管伤的临床治疗效果，探讨四肢主干动脉伤的早期处理方法，减少术后伤残率和死亡率。方法 回顾分析62例四肢主干血管伤用不同方法处理的临床效果，探讨其原因。结果 单纯血管吻合组9例，发生缺血性肌挛缩5例；采用血管吻合+切开减压(前臂或小腿深筋膜切开)组共47例，发生缺血性肌挛缩4例。单纯行血管吻合比血管吻合+切开减压更易发生缺血性肌挛缩(P<0.05)。8例通血后高钾血症均以血液透析处理后取得良好效果。截肢5例；死亡1例。长时间缺血易发生骨筋膜室综合征、高钾血症、急性肾功能衰竭。结论 对四肢主干血管损伤，及时行缺血肢体的切开减压，防止缺血性肌挛缩发生，密切监测血钾水平、每小时尿量，及时处理高钾血症、急性肾功能衰竭，对降低伤残率、杜绝死亡病例非常重要。关键词：四肢；血管损伤；外科治疗；并发症
Clinical observation on prevention of complications of limbs arterial injuries after surgical treatment
WANG Minggui,ZHU Qinghe,XIA Yongmei
(Department of Traumatic Surgery,Fuling Central Hospital,Chongqing 408000，China)
Abstract: Objective The aim of this study is to minimize the sequelas and complications in treatment of arterial injury in limbs and improve the treatment level.Methods The different effects with different therapeutic methods of the main artery injury in extremities in 62 cases were retrospectively analyzing,to explore the cause.Results There were greater possibilities to result in ischemic muscular atrophy in cases of simple vascular anastomosis than that of vascular anastomosis accompanied with simultaneous decompression fasciotomy of limbs compartments.There was an increasing possibility that hyperkalemia and acute renal failure wound come into being as the limbs were short of blood support too long.Conclusion When dealing with main artery injury in limbs,decompressing limbs compartments timely,monitoring the concentration of blood potassium level and per hour urine volume synchronously,treating hyperkalemia and acute renal failure in time are all very important for minimizing the rate of disability and eliminating death case. ......
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