高频彩超诊断上肢高压电烧伤血管损伤的应用价值

Clinical Value of Color Doppler Ultrasonography in Vascular Injury of Upper Limb with High-voltage Electric Burn

目的:探讨高分辨率超声在诊断上肢高压电烧伤血管损伤中的应用价值。方法:15例上肢高压电烧伤患者.术前应用彩色多普勒血流图(CDFI)显示重要血管(肱、桡、尺动静脉)管壁结构和腔内回声,声像图特征与手术、病理对照。脉冲多普勒(PW)测量血流速度与对侧上肢对照。结果:高频超声显示损伤桡、尺动脉节段性狭窄和扩张,管壁增厚,内膜波浪状不平;桡、尺静脉轮廓不清。肱动脉内膜断断续续,肱静脉内径小于动脉,血栓形成。CDFI显示动脉血流中断近段血流束串珠样,收缩期峰值流速(SPV)较正常组明显减慢(P<0.001),伴行静脉血流信号消失。手术及病理证实超声诊断符合率100%。结论:高频超声可实时直观显示损伤血管内膜等细小结构改变,简便、无创、重复性好,结合血流动力学定量指标,可预测截肢高度,值得推广。

Objective： To evaluate the role of color Doppler ultrasonography probing blood vessels of upper limb with high-voltage electric injury. Methods： Preoperatively, color Doppler ultrasonography was used for identifying the major blood vessels of upper limb in 15 cases with high-voltage electric injury, including brachial artery（BA） and brachial vein（BV）, ulnar artery（UA） and ulnar vein（UV） as well as radial artery（RA） and radial vein（RV） ,their structures were observed and compared with surgery and pathology. The hemodynamic indics were determined in the burn wound region and in 12 normal subjects, all data were analyzed statistically. Results： It was found segmental stenosis and dilation,the thicken wall and coarse endothelial in UA and RA,while homologous veins were not visualized. At BA, injuried degree was slight than artery of forearm, simply appeared tiny coloboma on endothelial. The inner diameter of BV was less than BA, at the same time, thrombosis was exist. CDFI showed beaded blood flow in the stenosis segment proximal to where blood flow ceased, corresponding systolic peak velocity was significantly lower than that of normal group（P〈0. 001）. Conclusion： The accordance of the examinations by ultrasonography with the observation by surgery and pathology suggests this non-traumatic technique have special value in the diagnosis of vascular injury in electrical burn, especially popular for identifying microstructures changes in vessel wall and predicting amputation level.