超声在四肢电烧伤手术前后的应用

Preoperative and Postoperative Application of Ultrasonography in Electric Burn Limbs

目的探讨超声检测技术在四肢电烧伤手术前、后的应用价值。方法采用HP—IPHX高分辨率彩色多普勒超声仪于手术前检测患肢创面段及其近心端5～15cm皮下组织、肌肉、血管，行伤情判断；于减张、清创、截肢（骨）、组织瓣移植术后追踪检测，观察术后组织恢复情况。结果共检测四肢电烧伤27例，56个患肢，99条血管；1．术前2D、CDFI检出皮下组织肿胀56个，焦痂6块，血管内膜水肿31条，血管内膜粗糙68条，血栓13条，血管屈曲走行变异22条。2．术后检出（1）减张术后2～3d皮下组织肿胀明显减轻；（2）清创、截肢（骨）术后皮下组织肿胀、焦痂、血栓消失；血管内膜水肿、血管走行变异及血管节段性管腔增宽、狭窄随恢复时间延长而减少；观察9个月仍有血管内膜粗糙。3．全部组织瓣移植成功。结论超声这一无创性检测技术可在手术前、后直观四肢电烧伤形态学及血流动力学变化，准确判断损伤程度、部位及术后组织血管恢复状况，为临床诊治提供科学依据，具有重要的临床应用价值及应用前景。

Objective To explore the value of preoperative and postoperative ultrasonography in detecting electric burn limbs. Methods HP-IPHX high resolution color and pulsed Doppler ultrasonography was employed preoperatively and postoperatively to detect the subcutaneous tissue ,muscles and blood vessels in the burn area and the area 5-15 cm proximal to the wound in order to estimate the extended degree of the injury, and to further evaluate the tissue recovery after tension decrease, debridement, amputation and tissue flap transplantation. Results Totally 56 injured limbs and 99 blood vessels in 27 patients with electric burn were examined. The features on 2D and CDFI were ： 1. Subcutaneous swelling was in 56 sites, eschar in 6 sites, intima edema in 31 blood vessels, rough intima in 68 vessels, 13 thrombiand 22 tortuous blood vessels were detected in the patients before surgery; 2. After surgery, there were： ①subcutaneous swelling alleviated significantly 2-3 days after tension decrease. ② subcutaneous swelling, eschar and thrombi disappeared after debridement and amputation, intima swelling, vascular tortuesity and widened segments and structure destruction of blood vessels were alleviated along with the recovery, but rough intima still existed 9 months after surgery; 3. all tissue flaps were successfully transplanted. Conclusions Being a non-invasive modality, ultrasonography can directly detect the morphological and haemodynamic changes in electric burn limbs, accurately evaluate the extention and position of injuries, and the recovery of tissues and blood vessels after surgery. Ultrasonography may provide scientific basis for clinical diagnosis and treatment, be worthy for wide use and have good prospect.