吸烟导致闭合性损伤手指发生动脉危象的诊断及救治

The Diagnosis and Treatment of Artery Crisis in Closed Finger Injury Caused by Cigarette Smoking

目的探讨吸烟所致闭合性手指损伤后发生动脉危象的早期诊断及救治措施。方法2005年1月—2008年12月,接诊闭合性手指损伤患者56例(70指)吸烟后出现伤指疼痛加剧、麻木、指腹张力低下、颜色苍白,利用高频脉冲超声多普勒血流仪(PUDVP)观察伤指血流灌注情况,并与同期未吸烟患者伤指血流灌注进行了比较。结果32例36指被诊断发生动脉危象,动脉危象发生率吸烟组明显高于未吸烟组,伤指动脉血流最大速度、指动脉血流量及手指末节温度吸烟组明显低于未吸烟组,动脉危象非手术方法治疗有效率吸烟组明显低于未吸烟组,手术探查指动脉血栓发生率吸烟组明显高于未吸烟组,指动脉痉挛发生率未吸烟组高于吸烟组。结论对吸烟的闭合性手指损伤患者应密切观察伤指的血运及感觉变化,指动脉危象发生后应采取积极救治措施。

Objective To explore the diagnosis and treatment of artery crisis in closed finger injury caused by cigarette smoking.Methods From January 2005 to December 2008,56 cases had aggravated pain,numbness,pale colour and finger pulp hypotonia in their 70 closed injured fingers after cigarette smoking.The blood flow perfusion of these injured digits was observed by use of high frequency pulsed ultrasonic doppler velocimetry（PUDVP）.The measurement results was analyzed and compared with digit blood perfusion of patients who refrained from smoking in the corresponding time period.Results Artery crisis was found and diagnosed in 36 digits of 32 cases.The incidence rate of artery crisis occurrence in smoking group was higher than that of non-smoking group.The average maximum velocity,the quantification of peak blood flow of digit artery and average temperature of paratelum fingers in smoker＇s were lower than that of non-smoker＇s.The effective power of non-operative for arterial crisis in smoking group was lower than non-smoking group.The incidence of digital artery thrombosis was much higher in smokers than in non-smokers but the incidence of arterial vessel wall spasming in smokers lower than in non-smokers.Conclusion Digit blood perfusion and changed sensation should be pay intimate attention to for those cases of closed finger injury who smoked cigarette after hand trauma.Energetic remedy measure must be taken for arterial digitalis crisis to retrieve the injuried finger.