微型超声在肢体战伤“黄金1小时”救治中的应用前景

The application prospect of microultrasound in the treatment of“golden 1 hour”for limb injury

Eastridge等曾分析了美军在2001-2011年海外战争期间的致命性创伤,结果显示87.3%的死亡发生在伤员被送达医疗机构救治之前的＂战术环境＂（主要包括火线和无敌火线阶段）,大部分为不可救治伤,只有24.3%为可救治伤。在可救治伤中,出血占90.9%,其中肢体出血的救治相对简单、有效的。除了出血之外,肢体战伤致肌肉损伤的最早病理改变是肌肉缺血,缺血再灌注后炎性渗出,局部肿胀,压力增高,最终引起筋膜间室综合征,进而加重肌肉坏死;而肌细胞坏死释放的大量毒素进入全身循环,产生以肾脏为主的多器官毒性。上述情况所致的严重后果是截肢或阵亡,被称为战争的＂二次灾难＂。

Limb injury is the common type of trauma in the battlefield,with high disability and mortality. Ultrasound is considered as the prior imaging examination by the features of convenience, easily operated,quick imaging,and so on. Microultrasound can be applied in the battlefronts,assisting the treatment of ＂golden 1 hour＂ after limb injury. Ultrasound can be used to determine the location and severity of limb blood vessels injuries, to identify muscle injury and osteofascial compartment syndrome. In addition,it can be applied to diagnose bone fracture, rupture of tendon and ligament,and foreigh bodies of limb. In recent years,nerve block anesthesia and analgesia can be performed under ultrasound guide. All the above is favorable of persistence in combat. As the emergence and clinical application of high-level microultrasound,it is with great value in the treatment of ＂golden 1 hour＂ after limb injury.