Kakar Sanjeev, Firoozabadi Reza, McKean Jason, Tornetta Paul
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA 02118, USA.
J Orthop Trauma. 2007 Feb;21(2):99-103. doi: 10.1097/BOT.0b013e318032c4f4.
In the treatment of tibia fractures, is the intraoperative diastolic blood pressure (DBP) less than pre- and postoperative DBP, and how does this relate to the diagnosis of compartment syndrome using DeltaP (diastolic blood pressure [DBP] - intracompartmental pressure)?
DESIGN, SETTING, AND PATIENTS: This was a prospective cohort study in a level 1 trauma center, with a consecutive series of 242 patients with a tibia fracture.
Intramedullary nail fixation of tibia fractures under general anesthesia.
Patient demographics, type and location of fracture, injury severity score, and blood pressures preoperatively, intraoperatively, and postoperatively.
There were 187 male and 55 female patients, whose ages ranged from 16 to 87 years (average, 39 years). There were 123 open and 119 closed tibia fractures. The average injury severity score was 14.7 (range: 9-41). Anesthetized patients had a significant decrease in their DBP and systolic blood pressure (SBP) compared with their preoperative, postanesthesia care unit and postoperative floor measurements. The mean DBP in the operating room was 18 +/- 13 mm Hg lower than the preoperative measurement (P < 0.05), whereas the difference in the preoperative and postoperative mean DBP was only 2 +/- 13 mm Hg.
There is a predictable response of DBP in patients with tibia fractures treated with intramedullary (IM) nailing under general anesthesia. The preoperative DBP is a good indicator of the postoperative DBP, and the intraoperative DBP is significantly lower (average 18 mm Hg; P < 0.05). The surgeon should recognize that intraoperative DeltaP may be lower than DeltaP once the patient is awakened in deciding whether to perform a fasciotomy or awaken the patient and perform serial examinations and or compartment pressure measurements. Intraoperative DeltaP may be spuriously low compared with that after the patient is awakened.
在胫骨骨折治疗中，术中舒张压（DBP）是否低于术前和术后舒张压，以及这与使用DeltaP（舒张压[DBP] - 骨筋膜室内压）诊断骨筋膜室综合征有何关系？
设计、地点和患者：这是一项在一级创伤中心进行的前瞻性队列研究，连续纳入242例胫骨骨折患者。
全身麻醉下胫骨骨折髓内钉固定术。
患者人口统计学资料、骨折类型和部位、损伤严重程度评分以及术前、术中和术后血压。
男性患者187例，女性患者55例，年龄16至87岁（平均39岁）。开放性胫骨骨折123例，闭合性胫骨骨折119例。平均损伤严重程度评分为14.7（范围：9 - 41）。与术前、麻醉后护理单元和术后病房测量值相比，麻醉患者的DBP和收缩压（SBP）显著降低。手术室平均DBP比术前测量值低18±13 mmHg（P < 0.05），而术前和术后平均DBP差值仅为2±13 mmHg。
全身麻醉下行髓内（IM）钉固定治疗的胫骨骨折患者，其DBP有可预测的变化。术前DBP是术后DBP的良好指标，术中DBP显著更低（平均18 mmHg；P < 0.05）。外科医生应认识到，在决定是否进行筋膜切开术或唤醒患者并进行系列检查和/或骨筋膜室压力测量时，术中DeltaP可能低于患者苏醒后的DeltaP。与患者苏醒后相比，术中DeltaP可能会假性降低。
