Mar G J, Barrington M J, McGuirk B R
Department of Anaesthesia, St Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, 3065 VIC, Australia.
Br J Anaesth. 2009 Jan;102(1):3-11. doi: 10.1093/bja/aen330. Epub 2008 Nov 19.
Acute compartment syndrome can cause significant disability if not treated early, but the diagnosis is challenging. This systematic review examines whether modern acute pain management techniques contribute to delayed diagnosis. A total of 28 case reports and case series were identified which referred to the influence of analgesic technique on the diagnosis of compartment syndrome, of which 23 discussed epidural analgesia. In 32 of 35 patients, classic signs and symptoms of compartment syndrome were present in the presence of epidural analgesia, including 18 patients with documented breakthrough pain. There were no randomized controlled trials or outcome-based comparative trials available to include in the review. Pain is often described as the cardinal symptom of compartment syndrome, but many authors consider it unreliable. Physical examination is also unreliable for diagnosis. There is no convincing evidence that patient-controlled analgesia opioids or regional analgesia delay the diagnosis of compartment syndrome provided patients are adequately monitored. Regardless of the type of analgesia used, a high index of clinical suspicion, ongoing assessment of patients, and compartment pressure measurement are essential for early diagnosis.
如果不及早治疗，急性骨筋膜室综合征会导致严重残疾，但诊断具有挑战性。本系统评价探讨现代急性疼痛管理技术是否会导致诊断延迟。共识别出28篇提及镇痛技术对骨筋膜室综合征诊断影响的病例报告和病例系列，其中23篇讨论了硬膜外镇痛。在35例患者中的32例中，硬膜外镇痛时出现了骨筋膜室综合征的典型体征和症状，其中18例有记录的突破性疼痛。没有随机对照试验或基于结果的比较试验可纳入该评价。疼痛常被描述为骨筋膜室综合征的主要症状，但许多作者认为它不可靠。体格检查对诊断也不可靠。没有令人信服的证据表明，只要对患者进行充分监测，患者自控镇痛阿片类药物或区域镇痛会延迟骨筋膜室综合征的诊断。无论使用何种镇痛类型，高度的临床怀疑、对患者的持续评估以及骨筋膜室内压力测量对于早期诊断至关重要。
