Department of Cardiology, Hallym University Hangang Sacred Heart Hospital, 94-200, Yeongdeungpo-dong, 150-030 Seoul, Korea.
Crit Care. 2012 Feb 12;16(1):R25. doi: 10.1186/cc11190.
The aim of this study was to evaluate the functional changes of the arterial endothelium and smooth muscle after a high-voltage electrical injury (HVEI), using flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD).
Twenty-five male patients injured in the upper extremities by current due to contact with more than 20,000 volts were enrolled in the study. FMD and NMD were measured on the brachial artery within 48 hours after HVEI, and follow-up FMD and NMD were evaluated six weeks later. In addition, we enrolled an age, sex and body mass index matched healthy control group consisting of 25 individuals. Including FMD and NMD, all the variables of the control group were investigated one time and compared with the initial and six week follow-up data of the HVEI group.
A significantly lower initial FMD was seen in the HVEI group compared with the control group (2.1±1.2% versus 13.6±3.4%, P<0.01). At the six week follow-up, the FMD of the HVEI group had significantly improved compared to the initial FMD (2.1±1.2% versus 5.1±2.1%, P<0.01), but it was still lower than the FMD of the control group (5.1±2.1% versus 13.6±3.4%, P<0.01). A significantly lower NMD was seen both initially and at the six week follow-up compared with the NMD of the control group (7.3±4.7% versus 20.4±4.1%, P<0.01 and 11.4±6.7% versus 20.4±4.1%, P<0.01, respectively). The FMD study of the contralateral arm which was uninjured by HVEI was available in six patients. In those patients, the six week follow-up FMD was significantly improved in the HVEI arm compared with the initial FMD (1.8±0.6% versus 4.4±1.6%, P<0.01). However, in the contralateral uninjured arm, there was no difference between the initial and the six week follow-up FMDs (5.5±1.4% versus 6.9±2.2%, P=0.26).
After HVEI, the endothelial and smooth muscle functions of the brachial artery were significantly decreased for at least six weeks. Long term cautious care might be needed for all victims of HVEI, because there is a chance of increased risk of thrombosis or stenosis in the injured arm.
本研究旨在通过血流介导的舒张功能（FMD）和硝酸盐介导的舒张功能（NMD）评估高压电损伤（HVEI）后动脉内皮和平滑肌的功能变化。
研究纳入了 25 名因接触 20,000 伏以上电流而导致上肢受伤的男性患者。在 HVEI 后 48 小时内对肱动脉进行 FMD 和 NMD 测量，并在 6 周后进行随访 FMD 和 NMD 评估。此外，我们还纳入了一个由 25 名年龄、性别和体重指数匹配的健康对照组。包括 FMD 和 NMD 在内，对照组的所有变量均进行了一次调查，并与 HVEI 组的初始和 6 周随访数据进行了比较。
与对照组相比，HVEI 组初始 FMD 显著降低（2.1±1.2% vs. 13.6±3.4%，P<0.01）。在 6 周随访时，HVEI 组的 FMD 与初始 FMD 相比显著改善（2.1±1.2% vs. 5.1±2.1%，P<0.01），但仍低于对照组的 FMD（5.1±2.1% vs. 13.6±3.4%，P<0.01）。与对照组相比，HVEI 组初始时和 6 周随访时的 NMD 均显著降低（7.3±4.7% vs. 20.4±4.1%，P<0.01 和 11.4±6.7% vs. 20.4±4.1%，P<0.01）。6 名患者的健侧手臂（未受 HVEI 损伤）进行了 FMD 研究。在这些患者中，HVEI 侧 6 周随访时的 FMD 与初始 FMD 相比显著改善（1.8±0.6% vs. 4.4±1.6%，P<0.01）。然而，在健侧未受伤的手臂中，初始 FMD 和 6 周随访 FMD 之间没有差异（5.5±1.4% vs. 6.9±2.2%，P=0.26）。
HVEI 后，肱动脉的内皮和平滑肌功能至少在 6 周内显著下降。所有 HVEI 受害者都需要长期谨慎护理，因为受伤手臂发生血栓形成或狭窄的风险可能会增加。
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