Devulapalli Chris, Han Kevin D, Bello Ricardo J, LaPorte Dawn M, Hepper C Tate, Katz Ryan D
Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2015 Nov;40(11):2262-2268.e5. doi: 10.1016/j.jhsa.2015.08.002. Epub 2015 Sep 26.
To review the literature pertaining to inadvertent intra-arterial drug injection in the upper extremity, explore the various treatment options and their outcomes, and identify risk factors for limb amputation following intra-arterial injection.
A systematic review of Medline, EMBASE, and Cochrane databases (inception to March 2013) was completed for patients presenting with intra-arterial drug injection of the upper extremity. Details on intervention and outcome were extracted and subjected to pooled analysis with amputation as the primary outcome.
A total of 25 articles (209 patients) were included for review. Mean patient age was 31 ± 8 years (male, 71%; female, 29%). Prescription opioids (33%) were the most commonly injected substance, and the brachial artery (39%) was the most common site. The overall weighted mean amputation incidence was 29%. Anticoagulants were the most common treatment used (77%). From pooled analysis, conditions requiring antibiotic use were significantly associated with a higher incidence of amputation; whereas use of steroids was associated with a lower incidence of amputation. Patients presenting 14 hours or more after injection and those injecting crushed pills rather than pure substances had significantly higher incidences of amputation.
Intra-arterial drug injection of the upper extremity carries an amputation incidence of nearly 30%. Conditions requiring adjunctive antibiotic use and delay in receiving care were both significantly associated with higher incidences of amputation. No single treatment protocol to date has established superiority.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
回顾有关上肢意外动脉内药物注射的文献，探讨各种治疗选择及其结果，并确定动脉内注射后肢体截肢的危险因素。
对Medline、EMBASE和Cochrane数据库（从创建至2013年3月）进行系统综述，纳入上肢动脉内药物注射患者。提取干预措施和结果的详细信息，并以截肢作为主要结果进行汇总分析。
共纳入25篇文章（209例患者）进行综述。患者平均年龄为31±8岁（男性占71%；女性占29%）。处方阿片类药物（33%）是最常注射的物质，肱动脉（39%）是最常见的注射部位。总体加权平均截肢发生率为29%。抗凝剂是最常用的治疗方法（77%）。汇总分析显示，需要使用抗生素的情况与截肢发生率较高显著相关；而使用类固醇与截肢发生率较低相关。注射后14小时或更长时间就诊的患者以及注射碾碎药丸而非纯物质的患者截肢发生率显著更高。
上肢动脉内药物注射的截肢发生率近30%。需要辅助使用抗生素的情况和延迟接受治疗均与截肢发生率较高显著相关。迄今为止，尚无单一治疗方案显示出优越性。
研究类型/证据水平：治疗性IV级。
