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高压电烧伤合并骨筋膜室综合征患者切开减压黄金期的评估

The Evaluation of a Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients With Compartment Syndrome.

作者信息

Putri A C, Tobing J N, Hasibuan L, Faried A, Mose J

机构信息

Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD) - Dr. Hasan Sadikin Hospital, Bandung, Indonesia.

Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, Bandung, Indonesia.

出版信息

Ann Burns Fire Disasters. 2023 Mar 31;36(1):57-62. eCollection 2023 Mar.

Abstract

Electrical burn injuries can cause various acute manifestations that require surgeons to make an early decision, such as fasciotomy for compartment syndromes. Early decompression can become a 'golden period'for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation. A cross-sectional study was performed on medical records. Inclusion criteria were patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria were patients whose extremities were already non-vital on admission and those lost to follow up. Demographic information, burn surface area and B-F time for patients amputated above the elbow (group A amputation), below the elbow (group B amputation), and no amputation (non-amputated) were investigated. More than 50% patients underwent amputation and 60% had less than 18 hours B-F time. Mean B-F time for non-amputated patients was 18 hours and for amputated patients 20.38 hours. Mean burn to amputation (B-A) time and fasciotomy to amputation (F-A) time in group B was about double compared to group A. The B-A time range of group Awas 4.2-7.3 days. Our study showed 18 hours maximum to be the golden period of burn to fasciotomy. The window period of muscle injury evaluation is maximum 7 days to permit limb salvation at the lowest level possible.

摘要

电烧伤可导致各种急性表现,这需要外科医生尽早做出决策,例如对骨筋膜室综合征进行筋膜切开术。早期减压可能成为挽救肢体的“黄金时期”。本研究评估烧伤至筋膜切开术(B-F时间)和截肢的时长。对病历进行了一项横断面研究。纳入标准为高压电损伤并伴有骨筋膜室综合征的患者。排除标准为入院时肢体已无生机的患者以及失访患者。对肘部以上截肢患者(A组截肢)、肘部以下截肢患者(B组截肢)和未截肢患者(非截肢)的人口统计学信息、烧伤面积和B-F时间进行了调查。超过50%的患者接受了截肢,60%的患者B-F时间少于18小时。非截肢患者的平均B-F时间为18小时,截肢患者为20.38小时。B组的平均烧伤至截肢(B-A)时间和筋膜切开术至截肢(F-A)时间约为A组的两倍。A组的B-A时间范围为4.2 - 7.3天。我们的研究表明,烧伤至筋膜切开术的最长黄金时期为18小时。肌肉损伤评估的窗口期最长为7天,以便尽可能在最低水平挽救肢体。

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