Babu S C, Shah P M, Clauss R H
Am J Surg. 1982 Aug;144(2):225-7. doi: 10.1016/0002-9610(82)90513-x.
Limb ischemia due to blunt trauma, dissecting hematoma, and cardiac dysfunction jeopardizes limbs and lives more than is generally appreciated. Delay in diagnosis after blunt trauma led to major amputation in 21 percent of our patients. Current principles avoid those hazards. Five patients presented with acute limb ischemia caused by dissecting hematoma of the aorta. Suspicion of that diagnosis is warranted in patients without a history of chronic vascular occlusive disease or cardiac disease, in young white males with Marfan characteristics, and in middle-aged hypertensive black males. Confirmation of the diagnosis requires urgent angiography. In selected cases, treatment with femorofemoral bypass will be limb- and life-saving. Ischemia due to low flow, which portends a dire prognosis, should be suspected in severely ill patients with a history of peripheral vascular disease. Analysis of cardiac and metabolic functions with the Automated Physiologic Profile system identified the cause of the low flow state in 10 patients, permitting precise management with specific therapy. A discernible improvement in circulatory status of the limb coincided with correction of the low flow states. Angiography and surgery were not necessary in 90 percent of this group, and should be avoided during low flow episodes.
钝性创伤、夹层血肿和心脏功能障碍所致的肢体缺血对肢体和生命造成的危害比人们普遍认识到的更大。钝性创伤后诊断延误导致我们21%的患者接受了大截肢手术。目前的原则可避免这些风险。有5例患者因主动脉夹层血肿出现急性肢体缺血。对于无慢性血管闭塞性疾病或心脏病史的患者、具有马凡综合征特征的年轻白人男性以及中年高血压黑人男性，有必要怀疑这一诊断。确诊需要紧急血管造影。在某些病例中，股股旁路手术治疗可挽救肢体和生命。对于有外周血管疾病史的重症患者，应怀疑存在预示预后不良的低流量缺血。使用自动生理分析系统对心脏和代谢功能进行分析，确定了10例患者低流量状态的原因，从而能够采用特定疗法进行精准治疗。肢体循环状态的明显改善与低流量状态的纠正相一致。该组90%的患者无需进行血管造影和手术，在低流量发作期间应避免进行此类检查和手术。
