Ouellette E A
Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Florida, USA.
Hand Clin. 1998 Aug;14(3):431-50.
A high index of suspicion for a compartment syndrome in the upper extremity should be maintained in all obtunded patients who are at risk for the condition. Obtunded patients are those with a dulled or altered physical or mental status secondary to injury, illness, or anesthesia; those with diminished or absent sensation in the upper extremity because of nerve injury or anesthesia; and those whose ability to communicate is impeded, such as infants and young children and the mentally ill or disabled. These patients represent a vulnerable group whose inability to demonstrate the hallmark symptoms and signs of the syndrome puts them in jeopardy of a late diagnosis of a compartment syndrome and its potentially devastating sequelae. The most likely causes of a compartment syndrome in this population are skeletal or soft-tissue trauma, prolonged limb compression, thrombolytic therapy after myocardial infarction, arterial or intravenous fluid administration, and upper extremity Surgery. Whenever a compartment syndrome of the hand, forearm, or upper arm is suspected, the obtunded patient should be examined closely and frequently, and any changes over time should be documented carefully. Intracompartmental pressure measurement provides a useful adjunct to the physical examination and history in these patients and may be diagnostic if other symptoms and signs are obscured. Once the compartment syndrome is diagnosed, emergent fasciotomy is indicated. To avoid a loss of function in the obtunded patient, special care must be taken postoperatively to assure that early motion exercises are carried out.
对于所有有发生上肢骨筋膜室综合征风险的意识不清患者，都应保持高度怀疑。意识不清的患者包括因受伤、疾病或麻醉导致身体或精神状态迟钝或改变的患者；因神经损伤或麻醉导致上肢感觉减退或丧失的患者；以及沟通能力受阻的患者，如婴幼儿、精神疾病患者或残疾患者。这些患者属于弱势群体，他们无法表现出该综合征的典型症状和体征，这使他们面临骨筋膜室综合征延迟诊断及其潜在毁灭性后果的风险。该人群发生骨筋膜室综合征最可能的原因是骨骼或软组织创伤、肢体长期受压、心肌梗死后的溶栓治疗、动静脉输液以及上肢手术。每当怀疑手部、前臂或上臂发生骨筋膜室综合征时，应对意识不清的患者进行密切且频繁的检查，并仔细记录随时间的任何变化。在这些患者中，测量骨筋膜室内压力对体格检查和病史询问有辅助作用，如果其他症状和体征不明显，测量结果可能具有诊断价值。一旦诊断出骨筋膜室综合征，应立即进行切开减压术。为避免意识不清的患者出现功能丧失，术后必须特别注意确保进行早期活动锻炼。
