目的:探討磁共振血管造影(MRA)以及計算機斷層掃描血管成像(CTA)對地震擠壓傷下肢血管病變的臨床價值。方法:對5·12汶川大地震中我院收治的已確診為地震擠壓傷致雙下肢橫紋肌溶解癥3例患者進行雙下肢MRA檢查,并對嚴重擠壓傷及下肢毀損,并行截肢的另三名患者進行術后CTA檢查。對MRA圖象雙下肢動脈進行回顧性分析,總結MRA征象,同時總結截肢術后患者CTA表現及臨床價值,并評價二者檢查在擠壓傷所至橫紋肌溶解癥的臨床診治中的作用。結果:3例未行截肢患者MRA雙下肢主要動脈未見確切狹窄及閉塞征象,管腔內未見充盈缺損影。3例已行截肢患者可見殘余肢體的明顯腫脹,雙側髂血管以及部分截斷肢體遠端血管內見止血彈簧鋼圈影像,部分截斷肢體遠端動脈分支變細。截斷血管未見再通,周圍無滲血改變。結論:MRA、CTA能直觀顯示雙下肢動脈損傷及術后情況,在臨床應用中各有優勢和局限性。對二者的合理選擇能為臨床診治提供有利信息。
ObjectiveTo summarize the progress of perioperative pain management in patients with lower limb vascular diseases. MethodRetrieved the literature about pain management in patients with lower limb vascular diseases both at home and abroad in recent years and reviewed the literature. ResultsLower limb vascular diseases were very common in elderly patients. Whether it was limb ischemic pain or surgery-related pain, it often increased the stress response and activation of the autonomic system, which was not conducive to the recovery of the disease. Good analgesic management was important for these patients. Perioperative pain management could be performed by intravenous analgesics, oral analgesics, local anesthesia, neuraxial anesthesia and peripheral nerve block. Acute and chronic pain should be actively managed during perioperative period. Pre-emptive analgesic strategies could be implemented in patients with severe peripheral vascular disease. ConclusionsGood perioperative analgesia management is necessary. Pain management which employes one or more analgesic methods is important in maximizing pain relief, function, and quality of life for this patient group.