筋膜間室壓測量-課件

筋膜室壓的測量APandlateralviewsofaTschernetype2tibialshaftfracture.2型脛腓骨折正側位片Withinapproximatelyonehourofpresentation,thepatient’sskinbegantoblister.大約一小時內病人皮膚開始出現(xiàn)水泡Abloodfilledblister.水泡內充血Aclearblister.清晰的水泡Compartmentpressureswerethereforemeasuredinallfourcompartments.Theareatobetestediscleanedwithbetadine.準備測4個筋膜室壓力，正在用聚維酮碘消毒Therearemultipledevicesmadeforthistechnique.Thisimageshowsoneofthem.組合式壓力儀Itisimportantthatwhenusingthedeviceitisheldparallelwiththefloorsoasnottoadverselyaffectthemeasurement.Thisisalsothecasewhenusingothertechniques,suchasarteriallinemeasurement,wherethetransducermustbeattheleveloftheexamination.必須與地面保持水平以免影響測量，否那么會影響傳感器。Thesyringeisfilledwithfluid…注射器裝填液體andthenzeroed數(shù)值歸零Measuringcompartmentpressuresusingalocationrelativelyclosetothefracturesitehasbeendemonstratedtogiveslightlymoreaccurate(increased)readings.越靠近骨折端的筋膜室獲得讀數(shù)越精確。Thisisdonewheneverpossible.Thepressureintheanteriormusculatureistakenfirst.Afterintroducingtheneedlethroughthefascia,theplungerisgentlyadvancedtocauseinflowofasmallamountoffluidandthepressureisallowedtoequilibrate.第一步先測脛前筋膜室，針頭穿透筋膜后輕推注射器，保持壓力平衡。Thepatienthadadiastolicpressurebeforeinductionofanesthesiaof74mmofmercury.Thusacompartmentsyndromewasdiagnosedintheanteriorcompartment(74-66=8).病人麻醉前心舒張壓是74mmHg，所以筋膜室綜合征診斷成立。Pressureinthelateralcompartmentismeasurednext,justposteriortothefibula.Thepressureinthelateralcompartmentwas45.繼續(xù)測量外側筋膜室，壓力是45.ANTERIORPRESSUREMEASUREDHERENext,compartmentpressureintheposteriorcompartmentsaremeasuredbyintroducingthedevicejustposteriortothetibiamedially,allowingmeasurementoffirstthesuperficial,andbyfartheradvancement,thedeepcompartment.后側筋膜室壓測量從脛骨內側進入，先淺后深。Theposteriorcompartmentsdidnothavepressureswithin30mmHgofthediastolicpressureandwereconsiderednottohavedevelopedcompartmentsyndromes,yet.后側筋膜室壓與心舒張壓差不在30內，故未診斷筋膜室壓綜合征。Afteranteriorandlateralcompartmentfasciotomy,thepatientwastreatedwithanunreamed,staticallylocked