筋膜间室压测量-课件

筋膜室压的测量APandlateralviewsofaTschernetype2tibialshaftfracture.2型胫腓骨折正侧位片Withinapproximatelyonehourofpresentation,thepatient’sskinbegantoblister.大约一小时内病人皮肤开始出现水泡Abloodfilledblister.水泡内充血Aclearblister.清晰的水泡Compartmentpressureswerethereforemeasuredinallfourcompartments.Theareatobetestediscleanedwithbetadine.准备测4个筋膜室压力，正在用聚维酮碘消毒Therearemultipledevicesmadeforthistechnique.Thisimageshowsoneofthem.组合式压力仪Itisimportantthatwhenusingthedeviceitisheldparallelwiththefloorsoasnottoadverselyaffectthemeasurement.Thisisalsothecasewhenusingothertechniques,suchasarteriallinemeasurement,wherethetransducermustbeattheleveloftheexamination.必须与地面保持水平以免影响测量，否那么会影响传感器。Thesyringeisfilledwithfluid…注射器装填液体andthenzeroed数值归零Measuringcompartmentpressuresusingalocationrelativelyclosetothefracturesitehasbeendemonstratedtogiveslightlymoreaccurate(increased)readings.越靠近骨折端的筋膜室获得读数越精确。Thisisdonewheneverpossible.Thepressureintheanteriormusculatureistakenfirst.Afterintroducingtheneedlethroughthefascia,theplungerisgentlyadvancedtocauseinflowofasmallamountoffluidandthepressureisallowedtoequilibrate.第一步先测胫前筋膜室，针头穿透筋膜后轻推注射器，保持压力平衡。Thepatienthadadiastolicpressurebeforeinductionofanesthesiaof74mmofmercury.Thusacompartmentsyndromewasdiagnosedintheanteriorcompartment(74-66=8).病人麻醉前心舒张压是74mmHg，所以筋膜室综合征诊断成立。Pressureinthelateralcompartmentismeasurednext,justposteriortothefibula.Thepressureinthelateralcompartmentwas45.继续测量外侧筋膜室，压力是45.ANTERIORPRESSUREMEASUREDHERENext,compartmentpressureintheposteriorcompartmentsaremeasuredbyintroducingthedevicejustposteriortothetibiamedially,allowingmeasurementoffirstthesuperficial,andbyfartheradvancement,thedeepcompartment.后侧筋膜室压测量从胫骨内侧进入，先浅后深。Theposteriorcompartmentsdidnothavepressureswithin30mmHgofthediastolicpressureandwereconsiderednottohavedevelopedcompartmentsyndromes,yet.后侧筋膜室压与心舒张压差不在30内，故未诊断筋膜室压综合征。Afteranteriorandlateralcompartmentfasciotomy,thepatientwastreatedwithanunreamed,staticallylocked