Noninvasive Measurements of Intramuscular Pressure Using Pulsed Phase-locked Loop Ultrasound for Detecting Compartment Syndromes: A Preliminary Report
Noninvasive Measurements of Intramuscular Pressure Using Pulsed Phase-locked Loop Ultrasound for Detecting Compartment Syndromes: A Preliminary Report
复制标题
使用脉冲锁相环超声无创测量肌内压力来检测筋膜室综合征：初步报告
DOI：
10.1097/00005131-200608000-00002
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发表时间：
2006
影响因子：
2.3
通讯作者：
A. Hargens
中科院分区：
文献类型：
--
作者：
J. Wiemann;T. Ueno;Bryan T. Leek;W. Yost;A. Schwartz;A. Hargens
目的建立人体筋膜间室填塞模型，验证超声脉冲锁相环（PPLL）筋膜位移波形分析在无创测量肌内压力（IMP）中的应用效果。设计人体实验。设置大学一级创伤中心。参与者：男性9名，女性1名，年龄20 ~ 59岁，男性急性间室综合征（ACS）患者3名，年龄31 ~ 38岁。干预措施：将大腿止血带从40 mm Hg逐步膨胀至100 mm Hg，以短暂增加志愿者的IMP。裂隙导管有创IMP和PPLL筋膜位移波形对模型ACS志愿者和ACS患者的影响。结果模型室填塞组，大腿袖带闭塞使前室IMP由平均12.1 mm Hg （SE=1.5）增加到平均27.4 mm Hg （SE=2.4， N=8， P<0.0001）。通过快速傅里叶变换，PPLL测得的筋膜位移波形基频幅值与次谐波幅值之比在相同方案下从静息平均值1.12 （SE=0.07）增加到平均值1.85 (SE=0.18) （N=6， P=0.001）。结合筋膜室综合征患者资料，IMP与PPLL呈线性相关，R2值为0.8887。结论股动脉下袖带压力可导致IMP显著且短暂性升高，可作为前房室填塞的模型。PPLL能够检测与动脉搏动相对应的筋膜位移波形，并进一步区分正常和升高的IMP。PPLL测量与有创IMP之间存在线性相关性。PPLL作为一种无创IMP测量设备用于检测室综合征具有潜在的实用性。
Objectives To develop a human model for compartment tamponade and test the efficacy of ultrasonic pulsed phase-locked loop (PPLL) fascial displacement waveform analysis for noninvasive measurement of intramuscular pressure (IMP). Design Human subject experiment. Setting University Level 1 trauma center. Participants Nine male and 1 female volunteers (age 20 to 59),3 male acute compartment syndrome (ACS) patients (age 31 to 38). Intervention Thigh tourniquet was inflated in a stepwise fashion from 40 to 100 mm Hg to increase IMP transiently in volunteers. Main Outcome Measurements Invasive IMP by slit catheter and PPLL fascial displacement waveform in volunteers with model ACS and patients with ACS. Results In the model compartment tamponade group, thigh cuff occlusion increased IMP in the anterior compartment from a mean of 12.1 mm Hg (SE=1.5) to a mean of 27.4 mm Hg (SE=2.4, N=8, P<0.0001). By fast Fourier transform, the ratio of the amplitude of the fundamental frequency to the amplitude of the second harmonic frequency of the fascial displacement waveform as measured by PPLL increased from a resting mean of 1.12 (SE=0.07) to a mean of 1.85 (SE=0.18) under the same protocol (N=6, P=0.001). Combined data with compartment syndrome patients revealed linear correlation between IMP and PPLL with an R2 value of 0.8887. Conclusions Subarterial thigh cuff pressure causes a significant and transient increase in IMP, serving as a model for anterior compartment tamponade. PPLL is able to detect fascial displacement waveforms corresponding to arterial pulsation and furthermore distinguishes between normal and elevated IMP. There is a linear correlation between PPLL measurements and invasive IMP. The PPLL shows potential utility as a device for noninvasive measurement of IMP for detecting compartment syndromes.