Diagnosis of Compartment Syndrome Based on Tissue Oxygenation.

摘要

The diagnosis of acute compartment syndrome (CS) remains problematic due to difficulty in diagnosis. Current treatment for acute extremity symptomatic CS is fasciotomy. However, surgical treatment has associated morbidity and may delay the recovery of the patients. Continuous measurement of intramuscular tissue oxygenation (PmO2) of the leg has been shown to be feasible in humans and highly responsive to induced compartment syndrome and fasciotomy in a dog model. Using the same model, we investigated the relationship between PmO2 and tissue viability. We further tested the feasibility of nonsurgical treatment of compartment syndrome using phenylephrine and dobutamine in the dog model. Under general anesthesia, CS was induced in the anterolateral compartment of one hindlimb via Hespan infusion. Polarographic oxygen probes were placed percutaneously into the anterolateral compartment. Compartment pressure, diastolic blood pressure and tissue oxygenation (PmO2) was recorded every 30 seconds. In the treated group, pharmacological treatments begin at 1 hour after the compartment syndrome is induced. Infusion of intravenous phenylephrine was initiated at 25mcg/min and titrated up to 100mcg/min as needed to increase the diastolic blood pressure 30mmHg above the baseline. Intravenous dobutamine at 60mcg/min was initiated 2 hours later. Six to seven hours after treatment, fasciotomy was performed on one leg. Animals were euthanized 2 weeks postoperatively at which point muscle biopsies were performed. Tissue viability was assessed MTT (3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Pharmacological treatment significantly increased PmO2 in the anterior compartment muscle. Two weeks after surgery, there was no significant difference between pharmacological treated and pharmacological plus fasciotomy treated groups.