To report the diagnosis methods and cl inical treatment effects of blood vessel trunk damage in l imbs. Methods From January 2001 to June 2006, 72 patients with vascular injury in l imbs were treated. There were 50 males and 22 females, aged from 5-60 years (median 39 years) and including 44 cases of open injury and 28 cases of closed injury.The locations were subclavian artery in 1, femoral artery in 23, popl iteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axilary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. Results In 72 cases, 67 survived and 5 were given amputation. Fortyeight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected l imbs were not different from that of normal l imbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory l imb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. Conclusion To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earl ier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earl ier opening the fascia cavity is the effective methods to recover the function of the l imbs and to avoid disabil ity.
Objective To discuss the relationship between the changes of hepatic blood flow detected by usingspectral Doppler ultrasound and serum TNF- α and IL-1 β levels after liver ischemia/reperfusion （I/R） of rat. Methods The hepatic ischemia 15 min and reperfusion models were established by using pringle method. The hepatic blood flow of hepatic artery and portal vein at 1， 6， and 24 hours after liver I/R were detected by using spectral Doppler ultrasound， the total blood flow volume （FV） was calculated， and the serum TNF- α and IL-1 β levels at each time point were detected. The correlation between the TNF-α， IL-1 β， and FV were analyzed. Results The FV at 1 hour and 6 hours after reperfusion in I/R group were less than those in sham operation （SO） group 〔（52.08±11.88） mL/min vs. （85.32±29.85） mL/min and （44.69±8.75）mL/min vs. （81.41±28.67） mL/min， P＜0.05〕. The FV at 24 hours after operation or reperfusion of 2 groups was no significant differences （P＞0.05）. The serum content of TNF-α at 1 hour after reperfusion in I/R group was higher than that in SO group 〔（310.52±39.83）pg/mL vs. （240.74±31.65）pg/mL， P＜0.05〕. The serum contents of TNF-α at 6 and 24 hours after operation or reperfusion of 2 groups were no significant differences （P＞0.05）. The serum contents of IL-1β at 1 hour and 6 hours in I/R group were higher than those in SO group 〔（38.08±3.73） pg/mLvs. （22.03±0.79） pg/mL and （27.44±6.11） pg/mL vs. （21.78±0.71） pg/mL， P＜0.05〕. The serum content of IL-1β at 24 hours after operation or reperfusion of 2 groups was no significant differences （P＞0.05）. There was a negative correlation between the FV and TNF-α or IL-1β （r=-0.43， P＜0.05；r=-0.46， P＜0.05）. Conclusions Spectral Doppler ultrasound can observe the changes of hepatic blood flow and evaluate the hepatic microcirculation indirectly. The hepatic blood flow after liver I/R decreases and it may be related to over expression of TNF-α and IL-1β.