止血带个性化压力值在下肢手术中的探讨

doi:10.13418/j.issn.1001-165x.2021.06.018

PDF(2430 KB)

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (6) : 721-726. DOI: 10.13418/j.issn.1001-165x.2021.06.018

临床研究

止血带个性化压力值在下肢手术中的探讨

郭晓泽¹，　李炳林^1，2，3，　卓荣锋²，　李展¹，　夏琼⁴，　章莹^1，2，3

作者信息 +

Personalized pressure of tourniquet in lower limb surgery

Guo Xiaoze¹， Li Binglin^1，2，3， Zhuo Rongfeng²， Li Zhan¹，Xia Qiong⁴， Zhang Ying^1，2，3

Author information +

文章历史 +

摘要

目的　分析在下肢手术中，大腿周径和收缩压与止血带压力的关系，探讨止血带个性化压力值。方法　选择2018年4月至2018年5月在南部战区总医院收治的55例行下肢手术且可使用止血带的患者，记录术中止血带压力、术区出血情况、大腿周径、收缩压及体重指数(BMI)等资料，根据大腿周径、收缩压及BMI对患者进行分组，分析各组止血带压力变化情况以及止血带压力与大腿周径、收缩压及BMI的相关性。结果止血效果为良好时，各分组止血带最低压力值及压力差比较差异均有统计学意义(P<0.05)；止血带压力与大腿周径(r=0.734，P<0.05)、收缩压(r=0.889，P<0.05)呈正相关，但止血带压力与BMI无相关性 (r=0.076，P>0.05)。结论　在下肢手术中，止血带的个性化压力值可根据大腿周径及收缩压进行设定，当患者收缩压≥130 mmHg时，则再增加30 mmHg。另外，止血带压力的设置不需参考BMI。

Abstract

Objective 　To analyze the relationship between thigh circumference (TC), systolic blood pressure (SBP) and tourniquet pressure in lower limb surgery, and discuss the personalized pressure of tourniquet. Methods Fifty-five patients who underwent lower limb surgery using tourniquet in General Hospital of Southern Theatre Command of PLA from April, 2018 to May, 2018 were included in the study. Patients were separately divided into groups according to the thigh circumference, systolic blood pressure and body mass index (BMI). The intraoperative tourniquet pressure, intraoperative blood bleeding, TC, SBP and BMI were recorded. The changes of tourniquet pressure and the correlation between tourniquet pressure and TC, SBP and BMI were recorded. Results In remarkable effect of hemostasis, there were significant differences in minimum pressure of tourniquet and the pressure difference between tourniquet and SBP in each group (P<0.05) . The tourniquet pressure was positively correlated with TC (r=0.734, P<0.05) and SBP (r=0.889, P<0.05), but it was not correlated with BMI (r=0.076, P>0.05), respectively. Conclusions The personalized tourniquet pressure can be set according to TC and BDP in lower limb surgery. Meanwhile, if the SBP is greater than 130 mmHg, the tourniquet pressure should add an extra 30 mmHg. In addition, there is no reference value for BMI in tourniquet pressure setting.

导出引用

郭晓泽, 李炳林, 卓荣锋, 李展, 夏琼, 章莹. 止血带个性化压力值在下肢手术中的探讨[J]. 中国临床解剖学杂志. 2021, 39(6): 721-726 https://doi.org/10.13418/j.issn.1001-165x.2021.06.018

Guo Xiaoze, Li Binglin, Zhuo Rongfeng, Li Zhan, Xia Qiong, Zhang Ying. Personalized pressure of tourniquet in lower limb surgery [J]. Chinese Journal of Clinical Anatomy. 2021, 39(6): 721-726 https://doi.org/10.13418/j.issn.1001-165x.2021.06.018

中图分类号： R605.972 R618　

参考文献

[1] Præstegaard M, Beisvåg E, Erichsen JL, et al.Tourniquet use in lower limb fracture surgery: a systematic review and meta-analysis[J].Eur J Orthop Surg Traumatol,2019,29(1):175-181. DOI: 10.1007/s00590-018-2282-z.
[2] 皮红英.止血带压力设置的基础与临床研究[D].中国人民解放军军医进修学院,2010.
[3] Cao Q, He Z, Fan Y, et al.Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion post-total knee arthroplasty: Full- versus second half-course application[J].J Orthop Surg (Hong Kong),2020, 28(1):1-8. DOI: 10.1177/2309499019896026.
[4] 周建国, 胡伟全, 毕声荣, 等. 个体化止血带压力在初次全膝关节置换中的应用[J].中国组织工程研究, 2019, 23(20): 3136-3142. DOI: 10.3969/j.issn. 2095-4344.1235.
[5] Tuncali B, Boya H, Kayhan Z, et al. Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial[J]. Acta Orthop Traumatol Turc, 2018, 52(4): 256-260. DOI: 10.1016/j.aott.2018.04.001.
[6] Ayik O, Demirel M, Birisik F,et al.The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes[published online ahead of print, 2020 Fed 19]. J Knee Surg, 2020. DOI: 10.1055/s-0040-1701454.
[7] Tuncali B, Boya H, Kayhan Z,et al.Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty[J]. Eklem Hastalik Cerrahisi,2018,29(1): 40-45. DOI: 10.5606/ehc.2018.57973.
[8] 李清梅, 贝抗胜, 邹金英, 等. 气囊止血带阻断下肢血流压力值的研究[J]. 中华护理杂志, 2006, 41(11): 965-968. DOI: CNKI:SUN:ZHHL. 0.2006-11-000.
[9] Goel R, Rondon AJ, Sydnor K,et al.Tourniquet Use Does Not Affect Functional Outcomes or Pain After Total Knee Arthroplasty[J]. J Bone Joint Surg,2019, 101(20):1821-1828. DOI: 10.2106/JBJS.19.00146.
[10] Kim TK, Bamne AB, Sim JA,et al.Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial[J]. BMC Musculoskelet Disord,2019,20(1):275. DOI:10.1186/s12891-019-2636-7.
[11] Jessee MB, Buckner SL, Dankel SJ,et al.The Influence of Cuff Width, Sex, and Race on Arterial Occlusion: Implications for Blood Flow Restriction Research[J]. Sports Med, 2016, 46(6): 913-921. DOI: 10.1007/s40279-016-0473-5.
[12] Benedick A, Rivera T, Vallier HA.Effect of Tourniquet Use During Ankle Fracture Fixation on Wound Healing and Infectious Complications[J]. Foot Ankle Int,2020, 41(6): 714-720. DOI: 10.1177/1071100720907379.