气压止血带在四肢骨科手术中应用研究进展

随着新型骨科手术辅助工具气压止血带在四肢骨科手术中的广泛应用,其并发症越来越引起临床重视.目前对气压止血带在四肢骨科手术中的操作细节,尤其是充气压的选择存在许多争议.为充分发挥气压止血带的作用,需要在使用范围、使用时间及设定充气压方面有一规范认识,及时防止可能引发的副损伤,避免并发症发生.该文就气压止血带在四肢骨科手术...     

止血带在四肢手术中的应用

止血带是用于暂时阻断主要血流流向肢体的一种器具，手术中用止血带可造成一个“无血区”。“无血区”有显的优点，在“无血区”里，对微细的结构，如肌腱和神经进行解剖和修复，操作较为容易，可避免因反复用纱布吸揩渗血而造成组织损伤；在大范围、大肢体创口的清创中，使用止血带可使病人减少失血。     

骨科四肢手术气压止血带安全使用的最佳证据应用

目的将气压止血带安全使用的最佳证据应用于骨科四肢手术患者,降低气压止血带使用并发症的发生率。方法遵循JBI的最佳证据临床应用程序,使用证据的持续质量改进模式图,获取气压止血带压力安全使用的相关证据,制定10条审查标准。采用现场观察、问卷调查、专家访谈等方法收集证据应用的障碍,分析可获得的资源,制定解决办法。结果证据应用后10条审查指标的执行情况显著高于基线审查(均P0.01);手术后即刻皮肤损伤发生率由基线审查的65.0%降至20.0%(P0.01)。结论手术室气压止血带安全使用最佳证据的临床应用,可规范手术室护士气压止血带临床操作,减少使用后并发症的发生,保证骨科手术患者的安全。     

四肢手术患儿术中应用气压止血带的护理

目的降低四肢手术患儿术中应用气压止血带所致的并发症。方法对151例术中应用气压止血带的四肢手术患儿,采取正确的方法绑扎止血带,选择恰当的压力(上肢使用压力19～29kPa,下肢使用压力28～55kPa)和使用时间,遵循充气快、放气慢的原则,使用中严密观察并采取针对性护理措施。结果 151例患儿术中术野清晰,无渗血和出血。手术结束肢端血运良好,皮肤无淤血点及水疱发生;术后72h随访无1例发生止血带疼痛,肢体对各种刺激反应正常,无神经肌肉损伤等并发症发生。结论正确使用气压止血带是预防四肢手术患儿止血带并发症的根本措施。     

四肢手术患儿术中应用气压止血带的护理

目的降低四肢手术患儿术中应用气压止血带所致的并发症。方法对151例术中应用气压止血带的四肢手术患儿,采取正确的方法绑扎止血带,选择恰当的压力（上肢使用压力19～29kPa,下肢使用压力28～55kPa）和使用时间,遵循充气快、放气慢的原则,使用中严密观察并采取针对性护理措施。结果 151例患儿术中术野清晰,无渗血和出血。手术结束肢端血运良好,皮肤无淤血点及水疱发生;术后72h随访无1例发生止血带疼痛,肢体对各种刺激反应正常,无神经肌肉损伤等并发症发生。结论正确使用气压止血带是预防四肢手术患儿止血带并发症的根本措施。     

气囊止血带的使用误区及对策

气囊止血带是四肢骨科手术的最好止血方法。若使用不当，最易步人误区，它不仅达不到理想的止血效果，反而起逆反作用。因此，走出误区、弥补缺陷、找出切实可行的护理对策，是更好地发挥止血带作用的当务之急。     

均压气囊止血带的研制及在上肢手术中的应用

目的 评价均压气囊止血带(EPPT)在上肢手术的应用效果.方法 选择健康成年志愿者40例先后用EPPT(A组)和常规止血带（B组）,测量肱动脉搏动消失时各组压力;按照随机数字表法将80例尺桡骨骨折病例随机分为两组,分别在EPPT(a)和常规止血带(b)下手术,观察止血效果、持续时间和并发症;采用SPSS 10.0统计软件对志愿者和临床试验分别行两独立样本均数t检验和两独立样本非参数检验.结果 志愿者试验,A组压力低于B组;临床试验,a组止血效果优于b组.结论 EPPT降低上肢手术止血压力,提供良好无血术野,避免并发症.     

止血带在手外科局麻手术中的应用

应用止血带在肢体手术操作中会带来诸多方便，是肢体手术所特有的骨科技术，临床应用较广泛。我们鉴于野战外科使用止血带的理论和经验，自1991年1月～1997年11月，在手外科病人局麻下应用止血带手术87例，取得良好的效果，将体会报告如下。     

踝部止血带与大腿止血带在足部手术中的应用比较

[目的]评价踝部止血带和大腿止血带在足部手术中的效果和安全性.[方法]回顾性研究选取本院行踝部以下手术的病例(2010年5月～ 2012年12月)共44例,其中,踝部止血带组21例,大腿止血带组23例.观察踝部止血带组和大腿止血带组的手术视野,术中血压、心率波动,止血带休克的变化,术后神经损伤,皮肤水泡等指标,对二者的应用效果和安全性进行比较分析.[结果]在足部手术中,二者均能提供一个良好的无血的手术视野,但术中使用踝部止血带相较大腿止血带所引起的术中血压波动及心率变化、术后神经症状和皮肤水泡发生率更低(P＜0.05),止血带休克发生率差异无统计学意义(P＞0.05).[结论]二者在足部手术中均能提供一个清晰地手术视野,但踝部止血带相比于大腿止血带在足部手术中具有更高的安全性.     

骨科下肢手术松解止血带后的血流动力学变化观察

骨科四肢手术前，在切口的近侧应用止血带以阻断患肢血运，可使术野清晰，出血减少和缩短手术时间，因此已被常规采用。但在松解止血带时，常可出现血流动力学的变化，甚至导致止血带性休克。为掌握其发生的规律，我们对250例下肢手术应用止血带的患者进行了临床观察，现报告观察结果如下。     

Pneumatic Tourniquet and Limb Blood Flow

The response of limb circulation to tourniquet ischaemia in the hind limb of the rabbit was studied. Muscle blood flow was evaluated by means of a local isotope technique using Xe¹²³ as the tracer and the changes occurring after tourniquet ischaemia of 60-180 minutes duration were investigated. The results obtained suggest that even when the tourniquet time is extended to 3 hours, no blood flow occurs in the limb distal to the tourniquet when the cuff is inflated to 300 mmHg. In all animals a hyperaemic reaction was noticed after releasing the tourniquet, and a peak reactive hyperaemia was registered 1 minute after the return of circulation. The magnitude of the reactive hyperaemia was independent of the length of tourniquet time. The hyperaemia was regularly of short duration and peak flow values were reached in 1 minute with the flow returning to normal or subnormal values after 5 minutes. Phlebography studies in 12 rabbits after 120-240 minute tourniquet blockade showed only one thrombosis in a deep popliteal vein after the 240-minute tourniquet time.     

Effect of Pneumatic Tourniquet on Muscle Oxygen Tension

Recent investigations suggest that circulation in a limb can be reduced with a tourniquet to less than 1 per cent of the control limb, or even completely occluded. The development of tissue oxygen tonometry with implanted silastic tubes has provided new possibilities for assessing muscle tissue oxygen tension. In the present work, this method was employed to register the effect of tourniquet blockade on the lower limb muscle PO₂, in rabbits. The duration of the tourniquet blockade was 60, 120 and 180 minutes. The baseline muscle PO₂, in the tibialis anterior muscle was 22.6 ± 0.6 mmHg. During the tourniquet blockade the oxygen tension dropped to minimal values between 9.2 ± 0.5 and 10.7 ± 0.6 mmHg in these experimental groups, but the tissue microclimate never reached fully anoxic conditions. The rapid response of muscle PO₂ to oxygen breathing after release of the blockade suggests that limb microcirculation tolerates tourniquet occlusion well.     

Limb Blood Flow in the Presence of a Tourniquet

There is little accurate data on the blood flow to a limb distal to the site of application of a tourniquet. This has been studied in Rhesus monkeys with 50 μ diameter microspheres labelled with ⁵¹Cr and by the washout of ²²Na injected into the tissues. One limb was exsanguinated and the circulation occluded with a pneumatic tourniquet and the opposite limb used as a control. The results show that blood flow to the occluded limb is less than 1 per cent of the flow to the control limb. It is unlikely that this relieves the ischaemia in any way as has been suggested.     

聚焦解决模式在老年高血压患者健康教育中的应用

目的 探讨聚焦解决模式在老年高血压患者健康教育中的应用方法及效果。方法 将100例住院老年高血压患者随机分为观察组与对照组各50例。对照组按照常规内容和模式进行健康教育，观察组按照聚焦解决模式5个步骤进行健康教育。分别于健康教育前、后对两组患者的高血压知识知晓率、服药依从性及血压进行比较评价。结果 观察组患者服药依从性和高血压知识知晓率显著优于对照组（均P〈0．05）；血压水平显著低于对照组（P〈0．05）。结论 采用聚焦解决模式对住院老年高血压患者实施健康教育．可显著提高健康教育效果．增强患者服药依从性，有效控制血压水平，从而提高患者的生活质量。     

Effect of Pneumatic Tourniquet on Muscle Oxygen Tension

Recent investigations suggest that circulation in a limb can be reduced with a tourniquet to less than 1 per cent of the control limb, or even completely occluded. The development of tissue oxygen tonometry with implanted silastic tubes has provided new possibilities for assessing muscle tissue oxygen tension. In the present work, this method was employed to register the effect of tourniquet blockade on the lower limb muscle PO₂, in rabbits. The duration of the tourniquet blockade was 60, 120 and 180 minutes. The baseline muscle PO₂, in the tibialis anterior muscle was 22.6 ± 0.6 mmHg. During the tourniquet blockade the oxygen tension dropped to minimal values between 9.2 ± 0.5 and 10.7 ± 0.6 mmHg in these experimental groups, but the tissue microclimate never reached fully anoxic conditions. The rapid response of muscle PO₂ to oxygen breathing after release of the blockade suggests that limb microcirculation tolerates tourniquet occlusion well.     

脉搏波法无创检测动脉血压的研究进展

文章介绍了脉搏波的测量方法以及利用脉搏波特征参数间接测量无创血压的原理和特点。综述了目前国内外利用脉搏波进行血压测量的现状以及探讨了发展趋势和存在的问题。     

高血压病人无创血压值与有创血压值的对比研究

目的探讨临床常用汞柱式血压计测量高血压病人血压的误差及其原因。方法选取高血压病人及正常血压者各 2 0例 ,用有创法及无创法分别测量同一上肢肱动脉血压 ,每例均于 7:0 0～ 8:0 0空腹状态用两种方法测血压 6次。结果汞柱式血压计测量血压的结果与实际血压相比 ,在高血压病人中收缩压约低 10mmHg(P <0 .0 1) ,舒张压差异无显著性意义 (P >0 .0 5 ) ;在血压正常者中 ,收缩压低 6mmHg左右 (P <0 .0 1) ,舒张压约高 9mmHg(P<0 .0 5 )。造成这种误差的原因与臂围大小无明显关系。结论用汞柱式血压计测量肱动脉血压的值与实际值有一定差异 ,对于高血压病人 ,收缩压误差较大 ,而舒张压则较准确 ;对于正常人收缩压易低估 ,舒张压易高估。高血压病人的血压较高且有明显动脉硬化者 ,临床表现与血压不符时 ,可考虑采用有创法测量血压 ,以便准确了解病情。     

Effects of Three Anaesthesia Methods on Haemodynamic Responses Connected with the Use of Thigh Tourniquet in Orthopaedic Patients

Haemodynamic changes were studied in 51 patients undergoing orthopaedic surgery of the lower extremity, including exsanguination and thigh tourniquet for longer than 60 min. The patients were randomly divided into three anaesthesia groups: general anaesthesia (including enflurane), epidural anaesthesia (20 ml 0.5% bupivacaine) and spinal anaesthesia (3 ml 0.5% bupivacaine). During the study, five epidural and one spinal patient excluded from haemodynamic comparison required general anaesthesia because of pain from the surgery or ischaemia. In the general anaesthesia group, there was a rise in either systolic or diastolic arterial pressure of over 30% of the control value in 8/15 patients. In the spinal anaesthesia patients, there was a transient rise above 30% in only one patient out of 15 and no rise in the 15 epidural group patients. On the other hand, 11/15 of the epidural patients needed additional analgesics and/or sedation for pain or restlessness. The mean rise in the haemodynamic parameters including CVP was small on inflation of the tourniquet cuff; on deflation there was a mean decrease in CVP of 1-3 cmH2 (0.1-0.3 kPa), the maximum decrease being 8 cmH2O (0.8 kPa). The mean decrease in systolic arterial blood pressure ranged from 2 to 14 mmHg (0.27 to 1.87 kPa) when the cuff was deflated.     

Effect of Different Tourniquet Pressure on Postoperative Pain and Complications After Total Knee Arthroplasty: A Prospective,Randomized Controlled Trial

BackgroundTourniquet pressure inflation is commonly selected between 100 and 150 mm Hg above the systolic blood pressure (SBP). Given the lack of evidence to support a given inflation pressure, our study aimed to ascertain the lowest tourniquet pressure that facilitated total knee arthroplasty (TKA) and resulted in the least postoperative pain and complications.MethodsIn a double-blind, randomized controlled trial of patients scheduled for unilateral primary TKA, 150 were assigned to use tourniquet pressures of SBP + 75 mm Hg (group I), SBP + 100 mm Hg (group II), and SBP + 150 mm Hg (group III). The quality of the bloodless field, total blood loss, and limb swelling were determined perioperatively. Clinical outcomes were evaluated by visual analog scale for pain at thigh and surgical site, serum creatinine phosphokinase levels, wound complications, range of motion, and Knee Society Score.ResultsVisual analog scale for pain at thigh and surgical site were lowest in group I (P < .01) and highest in group III (P < .01). However, the quality of bloodless field at the tibial cutting surface was significantly better in group III compared to group I/II but not at the femoral cutting surface. The total blood loss and limb swelling showed no difference among 3 groups. Postoperative serum creatinine phosphokinase levels at 24 and 48 hours and wound complications in group III were significantly higher than group I (P < .01) and group II (P < .01). Nevertheless, postoperative knee range of motion and Knee Society Score were not significantly different among 3 groups.ConclusionPost TKA, the lowest tourniquet pressure was associated with significantly less postoperative tourniquet and surgical site pain, muscle damage, and wound complications.