Evaluation of emergency tourniquets for prehospital use in China

Objective

Massive hemorrhage is life-threatening during armed conflicts. Tourniquets are important medical devices used to reduce severe bleeding in trauma. The aim of this study was to empirically evaluate the current tourniquets used in China and provide information to emergency nurses in selecting the appropriate tourniquet.

Methods

Five tourniquets were self-applied by 20 healthy participants. The blood flow distal to the tourniquet site was assessed using vascular Doppler ultrasound. Application time, pain, numbness, and other parameters were evaluated.

Results

The bladder tourniquet and windlass tourniquet effectively occluded arterial blood flow with success rates higher than 75% in both the upper and lower extremities. The Cargo-strap was the fastest to apply, taking (7.22±2.30) s for the upper extremity and (6.48±2.40) s for the lower extremity. The rubber tube was the most painful, and the improvised tourniquet was the least efficient. The success rates were higher in the lower extremity than in the upper extremity (P<0.05, X²=5.714).

Conclusions

The bladder tourniquet and the windlass tourniquet are efficient tourniquets, although the windlass is superior with respect to portability and pain. The Cargo-strap and rubber tourniquets have several disadvantages that reduce their suitability for field use. The improvised tourniquet is not recommended because of low efficiency and severe pain during implementation.     

三种止血带动脉止血对犬束扎肢体静脉血气的影响

目的 通过动物实验观察三种止血带在控制犬下肢动脉出血时静脉血气指标的变化,分析并比较不同止血带对束扎侧组织的损伤程度.方法 将18只犬完全随机分为三组,并制作成后肢股动脉出血模型.采用橡皮管止血带、卡式止血带和多功能自控加压止血绷带(简称止血绷带)三种止血带对三组犬进行股动脉止血.分别测量三组犬止血带下压力并在止血后0.5,1,3,6 h检测束扎肢体静脉血气指标.结果 (1)止血绷带组的带下压力为0.74 kg,显著小于橡皮管止血带组(1.46 kg)和卡式止血带组(2.09 kg)(P＜0.05).(2)止血后1 h,止血绷带组静脉血氧分压(PvO2)为(36.45±10.45)mm Hg,橡皮管止血带组为(28.73±9.07)mm Hg,均高于卡式止血带组的(21.87±4.30)mmHg(P＜0.05);止血后3,6 h,止血绷带组二氧化碳分压(PvCO2)分别为(50.67±9.31)mm Hg和(60.02±10.85)mm Hg,橡皮管止血带组分别为(16.85±16.51)mmHg和(60.02±10.85)mm Hg,均低于卡式止血带组(P＜0.05或0.01).结论 止血绷带在较小压力下能有效止住犬的股动脉出血;在三种止血带中,止血绷带对束侧组织的损伤最小.     

UK combat-related pelvic junctional vascular injuries 2008–2011: Implications for future intervention

In a recent publication, 297 of 6450 (4.6%) military coalition deaths over ten years were reported to be due to junctional bleeding. The authors suggested that some of these deaths could have been avoided with a junctional haemorrhage control device.     

止血带对兔血液流变学的影响

目的 探讨止血带对血液流变学的影响。方法 大白兔20只,止血带应用时间为3h。分别于止血带充气前和释放止血带后2min抽取静脉血测定血液流变学指标：血液粘度、血球压积、纤维蛋白原、红细胞聚积指数、变形指数及刚性指数、K值方程;以止血带充气前指标作为。于松止血带后5min取腓肠肌标本观察微血管超微结构。结果 与基础值相比,应用止血带后全血粘度及血浆粘度均升高（P＜0．05或0．01）,红细胞聚集指数和刚性指数上升,变形指数下降（P＜0．05）,K值方程,纤维蛋白原均增高（P＜0．05或0．01）,血球压积无显著性变化（P＞0．05）,透射电镜下见微血管内皮细胞轻度肿胀,血管内颗粒物浓聚,但无血栓形成。结论 长时间应用止血带后血液处于高粘带状态,有血栓形成倾向。     

参麦注射液减轻肢体缺血再灌注后肺功能障碍的机制研究

目的观察参麦注射液对使用止血带的下肢手术患者肺功能的影响及可能的机制。方法选择单侧下肢手术患者41例,年龄20～60岁,体重指数18～28kg/m2,ASA分级Ⅰ或Ⅱ级,止血带持续充气或手术时间1.0～1.5h,根据是否应用止血带分为无止血带组(N组,n=15)和止血带组,再将止血带组患者按单盲法随机分为缺血再灌组(I/R组,n=14)和参麦组(SM组,n=12)。所有患者于L1,2或L2,3间隙行腰麻-硬膜外联合阻滞,感觉阻滞平面控制在T8以下。SM组在上止血带前15min将参麦注射液0.6ml/kg加入100ml生理盐水静脉滴注完毕,而I/R组则在相同时间内静脉滴注等量生理盐水。3组患者于扎止血带/手术开始前即刻(T0)、止血带松开后/术后0.5h(T1)、2h(T2)、6h(T3)和24h(T4)时分别采集桡动脉血样行血气分析,测定血浆丙二醛(MDA)、血清白细胞介素6(IL-6)和IL-8浓度。结果与T0比较,I/R组T3时PaO2降低,PA-aDO2、RI和血浆MDA浓度升高,血清IL-6和IL-8浓度在T3～4时升高,SM组血清IL-6浓度T3时升高(P<0.05或0.01),N组和SM组各时点各项指标差异无统计学意义(P>0.05);与N组比较,I/R组PaO2降低,PA-aDO2、RI、血浆MDA浓度、血清IL-6和IL-8浓度升高(P<0.05或0.01);与I/R比较,SM组PaO2升高,PA-aDO2、RI、血浆MDA浓度、血清IL-6和IL-8浓度降低(P<0.05或0.01)。结论单侧下肢手术患者,止血带的应用可导致肺换气功能障碍,参麦注射液可有效改善患者的肺换气功能,机制可能与其抑制氧自由基脂质过氧化和全身炎症反应有关。     

人工全膝关节置换术中止血带应用方法的效果比较

目的评估人工全膝关节置换术时止血带两种不同的使用方法对患者术后康复的影响。方法回顾分析我院2009年5月-2010年10月47例初次人工全膝关节置换术患者病例,其中女性42例,男性5例,平均年龄62.68岁;记录术后第1、3、5d的血红蛋白及红细胞计数下降值,术后关节腔引流量、术中失血量、止血带时间、总手术时间,并根据对止血带两种不同的使用方法进行比较。结果止血带两种应用方法对术后患者血红蛋白及红细胞计数下降值、术后关节腔引流量、术中失血量、总手术时间无明显影响。结论采用股骨截骨至关节囊缝合期间使用止血带可显著缩短止血带使用时间,并不会导致术中出血量增加和术后贫血情况加剧。     

止血带压迫对大鼠坐骨神经轴浆运输的影响

目的 评价止血带压迫对大鼠坐骨神经轴浆运输的影响.方法 雄性SD大鼠24只,12周龄,体重250～300 g,采用抛硬币法,将大鼠随机分为4组(n=6):止血带压迫1 h组(A组)、2 h组(B组)、4 h组(C组)和12 h组(D组).在股骨中上1/3处,结扎弹性止血带,A组持续压迫1 h;其余各组每持续压迫1 h后松开止血带10 min,直至累计压迫总时间到达预定时间.取压迫处坐骨神经,采用免疫组化法测定止血带压迫部位近心端和远心端类胰岛素样生长因子-1(IGF-1)的表达水平.对压迫时间与IGF-1表达间进行直线回归分析.结果 与A组比较,其他3组止血带压迫部位远心端IGF-1表达差异无统计学意义(P＞0.05),止血带压迫部位近心端IGF-1表达上调,且呈时间依赖性(P＜0.01).压迫时间(X)与止血带压迫部位近心端IGF-1表达(Y)间的直线回归方程为Y=0.422X+0.887,而与止血带压迫部位远心端IGF-1表达不呈直线关系.结论 止血带压迫可抑制大鼠坐骨神经的轴浆运输,且呈时间依赖性.

Abstract：

Objective To investigate the effect of tourniquet compression on axonal transport in sciatic nerve of rats.Methods Twenty-four 12-week old male SD rats weighing 250-300 g were randomly divided into 4groups according to the duration of tourniquet compression(n=6 each):1,2,4 and 12 h.The tourniquet was applied to the middle 1/3 of thigh.In each animal whether the left or right thigh was compressed was determined by a flip of coin.The tourniquet was released for 10 min after every hour of compression.A 3-cm segment of sciatic nerve was removed at the end of tourniquet compression(1.5 cm proximal and 1.5 cm distal to the site of compression).Immuno-histochemistry was used to measure the expression of insulin-like growth factor-1(IGF-1)in the sciatic nerve.The ratio of average optic density of the compressed sciatic nerve to that of control was used to estimate the degree of IGF-1 accumulation.The regression equation of the interaction between the duration of compression and accumulation of IGF-1 was analyzed.Results There was significant accumulation of IGF-1 in the sciatic nerve proximal to the compressed site.The accumulation increased with the duration of compression.There was no significant accumulation of IGF-1 in the sciatic nerve distal to the compressed site.The regression equation of the interaction between the duration of compression(X)and accumulation of IGF-1(Y)was Y=0.422X+0.887.Conclusion Tourniquet compression of sciatic nerve can inhibit axonal transport.The accumulation increases with the duration of compression.     

止血带对全膝关节置换术后深静脉血栓形成的影响

目的 探讨止血带对全膝关节置换术后深静脉血栓形成的影响.方法 采用随机对照研究,将连续入院的拟行初次全膝关节置换的80例患者随机分为两组:一组使用止血带(止血带组,40例),一组不使用止血带(非止血带组,40例).全部采用后十字韧带替代型骨水泥固定人工膝关节(Smith-Nephew),手术由同一组医生完成.比较两组患者围手术期失血量、深静脉血栓和肺动脉栓塞发生率、术中栓子面积百分率%Ae(即总栓子面积占右心房面积的百分率).术前及术后第1～10天行彩色多普勒超声检查,观察双下肢深静脉血栓的发生;术中使用经食道超声心动图监测右心房,评估止血带释放后的%Ae.结果 止血带组患者术中失血最小于非止血带组患者,但两组患者围手术期总失血量比较差异无统计学意义.止血带组患者和非止血带组患者深静脉血栓发生率比较无统计学差异,两组均未发生肺动脉栓塞.止血带组患者%Ae在释放止血带后的1 min达到高峰;非止血带组患者%Ae仅在扩髓和植入假体时出现高峰,然后缓慢下降;止血带组患者%Ae在释放止血带后大于非止血带组患者.结论 止血带的使用对全膝关节置换术围手术期总失血量并无明显影响,不增加深静脉血栓和肺栓塞的发生风险.     

安装大腿近侧气囊止血带对髌股关节运动的影响

目的探讨膝关节屈曲和伸直状态下安装大腿近侧气囊止血带对髌股关节运动的影响。方法收集住院的非髌股关节疾病患者,选择膝关节20侧,在腰麻或连续硬膜外状态下屈膝30°时测量膝关节髌骨高度和股骨滑车角,然后分伸膝位安装止血带和屈膝位安装止血带两组自身先后对比,测量膝关节不同屈曲角度下Laurin髌股关节外侧角和Merchant吻合角。比较气囊止血带在膝关节不同屈伸状态下对髌股关节运动学的影响。结果在膝关节屈曲30°时,髌骨高度的Caton指数为(1.02±0.19),股骨滑车角(138.9±7.4)°。在膝关节屈曲过程中,髌股关节呈现Merchant吻合角增大的趋势,尤其在膝关节屈曲30~45°的时候变化明显,当屈曲角度继续增大时吻合角基本稳定;Lauren髌股关节外侧角保持相对稳定。伸直位和屈曲位安装止血带引起髌股关节Merchant吻合角和Lauren髌股关节外侧角间的差异没有统计学意义。结论在正常膝关节,大腿近侧气囊止血带对髌股轨迹的影响主要表现为最初屈曲的45°内Merchant髌股吻合角的的增大,而Laurin髌股关节外侧较保持相对稳定。伸直位和屈曲位安装大腿近侧气囊止血带对正常膝关节髌股关节运动的改变没有统计学意义。