超声技术判断老年患者下肢手术止血带最佳充气压力的研究

Determination of Tourniquet Charge Pressure by Ultrasound during Lower Extremity Operation for Elderly Patients

目的探讨超声技术判断老年患者下肢手术止血带充气压力的效果。方法 2011年6月—2013年6月实施下肢手术且使用止血带的老年患者60例,随机分为试验组和对照组各30例。试验组患者依据超声技术判断止血带的最佳压力,对照组采用常规充气压力。比较两组患者入室(T1),麻醉结束后(T2)、充气60 min(T3),松止血带即刻(T4),松止血带10 min(T5)5个时间点平均动脉压、心率、动脉血气、乳酸脱氢酶、乳酸含量,记录两组患者在使用止血带过程中发生烦躁不安和疼痛的程度,评价止血带止血效果。结果两组患者止血带使用时间差异无统计学意义,试验组充气压力显著低于对照组。与对照组相比试验组患者T5时刻平均动脉压显著增高,心率显著减慢,与T1时刻相比,试验组患者T5时刻乳酸脱氢酶和乳酸显著增高。试验组与对照组在止血效果方面差异无统计学意义。与对照组相比,试验组患者使用止血带过程中疼痛评分,烦躁和并发症的发生率较低。结论老年患者使用超声指导设置气囊压力的方法,能够稳定血流动力学参数,降低止血带并发症的发生率,减轻患者使用止血带的不适感,提高围术期护理的质量。

Objective To explore the determination of tourniquet charge pressure by ultrasound in lower limb surgery for elderly patients. Methods Totally 60 elderly patients undergoing lower limb surgery with a tourniquet from June 2011 to June 2013 were divided into experimental group with ultrasound technology to determine the optimum charge pressure of tourniquet and control group with conventional pneumatic pressure. Mean arterial pressure （MAP）, heart rate （HR）, lactate dehydrogenase （LDH）, lactic acid at different time points and the effect of tourniquet were measured and patients ’ irritability and degree of pain were recorded. Results There was lower tourniquet charge pressure in experimental group. Compared with those in control group, MAP increased significantly while HR was significantly slower ten minutes after releasing the tourniquet in experimental group. Intra-group comparison in experimental group indicated that （LDH） and lactic acid increased significantly ten minutes after releasing the tourniquet when compared with the time patients entered into the operating room. There was no statistical significance of the effect of tourniquet in both groups while there were lower pain score and lower occurrence of irritability and complications in experimental group. Conclusion It is practical to determine the charge pressure of tourniquet for elderly patients in extremity surgery by ultrasound, which helps to reduce the incidence of complications and improve patients ’ discomfort and the nursing quality.