膝关节表面置换术中气压止血带的个体化压力护理研究

Research on Nursing of pneumatic tourniquet pressure settings in Total knee arthroplasty

目的:探讨气压止血带在膝关节表面置换术中个体化压力设置方法及影响因素。方法:腰硬联合麻醉下择期行膝关节表面置换术的患者60例,随机分为两组,每组30例,处理组(T组):行气压止血带个体化设置;对照组(C组):行常规止血带设置,压力设置为500 mm Hg。测量并记录术前大腿根部的周径(cm)、大腿局部的动脉收缩压(mm Hg)、患者的体重指数(BMI)、年龄(y)、手术时间(min),统计术中的出血量(ml)、术中使用止血带的压力(mm Hg),对影响因素进行多元线性回归筛选,并得出回归方程。同时记录并统计相关并发症。结果:两组患者间的观察指标中,大腿周径、大腿动脉收缩压、体重指数、年龄、止血带时间及术中出血量比较差异无统计学意义(P>0.05),大腿周径(P<0.05)及大腿动脉收缩压(P<0.05)是止血带个体化压力设置主要影响因素,在回归方程中X1代表大腿周径,X2代表大腿动脉收缩压,个体化压力设置回归方程:y=116.223 71+2.863 81 X1+0.615 31 X2。结论:止血带压力个体化设置在膝关节表面置换中可达到临床医学要求,可有效减少术中出血量。

Objective To investigate the method and effect on pneumatic tourniquet pressure settings in total knee arthroplasty. Method Sixty patients with lumbar elective knee replacement surgery under epidural anesthesia were randomly divided into two groups,30 cases in each group,the treatment group（ group T） ： pneumatic tourniquet individual settings; the control group（ group C） ： conventional tourniquet pressure setting： the pressure was set to 500 mm Hg. Thigh circumference（ cm）,systolic blood pressure of the thigh（ mmHg）,the body mass index（ BMI）,age（ y）,operation time（ min）,perioperative blood loss（ ml）,total tourniquet pressure（ mmHg） were observed and recorded. The influencing factors on tourniquet pressure setting was analyze with multiple linear regression filter and the regression equation were obtained. The complications about pneumatic tourniquet were recorded. Results Thigh circumference,systolic blood pressure of the thigh,the body mass index,age,operation time,perioperative blood loss in two groups had no significant difference（ P〉0. 05）. Thigh circumference（ P〈0. 05） and femoral artery systolic pressure（ P〈0. 05） were the main factors on individual tourniquet pressure setting. X1 represents thigh circumference and X2 represents the thigh artery systolic blood pressure in the regression equation： y = 116. 223 71 ＋ 2. 863 81 X1＋ 0. 615 31 X2. Conclusion The tourniquet pressure individual settings can reach clinical requirements in knee arthroplasty,can effectively reduce the amount of bleeding.