气压止血带个体化压力设置策略对四肢骨科手术止血效果的影响

Effect of individualized inflation pressure setting of pneumatic tourniquet in surgical hemostasis in the limb orthopedic surgery

目的探讨分析气压止血带个体化设置充气压力的应用效果。方法选取2016年1月—2017年12月行四肢骨科手术的患者210例,根据随机数字表法分为基础血压组(BP组)、四肢周径组(LD组)和传统压力组(TP组),BP组根根据患者基础血压的收缩压设定气压止血带充气压力,LD组根据患者肢体周径设定充气压力,TP组根据传统压力设定(仪器使用说明书推荐值)。比较3种充气压力下的止血效果及止血带副损伤评价及患者术中躁动情况。结果 BP组和LD组患者上肢及下肢止血带压力均低于TP组,差异有统计学意义(P <0. 05)。BP组和LD组止血效果均优于TP组,差异有统计学意义(χ~2=6. 71,P=0. 03;χ~2=8. 53,P=0. 01)。BP组和LD组止血带副损伤评价均优于TP组,差异有统计学意义(χ~2=9. 76,P=0. 01;χ~2=9. 14,P=0. 01)。BP组和LD组术中躁动评分低于TP组,差异有统计学意义(χ~2=9. 95,P=0. 02;χ~2=10. 65,P=0. 01)。结论个体化充气压力策略能有效改善术中止血效果,减少止血带副损伤的发生。

Objective To investigate the effect of individualized inflation pressure setting of pneumatic tourniquet in surgical hemostasis in the limb orthopedic surgery. Methods A total of 210 patients with limb orthopedic surgeries were randomly divided into blood pressure （BP） group, limb diameter （LD） group and traditional pressure （TP） group. The inflation pressure of pneumatic tourniquet was set based on the systolic pressure in the BP group, based on limb diame- ter in the LD group and based on the recommended value. The efficacy on surgical hemostasis, collateral damage and intraoperative agitation were observed and compared among three groups. Results The inflation pressure of pneumatic tourniquet in BP group and LD group was lower than that in the TP group （P 〈 0.05）. There was a better hemostatic effect in the BP group and LD group compared with that in the TP group （X2 =6.71 ,P =0.03 ;X2 =8.53 ,P =0.01 ）. The e- valuation on collateral damage in BP group and LD group was better than that in the LD group （X2 = 9.76,P =0.01 ;X2 =9.14,P =0.01 ）. Compared with patients in the LD group, patients in the BP group and LD group had a less severity of intraoperative agitation （x2 =9.95 ,P =0.02;）（2 = 10.65, P = 0.01 ）. Conclusion The individualized inflation pressure setting of pneumatic tourniquet is effective to improve the hemostatic effect and reduce the risk of collateral damage in the limb or- thopedic surgery.