双下肢近端绑扎止血带在创伤骨折伴失血性休克中的临床应用

Clinical application of tourniquets in proximal lower extremities in traumatic fracture with hemorrhagic shock

目的探讨双下肢近端绑扎止血带在四肢骨折伴失血性休克急救中实际临床应用的有效性和安全性。方法采用回顾性病例对照研究分析西南医科大学附属中医医院骨科2010年1月—2017年7月收治的四肢骨折伴失血性休克53例,其中仅在创伤肢体常规使用止血带(伤肢组) 26例,双下肢近端绑扎止血带+创伤肢体常规使用止血带组(双下肢组) 27例,观察两组入院24h内病死率,血压恢复到正常值低限范围所需时间,止血带休克发生率,术后神经、肌肉、皮肤损害及血栓发生率。结果入院24h内病死率:双下肢组无一例死亡,伤肢组3例(病死率11. 5%),差异有统计学意义(P <0. 05)。双下肢组血压恢复到正常值低限范围所需时间为(18. 59±3. 05) min,伤肢组血压恢复到正常值低限范围所需时间为(49. 22±7. 66) min(P <0. 05)。伤肢组无止血带休克反应,双下肢组止血带休克反应发生1例(P> 0. 05)。术后发生神经、肌肉、皮肤损害双下肢组2例,伤肢组1例(P> 0. 05);伤肢组术后肢体未发生静脉血栓,双下肢组术后发生静脉血栓1例(P> 0. 05)。结论在创伤四肢骨折伴严重休克的急救中使用双下肢近端绑扎止血带的方法可以降低入院24h内病死率,血压可以更快恢复到正常值的低限,且不会提高止血带休克发生率、血栓形成率和术后神经、肌肉、皮肤损伤发生率。

Objective To investigate the effectiveness and safety of the clinical application of tourniquets in the proximal extremity of both lower extremities in emergency treatment of limb fracture with hemorrhagic shock.Methods A retrospective case-control study was used to analyze 53 cases from Jan.2010 to Jul.2017.The control group used only tourniquets on traumatic limbs for 26 patients;the experimental group used tourniquets on both traumatic limbs and lower extremities for 27 patients.The death rate within 24 h after admission,the time required for blood pressure to recover to the lowest normal value,the incidence of tourniquet shock,and the incidence of postoperative neurological,muscular,and skin damage,and the thrombosis rate were observed.Results The number of died patients within 24 h after admission was 0 in the experimental group(mortality rate 0%)and 3 in the control group(mortality rate 11.5%,P<0.05).The time required for the blood pressure of the experimental group to recover to the lowest normal value was(18.59±3.05)min,and the time for the blood pressure of the control group to recover to the lowest normal value was(49.22±7.66)min(P<0.05).There was no tourniquet shock in the control group and 1 case of tourniquet shock in the experimental group(P >0.05).Nerve,muscle,and skin damage occurred in 2 patients in the experimental group and 1 in the control group(P >0.05).No venous thrombosis occurred in the control group,and 1 patient with venous thrombosis occurred in the experimental group(P >0.05).Conclusion When traumatic fracture with severe shock occurs,the usage of tourniquet to both proximal lower extremities can reduce death rate within 24 h of admission.It can restore blood pressure to the lowest normal range more quickly,and will not increase the incidence of tourniquet shock and thrombosis and the damage of nerve,muscle,and skin after surgery.