全膝关节置换术个性化止血带压力设置

Personalized tourniquet pressure setting in total knee arthroplasty

[目的]探讨全膝关节置换术中,应用彩色多普勒超声技术个性化设定止血带充气压力对其临床疗效的影响。[方法]将2017年3月~2017年8月在全麻下行初次单侧全膝关节置换术的71例患者随机分为两组。个性化压力组36例,便携式彩超探头置于腘动脉处,当腘动脉血流峰图完全消失时的充气压力为个性化止血带压力值;固定压力组35例采用传统固定止血带压力值为270mmHg。比较两组止血带压力值、止血带使用时间、围手术期失血量、切口及止血带部位VAS疼痛评分、止血带部位周径、膝关节功能(HSS)评分、切口和止血带并发症。[结果]个性化压力组止血带的压力值、术后引流量、隐性失血量、总失血量、术后第1、3d切口及止血带部位VAS评分、术后止血带部位周径、止血带部位及切口部位并发症均显著低于固定压力组(P<0.05);术后1周膝关节功能评分,个性化压力组显著高于固定压力组(P<0.05)。而在术中失血量和止血带使用时间方面,两组差异无统计学意义(P>0.05)。[结论]在全膝关节置换术中应用彩色多普勒超声仪设定个体化止血带的压力值,不仅可确保止血效果,而且可有效减少不良反应的发生率,从而提升使用止血带时的安全性,更有利于患者术后快速康复。

[Objective]To investigate the effect of personalized tourniquet pressure setting by color Doppler ultrasound in total knee arthroplasty(TKA)on early outcomes.[Methods]A total of 71 patients who received unilateral total knee arthroplasty from March 2017 to August 2017 under general anesthesia were randomly divided into two groups.The personalized group was composed of 36 patients who had the tourniquet pressure set individually based on the pressure that made the blood flow of popliteal artery disappeared completely on color Doppler ultrasound,while the static group was consisted of 35 patients who underwent TKA with the pneumatic tourniquet pressure keeping 270 mm Hg.The pressure of tourniquet,tourniquet time used,perioperative bleeding volume,VAS scores of incision and tourniquet site,circumference of tourniquet site,knee joint function(HSS)score,and complications of tourniquet site and incision were compared between the two gropus.[Results]The personalized group proved of significantly less figures in tourniquet pressure,postoperative drainage,occult blood loss,VAS scores of incision and tourniquet site at 1 and 3 days postoperatively than the static group(P<0.05),whereas the former got significantly higher HHS score at 1 week postoperatively than the latter(P<0.05).However,there were no statistically significant differences regarding to the intraoperative blood loss and the time of tourniquet used between the two groups(P>0.05).[Conclusion]This personalized tourniquet pressure setting by color Doppler ultrasound in total knee arthroplasty not only ensure the hemostasis effect,but also effectively reduce adverse reactions,enhance the safety of using tourniquet and facilitate early recovery after operation.