两种不同灌注方法对肩关节镜下手术出血与视野显露的影响

Effect of two different perfusion treatments on surgical bleeding and the operative field in shoulder arthroscopic surgery

目的探讨改良加压灌注和常规重力灌注对肩关节镜下手术出血与视野显露的影响。方法选取我院2018-01/2019-07期间因肩袖撕裂收住我院骨科拟行肩关节镜手术治疗的患者60例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为观察组(n=30)和对照组(n=30)。观察组应用改良气压止血仪加压灌注,对照组应用常规重力灌注,监测并记录关节腔压力(mmHg)、关节腔灌注引流液中红细胞计数(个)、灌注液总量(L)、手术时间(min)、术后肩关节肿胀度(cm)。结果观察组第1次更换灌注液时关节腔压力高于对照组,关节腔灌注引流液中的红细胞计数及手术时间少于对照组,差异有统计学意义(P<0.05);2组灌注液总量及术后肩关节肿胀度无统计学意义(P>0.05)。结论在肩关节镜手术中使用改良加压灌注法,具有操作简便、压力稳定、视野清晰、手术时间短等优点,值得临床推广使用。

Objective To investigate the effect of improved enhancing perfusion and conventional gravity perfusion on surgical bleeding and the operative field in shoulder arthroscopic surgeries.Methods A total of 60 patients with rotator cuff tears,American Society of Anesthesiologists physical status beingⅠorⅡ,undertaking arthroscopic shoulder surgery from January 2018 to July 2019 were randomly divided into the observation group(n=30)and the control group(n=30),according to the random number table method.Patients in the observation group underwent enhancing perfusion with improved pneumatic tourniquet.Meanwhile patients in the control group underwent conventional gravity perfusion.The joint pressure,red blood cell count of intracavitary perfusate,the total amount of perfusate,operative time,postoperative swelling of shoulder joint were monitored and recorded.Results At the first time of the replacement of the perfusate,the shoulder joint pressure in the observation group was higher than that in the control group(P<0.05),and the red blood cell count of intracavitary perfusate in the observation group was fewer than that in the control group(P<0.05).After operation,the operation time in the observation group was shorter than that in the control group(P<0.05),there was no significant difference between the two groups in the total amount of the perfusate and the swelling of shoulder joint(P>0.05).Conclusion The improved enhancing perfusion in shoulder arthroscopic surgery has the advantages in simple operations,steady pressure,clear view,short operation time,and good perfusion effect,which is worthy of clinical promotion.