止血带个性化压力值在下肢手术中的探讨

Personalized pressure of tourniquet in lower limb surgery

目的分析在下肢手术中,大腿周径和收缩压与止血带压力的关系,探讨止血带个性化压力值。方法选择2018年4月至2018年5月在南部战区总医院收治的55例行下肢手术且可使用止血带的患者,记录术中止血带压力、术区出血情况、大腿周径、收缩压及体重指数(BMI)等资料,根据大腿周径、收缩压及BMI对患者进行分组,分析各组止血带压力变化情况以及止血带压力与大腿周径、收缩压及BMI的相关性。结果止血效果为良好时,各分组止血带最低压力值及压力差比较差异均有统计学意义(P<0.05);止血带压力与大腿周径(r=0.734,P<0.05)、收缩压(r=0.889,P<0.05)呈正相关,但止血带压力与BMI无相关性(r=0.076,P>0.05)。结论在下肢手术中,止血带的个性化压力值可根据大腿周径及收缩压进行设定,当患者收缩压≥130mmHg时,则再增加30mmHg。另外,止血带压力的设置不需参考BMI。

Objective To analyze the relationship between thigh circumference(TC),systolic blood pressure(SBP)and tourniquet pressure in lower limb surgery,and discuss the personalized pressure of tourniquet.Methods Fifty-five patients who underwent lower limb surgery using tourniquet in General Hospital of Southern Theatre Command of PLA from April,2018 to May,2018 were included in the study.Patients were separately divided into groups according to the thigh circumference,systolic blood pressure and body mass index(BMI).The intraoperative tourniquet pressure,intraoperative blood bleeding,TC,SBP and BMI were recorded.The changes of tourniquet pressure and the correlation between tourniquet pressure and TC,SBP and BMI were recorded.Results In remarkable effect of hemostasis,there were significant differences in minimum pressure of tourniquet and the pressure difference between tourniquet and SBP in each group(P<0.05).The tourniquet pressure was positively correlated with TC(r=0.734,P<0.05)and SBP(r=0.889,P<0.05),but it was not correlated with BMI(r=0.076,P>0.05),respectively.Conclusions The personalized tourniquet pressure can be set according to TC and BDP in lower limb surgery.Meanwhile,if the SBP is greater than 130 mmHg,the tourniquet pressure should add an extra 30 mmHg.In addition,there is no reference value for BMI in tourniquet pressure setting.