[1]魏亚囡,佘 濛,高子军,等.控制性降压联合肢体闭塞压设定止血带压力对下肢手术患者的影响[J].陕西医学杂志,2022,51(5):570-573,603.[doi:DOI:10.3969/j.issn.1000-7377.2022.05.013]
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控制性降压联合肢体闭塞压设定止血带压力对下肢手术患者的影响
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年5期
页码:
570-573,603
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

作者:
魏亚囡1佘 濛2高子军2李 静2张禄露1董补怀2
(1.西安医学院,陕西 西安 710068; 2.西安交通大学附属红会医院麻醉科,陕西 西安 710054)
关键词:
止血带压力 控制性降压 肢体闭塞压 疼痛 下肢手术 前叉韧带重建术
分类号:
R 658.3
DOI:
DOI:10.3969/j.issn.1000-7377.2022.05.013
文献标志码:
A
摘要:
目的:探讨控制性降压联合肢体闭塞压设定止血带压力对下肢手术患者的影响。方法:将60例择期行膝关节镜前叉韧带重建术的患者采用随机数字表法分为两组,试验组采用控制性降压联合肢体闭塞压法设定止血带压力,对照组采用传统收缩压+150 mmHg设定止血带压力。记录入室收缩压、止血带压力设定值、止血带时间、手术时间、平均动脉压。记录两组术后6、24、48 h止血带部位和手术部位的VAS评分。记录镇痛泵有效按压次数。于术前(T0)、放气后8 h(T1)、放气后24 h(T2)测定肌酸激酶(CPK)和肌红蛋白(Mb)的浓度。分别于术前和术后24、48 h测量大腿围,并计算术后与术前的差值。记录止血带相关高血压、皮肤压红、寒战和静脉血栓的发生情况。分别于术前、术后第7、14天对患者进行膝关节活动度(ROM)和膝关节评分。结果:两组均提供了良好的手术视野,与对照组相比,试验组的术中平均动脉压和止血带压力明显降低(均P<0.01); 两组止血带使用时间和入室收缩压比较差异无统计学意义(均P>0.05)。术后6、24 h试验组的止血带部位疼痛和手术部位疼痛明显低于对照组(均P<0.05),而术后48 h止血带部位疼痛和手术部位疼痛比较差异无统计学意义(均P>0.05),两组术后镇痛泵有效按压次数比较差异无统计学意义(均P>0.05)。与T0时比较,T1、T2时两组血清CPK和Mb浓度明显升高(均P<0.05); 与对照组比较,T1、T2时试验组血清CPK和Mb浓度明显降低(均P<0.05)。与试验组相比,对照组止血带相关高血压、皮肤压红和寒战发生率明显增加(均P<0.05)。术后第24、48 小时肢体肿胀和静脉血栓发生率两组间比较差异无统计学意义(均P>0.05)。两组患者术前及术后第7、14天ROM和膝关节评分比较差异无统计学意义(均P>0.05)。结论:控制性降压联合肢体闭塞压设定止血带压力的方法在提供同样良好手术视野条件下,不仅降低了止血带压力,还减轻了患者术后疼痛和软组织损伤。

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备注/Memo

备注/Memo:
基金项目:西安市科技局科研项目(21YXYJ0025)
更新日期/Last Update: 2022-05-05