目的 对骨科下肢手术时空气止血带压力设置进行改良设定,以降低止血带压力过高导致的相关并发症发生率。方法 将70例拟全麻下行预计手术时间在90 min以内骨科下肢手术的患者随机分为两组。对照组止血带压力设定为患者上臂无创袖带测量血压收缩压值的2倍并锁定,改良组设定为无创袖带测量健侧下肢与患侧捆绑止血带相对应处的血压收缩压值上调30%并锁定。麻醉后观察并记录患者术中右上肢、健侧下肢血压测量值。比较两组患者术中出血情况、止血带休克发生、术毕时止血带捆绑处皮肤情况、术后第1天止血带捆绑处疼痛情况和患肢感觉异常等并发症的差异。结果 两组需降压患者比例差异无统计学意义(P=0.051);两组术中出血情况差异无统计学意义(P＞0.05)。改良组术后皮肤状况好于对照组(P＜0.05)。改良组术后止血带部位疼痛程度低于对照组(P＜0.001)。两组均未见止血带休克、相关感觉运动异常等并发症。结论 根据患者健侧下肢收缩压测量值设置充气止血带压力在短时间的下肢骨科手术中可做到止血满意。

Objective To reduce the incidence of complications caused by excessive tourniquet pressure by modifying the setting of pneumatic tourniquet pressure in lower limb surgery.Methods Seventy patients whose expected operation time was less than 90 min under general anesthesia were randomly divided into two groups.In the control group, the pressure of pneumatic tourniquet was set at twice the systolic blood pressure measured with a non-invasive cuff on the upper arm of the patient and locked.In the improved group, the pressure of pneumatic tourniquet was set at 130% of the systolic blood pressure measured with a non-invasive cuff on the lower limb of the healthy side and with a tourniquet applied to a specific location on the limb of the affected side and locked.The blood pressure measurements of right upper limb and unaffected lower limb were observed and recorded after anesthesia.Comparisons were made on indicators such as intraoperative hemorrhage, tourniquet shock, skin conditions where tourniquet was applied at the end of the operation, pains where tourniquet was applied on the first day after the operation, and paresthesia of the affected limb.Results There was no significant difference between the two groups in the proportion of patients requiring pressure release (P=0.051) and intraoperative hemorrhage (P>0.05).The skin conditions of the improved group was better than that of the control group (P<0.05).The postoperative pain degree of the improved group was lower than that of the control group (P<0.001).There were no complications such as tourniquet shock and associated paresthesia in both groups.Conclusion Setting pneumatic tourniquet pressure according to the systolic blood pressure of the unaffected lower limb could achieve a good hemostasis during a fast lower limb surgery.