雷英歌;李惠萍;张金陵;梅斌;陶晖;

• 1:安徽医科大学护理学院
• 2:安徽医科大学第一附属医院

摘要(Abstract)：

[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270 mmHg。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、3 d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。

关键词(KeyWords)： 全膝关节置换;彩色多普勒超声;气囊止血带;充气压力;个性化

Abstract:

Keywords:

基金项目(Foundation): 安徽省科技厅科技攻关公益性技术应用研究联动计划项目(编号:1704f0804029)

作者(Author): 雷英歌;李惠萍;张金陵;梅斌;陶晖;

Email:

DOI:

参考文献(References)：

• [1]Esler CN, Blakeway C, Fiddian NJ, et al. The use of a closed-suction drain in total knee arthroplasty:a prospective, randomised study[J]. J Bone Joint Surg Br, 2003, 85(2):215-217.
• [2]Olivecrona C, Lapidus LJ, Benson L, et al. Tourniquet time affects postoperative complications after knee arthroplasty[J]. Int Orthop,2013, 37(5):827-832.
• [3]Zhang W, Li N, Chen S. The effects of a tourniquet used in total knee arthroplasty:a meta-analysis[J]. Orthop Surg, 2014, 9(1):13-17.
• [4]Yal??nkaya M, So€kücüS, Erdogan S, et al. Tourniquet use in orthopedic surgery:a descriptive survey study among Turkish orthopedic surgeons and residents in Istanbul[J]. Acta Orthop Traumatol Turc, 2014, 4(8):483-490.
• [5]Boya H, Tuncal?B. Practice of tourniquets use in Turkey:a pilot study[J]. Acta Orthop Traumatol Turc, 2016, 50(2):162-170.
• [6]Noordin S, McEwen JA, Kragh Jr JF, et al. Surgical tourniquets in orthopaedics[J]. J Bone Joint Surg Am, 2009, 9(1):2958-2967.
• [7]Watanabe H, Kikkawa I, Madoiwa S, et al. Changes in blood coagulation fibrinolysis markers by pneumatic tourniquet during total knee joint arthroplasty with venous thromboembolism[J]. Arthroplasty, 2014, 2(9):569-573.
• [8]Gross JB. Estimating allowable blood loss:corrected for dilution[J]. Anesthesiology, 1983, 58(3):277-280.
• [9]Chen S, Li J, Peng H, et al. The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty[J]. Int Orthop, 2014, 38(2):355-359.
• [10]Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty:a randomized controlled trial[J]. J Bone Joint Surg Am, 2012, 94(24):2209-2215.
• [11]祝蒙见,尹宗生,谢康,等.充气式止血带不同应用方式对全膝关节置换术效果的影响[J].山东医药, 2016, 56(2):49-51.
• [12]吴鑫杰,谭明生.充气式止血带在全膝关节置换术中应用的研究进展[J].中国矫形外科杂志, 2018, 26(17):1601-1604.
• [13]Jiang F, Zhong H, Hong Y, et al. Use of a tourniquet in total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials[J]. Orthop Sci, 2015, 20(1):110-123.
• [14]Cremeans-Smith JK, Greene K, Delahanty DL. Physiological indices of stress prior to and following total knee arthro-plasty predict the occurrence of severe post-operative pain[J]. Pain Med, 2016,17(5):970-979.
• [15]Harsten A, Bandholm T, Kehlet H, et al. Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty:a randomized controlled trial[J]. Knee, 2015, 22(2):126-130.
• [16]Kovar FM, Jaindl M, Oberleitner G, et al. Nerve compression and pain in human volunteers with narrow vs wide tourniquets[J].World J Orthop, 2015, 6(4):394-399.
• [17]Murata I, Nozaki R, Ooi K, et al. Nitrite reduces ischemia/reperfusion-induced muscle damage and improves survival rates in ratcrush injury model[J]. Trauma Acute Care Surg, 2012, 72(6):1548-1554.
• [18]Unver B, Karatosun V, Tuncali B. Effects of tourniquet pressure on rehabilitation outcomes in patients undergoing total knee arthroplasty[J]. Orthop Nurs, 2013, 32(4):217-222.
• [19]马骏,李国庆,曹力.全膝关节置换术中不同压力止血带对术后肿胀及疼痛影响的临床研究[J].中国矫形外科杂志, 2013,21(13):1297-1301.
• [20]Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account[J]. Knee, 2000, 7(3):151-155.
• [21]Li B, Wen Y, Wu H, et al. The effect of tourniquet use on hidden blood loss in total knee arthroplasty[J]. Int orthop, 2009, 33(5):1263-1268.
• [22]肖鹏,吴学建,刘宏建.人工关节置换术后隐性失血的相关分析[J].中国组织工程研究与临床康复, 2008, 12(4):635-638.
• [23]Prasad N, Padmanabhan V, Mullaji A, et al. Blood loss in total knee arthroplasty:an analysis of risk factors[J]. Int Orthop, 2011,223(5):134-137.
• [24]Chen S, Li J, Peng H. The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery inprimary total knee arthroplasty[J]. Int Orthop, 2014, 38(2):355-359.
• [25]Liu D, Graham D, Gillies K, et al. Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty[J]. Knee Surg Relat Res, 2014, 26(4):207-213.
• [26]Van Egmond JC, Verburg H, Mathijssen NM. The first 6 weeks of recovery after total knee arthroplasty with fast track[J]. Acta Orthop, 2015, 86(6):708-713.
• [27]Sukur E, Ozturkmen Y, Akman YE, et al. The effect of tourniquet and knee position during wound closure after total knee arthroplasty on early recovery of range of motion:a prospective, randomized study[J]. Arch Orthop Trauma Surg, 2016, 136(12):1773-1780.