血氧监测仪在断指、断肢再植术中气囊止血带个体化压力值设定中的应用探讨  

Investigation of application by blood oxygenation monitor in individualized pressure value setting of pneumatic tourniquet for replantation of severed finger and severed limb

作　　者：陈小花[1] 李建炜[1] 钟华[1] 陈广谋 黄艳[1] 陈秋夏[1] 谢彩彤[1] 

机构地区：[1]湛江中心人民医院手术室,524037

出　　处：《中国实用医药》2017年第10期62-64,共3页China Practical Medicine

基　　金：湛江市科技攻关项目(项目编号:2016B01211);湛江市财政资助项目(项目编号:2015A06011)

摘　　要：目的探讨在断指、断肢再植术中使用气囊止血带时通过血氧监测仪设定个体化压力值的止血效果。方法 56例成年上肢断指、断肢再植手术患者,随机分为实验组和对照组,每组28例。实验组将血氧监测仪感光探头夹在手术侧正常肢体的手指或脚趾上,一旦动脉波形消失成直线,立即停止充气,连续测3次取平均值,这个充气压力即为手术肢体可以使用的最佳个体化压力值;对照组止血带压力按传统方式设定,观察和记录两组止血带充气压力、术中的止血效果和术后止血带损伤发生情况。结果两组患者止血效果比较差异无统计学意义(P>0.05);实验组充气压力(35.14±3.15)k Pa低于对照组(49.05±2.19)k Pa,差异具有统计学意义(P<0.05),实验组患者舒适度躁动评分(0.3±0.5)分,低于对照组(0.7±0.4)分,差异具有统计学意义(P<0.05),实验组设置个性化压力术后并发症发生率(3.6%)少于对照组(42.9%)(P<0.05)。结论通过血氧监测仪设定个体化气囊止血带压力值,可在断指、断肢再植术中降低充气压力,即达到良好的术野显露,患者感觉舒适又减少止血带损伤发生。Objective To investigate hemostatic effect by blood oxygenation monitor for individualized pressure value setting of pneumatic tourniquet in replantation of severed finger and severed limb. Methods A total of 56 adult patients in replantation of severed finger and severed limb were randomly divided into experimental group and control group, with 28 cases in each group. In the experimental group, sensitizing probe of blood oxygenation monitor was pressed on finger or toe of operation side to taken mean value of air inflation pressure when arterial pressure waveform as a straight line for three times as the best individualized pressure value in replantation operation. The control group received traditional pressure value setting in tourniquet. Observation and records were made on tourniquet pressure value, intraoperative hemostatic effect and postoperative tourniquet damage in the two groups. Results There was no statistically significant difference of hemostatic effect between the two groups （P〉0.05）. The experimental group had lower air inflation pressure as （35.14 ±3.15） kPa than （49.05 ±2.19） kPa in the control group, and the difference had statistical significance （P〈0.05）. The experimental group had lower comfort agitation score as （0.3 ± 0.5） points than （0.7 ±0.4） points in the control group, and their difference had statistical significance （P〈0.05）. The experimental group had lower incidence of postoperative complications （3.6%） than the control group （42.9%） （P〈0.05）. Conclusion Blood oxygenation monitor for individualized pressure value setting of pneumatic tourniquet can lower intraoperative air inflation pressure in replantation of severed finger and severed limb, along with good exposure of surgical field. This method enhances comfort in patients and reduces occurrence of tourniquet damage.

关 键 词：止血带 压力测定 断指、断肢再植 

分 类 号：R658.1[医药卫生—外科学]