肢体止血带后低血压反应和酸血症临床观察  

Clinical observation of hypotensive response and acidemia after the use of limb tourniquets

作　　者：费建平[1] 王欢锋[1] 

机构地区：[1]昆山市中医医院麻醉科,江苏昆山215300

出　　处：《武警后勤学院学报（医学版）》2017年第9期755-758,共4页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨止血带后循环改变和动脉血气改变的一般规律。【方法】以30例单侧止血带条件下行下肢手术患者为实验组,采集入室后(T0)、全麻插管后30 min(T1)、松止血带前(T2)、松止血带后1 min(T3)、3 min(T4)、5 min(T5)、7 min(T6)、10min(T7)动脉血气、循环指标和EtCO_2;未用止血带的下肢创伤手术20例患者为对照组,在全麻插管后30 min(T1)、手术时间60 min(T2)时采集动脉血气分析。【结果】实验组术前、术后(松止血带前)与对照组术前、术后(手术60 min)EtCO_2、PaCO_2、Lac、BEec、BB组间比较,差异均无统计学意义(P>0.05)。实验组中与T2比较,T3、T4、T5、T6、T7时SBP、DBP均下降,差异有统计学意义(P<0.001),但HR无明显改变,差异无统计学意义(P>0.05),T7与T6比较,SBP升高,差异有统计学意义(P<0.01);与T2比较,T3、T4、T5时,EtCO_2、PaCO_2快速、持续升高,T6、T7时下降。T4~T7时PaCO_2高于T2,T4~T6时EtCO_2高于T2,差异有统计学意义(P<0.05);松止血带后,PH、BEec、BB均先降后升,T4~T7PH值低于T2,差异有统计学意义(P<0.01)。T4~T7时Lac均高于T2,差异有统计学意义(P<0.001)。【结论】肢体长时间使用止血带后存在高碳酸血症和乳酸血症的危险,松止血带后应积极应对低血压反应,及时纠正酸碱失衡。[Objective] To explore the general fluctuation rules of blood circulation and arterial blood gas after the use of tourniquets. [Methods] A total of 30 cases undergoing lower limb surgery with unilateral tourniquet were divided into the experimental group. Before intubation （TO）, 30 min after intubation （T1）, before tourniquet release （T2）, 1 min after tourniquet release （T3）, 3 min （T4）, 5 min （T5）, 7 min （T6） and 10 min after tourniquet release （T7）, the indexes of arterial blood gas and circulation index as well as EtCO2 were determined. Twenty cases undergoing lower limb trauma surgery without tourniquet were divided into the control group. The indexes of arterial blood gas were tested at the point of 30 min after intubation （T1）, 60min after the beginning of the operation （T2）. [Results] There was no significant difference in EtCO2, PaCO2, Lac, BEec and BB between the experimental group and the control group before and after the operation （P〉0.05）. In the experimental group, compared with T2, SBP and DBP decreased at T3, T4, T5, T6 and T7, and the difference was statistically significant（P〈0.001）; however, there was no statistical significance in HR（P〉0.05）; compared with T6, SBP increased at T7, and the difference was statistically significant（P〈0.01）; compared with T2, EtCO2 and PaCO2 rose continuously and rapidly at T3, T4 and TS, but decreased at T6 and T7. The levels of PaCO2 at T4,T5,T6 and T7 were higher than that at T2, and the levels of EtCO2 at T4, T5 and T6 were higher than that at T2, there was significant difference （P〈0.05）. After tourniquet release, PH, BEec and BB were in falling-rising levels, and PH values at T4, T5, T6 and T7 were lower than that at T2 （P〈0.01）. The levels of Lac at T4, T5, T6 and T7 were higher than that at T2, and there was significant difference （P〈0.001）. [Conclusion] There is a risk of hypercapnia and lactic acidosis after long time use of limb tourniquets. Hypotensive response should act

关 键 词：止血带性低血压反应 高碳酸血症 高乳酸血症 

分 类 号：R614.2[医药卫生—麻醉学]