基于血氧监测仪在老年患者膝关节置换术中止血带压力值参数设定的应用研究  

Study on the application of the setting of pressure parameters of intraoperative tourniquet in senile patients based on the blood oxygen monitor

作　　者：杨英 高兴莲 余雷[1] 刘海峰[1] 吴荷玉 姚冲 YANG Ying;GAO Xing-lian;YU Lei(Operating Room,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院手术室,湖北武汉430022

出　　处：《中国医学装备》2020年第10期132-135,共4页China Medical Equipment

基　　金：湖北省自然科学基金(2017CFB794)“手术室压疮高危因素评估系统构建”;华中科技大学同济医学院附属协和医院新技术(02.03.2017-276)“监护仪动脉波形在四肢骨手术气压止血带的充气压力参数精准设定的应用研究”。

摘　　要：目的:探讨血氧监测在老年膝关节置换术中充气压力参数精准设定的应用效果。方法:选取医院骨科实施择期膝关节置换手术且使用止血带的100例老年患者,利用随机抽样法将其分为对照组和观察组,每组50例。对照组给予常规的止血带压力参数,观察组应用血氧监护仪波形设置个性化的压力参数,比较两组患者止血带实际压力、术中出血情况评分、术后血红蛋白和红细胞压积,以及术后患肢视觉模拟量表(VAS)疼痛评分和皮肤情况。结果:对照组患者止血带实际压力值为450 mmHg,观察组为413.83 mmHg,两组相比差异有统计学意义(t=60.27,P<0.05)。两组患者血红蛋白和红细胞压积差异无统计学意义。对照组患者术中出血评分为(3.20±0.92)分,观察组为(2.80±0.79)分,两组比较差异无统计学意义。对照组患者术后患肢VAS疼痛评分为(7.44±0.61)分,观察组为(7.00±0.81)分,两组比较差异有统计学意义(t=-3.07,P<0.05)。对照组术后止血带使用部位皮肤正常、皮肤压红和皮肤水疱分别为38例、10例和2例;观察组术分别为47例、3例和0例,两组比较差异有统计学意义(x^2=31.51,x^2=16.90,x^2=9.64;P<0.05)。结论:老年膝关节置换术应用血氧监测精准设定止血带充气压力,满足手术要求的同时能够显著降低止血袖带引起的皮肤压力性损伤(器械性压伤),减少患者术后疼痛。Objective:To explore the application effect of the accurate setting of the parameter of inflation pressure of blood oxygen monitoring in the operation of knee arthroplasty of senile patients.Methods:The 100 senile patients who underwent elective knee arthroplasty and tourniquet were selected and were divided into control group and observation group by simple random sampling method,with 50 cases in each group.The patients in control group received routine pressure parameters of tourniquet,and the patients in observation group received individualized pressure parameters which were set by the waveform of blood oxygen monitor.The actual pressure of tourniquet,the score of intraoperative bleeding,postoperative hemoglobin and hematocrit,and visual analogue scale(VAS)pain scores of postoperative injured limb and skin conditions between the two groups were compared.Results:The actual pressure value of tourniquet in control group was 450 mmHg,and that of observation group was 413.83 mmHg,the difference of that between the two groups was statistically significant(t=60.27,P<0.05).There were no significant differences in hemoglobin and hematocrit between the two groups.The score of intraoperative bleeding in control group was(3.20±0.92),and that of observation group was(2.80±0.79),and there was no significant difference between the two groups.The VAS pain score of the injured limb of control group was(7.44±0.61),and that of observation group was(7.00±0.81),and the difference of that between the two groups was statistically significant(t=-3.07,P<0.05).In the control group,38 cases,10 cases and 2 cases were normal skin,skin with pressured red and blister on skin,respectively,while they were 47 cases,3 cases and 0 cases in observation group,respectively,and the differences of these between two groups were statistically significant(x^2=31.51,x^2=16.90,x^2=9.64,P<0.05).Conclusion:The accurate setting of inflation pressure of tourniquet in the knee arthroplasty of senile patients by using blood oxygen monitoring can significan

关 键 词：血氧监测 压力参数 精准设置 膝关节置换术 临床研究 

分 类 号：R687.4[医药卫生—骨科学]