不同术中止血带压力与时长对人工全膝关节置换术患者康复的影响  

Eff ects of optimizing intraoperative tourniquet pressure and duration on postoperative rehabilitation of total knee arthroplasty patients

作　　者：顾海燕[1] 王婷婷 高红 GU Haiyan;WANG Tingting;GAO Hong(The Second Affi liated Hospital of Nantong University,Nantong,226001,China)

机构地区：[1]南通大学第二附属医院,江苏省南通市226001

出　　处：《护理实践与研究》2022年第17期2609-2613,共5页Nursing Practice and Research

基　　金：南通市市级科技计划项目(编号:MSZ18224);南通市市级科技计划项目(编号:MS12017011-7)。

摘　　要：目的研究术中优化止血带使用方法对人工全膝关节置换术(TKA)患者术后康复的影响。方法选取南通市第一人民医院2018年1月—2019年7月实施TKA手术的90例患者,按照组间基线资料可比的原则分为观察组、对照1组、对照2组,每组30例。三组患者在术中止血带压力和止血带加压时间段的选择上有所不同,对照1组患者止血带压力设定为300 mmHg,全程使用止血带。对照2组患者止血带压力设定为<225 mmHg,全程使用止血带。观察组患者止血带压力为<225 mmHg,仅在安装膝关节假体时使用止血带。比较三组患者手术时长、术后平均住院时间、术后第1、6天股四头肌肌力和大腿肿胀率,比较术后7天、1个月美国膝关节协会(AKSS)评分结果以及三组患者术后当天及术后第3天膝关节疼痛评分(NRS)等。结果三组患者手术时长及术后平均住院日对比,观察组患者手术时常短于对照1组和对照2组,但差异无统计学意义(P>0.05);观察组术后平均住院时间短于对照1组、对照2组,差异有统计学意义(P<0.05)。三组患者术后第1、6天患肢股四头肌肌力对比,观察组均优于对照1组、对照2组,差异有统计学意义(P<0.05);术后第1天观察组大腿肿胀程度优于对照1组、对照2组,差异有统计学意义(P<0.05),术后第6天三组大腿肿胀程度均减轻,但差异无统计学意义(P>0.05)。手术当天观察组NRS评分最低,术后第7天观察组AKSS评分最高,三组间差异有统计学意义(P<0.05)。观察组术中出血量多于对照1组,少于对照2组,组间差异无统计学意义(P>0.05)。结论改良止血带优化策略不会增加患者术中出血量,不会延长手术时间,但是能减轻患者术后疼痛和肿胀程度,降低术后并发症的发生,有利于股四头肌肌力和膝关节功能的恢复,并且缩短术后住院天数。Objective To study the eff ect of optimal intraoperative tourniquet application on postoperative rehabilitation of total knee arthroplasty(TKA)patients.Methods A total of 90 patients who underwent TKA in Nantong First People's Hospital from January 2018 to July 2019 were selected and divided into an observation group,control group 1 and control group 2 according to the principle of comparable baseline data between groups,with 30 cases in each group.The choice of intraoperative tourniquet pressure and tourniquet pressure time were different among the three groups.In control group 1,the tourniquet pressure was set at 300 mmHg,and the tourniquet was used during the whole process.In control group 2,the tourniquet pressure was set to<225 mmHg,and the tourniquet was used throughout the whole process.In the observation group,the tourniquet pressure was<225 mmHg,and the tourniquet was only used when the knee prosthesis was installed.The operation time,average postoperative hospital stay,quadriceps muscle strength and thigh swelling rate on the 1st and 6th day after operation were compared among the three groups.The results of American knee society score on the 7th day and the 1st month after operation,and the knee pain score on the 1st and 3rd day after operation were compared among the three groups.Results The operation time and average postoperative hospital stay of the three groups were compared,the operation time of the observation group was shorter than the control group 1 and control group 2,but the diff erence was not statistically signifi cant(P>0.05).The average postoperative hospital stay in the observation group was shorter than the control group 1 and the control group 2,the diff erence was statistically signifi cant(P<0.05).The quadriceps femoris muscle strength of the aff ected limb of the three groups on the 1st and 6th day after operation,the observation group was better than the control group 1 and the control group 2,and the diff erence was statistically signifi cant(P<0.05).On the 1st day after operati

关 键 词：人工全膝关节置换术 改良止血带 优化策略 快速康复 术后康复 

分 类 号：R473.6[医药卫生—护理学]