止血带在下肢坏疽截肢术中的应用  

Application of tourniquet in amputation for lower limb gangrene

作　　者：田罡[1,2,4] 张皓媛 宋佳佳 唐鹏[1,2] 闵红巍 顾蕊 刘克敏[1,2,4] TIAN Gang;ZHANG Haoyuan;SONG Jiajia;TANG Peng;MIN Hongwei;GU Rui;LIU Kemin(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Department of Orthopaedics,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Prosthetics and Orthotics,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Beijing Amputee Rehabilitation Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院骨科,北京市100068 [3]中国康复研究中心北京博爱医院假肢矫形部,北京市100068 [4]北京截肢者康复会诊中心,北京市100068

出　　处：《中国康复理论与实践》2024年第5期560-564,共5页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心科研基金项目(No.2023ZX-13)。

摘　　要：目的探讨在下肢坏疽肢体截肢手术中使用止血带的有效性和安全性。方法回顾性分析2009年1月至2023年6月北京博爱医院因下肢坏疽接受截肢的41例患者共44个肢体,根据手术中是否使用止血带分为非止血带组(n=28)和止血带组(n=16),比较两组手术野清晰度、手术出血量、切口愈合、术后30 d内再手术率、术中血压及心率、手术时间。结果止血带组手术野更清晰(χ^(2)=42.385,P<0.001),手术出血量更少(Z=-2.082,P<0.05)。应用止血带的肢体均未出现止血带相关损害,如神经损伤和局部皮肤损伤。两组切口愈合甲级愈合率无显著性差异(χ^(2)=0.028,P=0.624)。结论下肢坏疽肢体截肢时应用止血带可以提高手术野清晰度,减少手术中出血,不影响切口愈合。Objective To explore the efficacy and safety of using a tourniquet in amputation for lower limb gangrene.Methods All patients underwent amputation for lower limb gangrene from January,2009 to June,2023 in Beijing Bo'ai Hospital were reviewed,involving 41 patients with a total of 44 limbs,and they were divided into non-tourniquet group(n=28)and tourniquet group(n=16)according to whether a tourniquet was used during surgery.The amputation field clearness,surgical bleeding,incision healing,reoperation rate within 30 days post-operation,intraoperative blood pressure and heart rate,and operation time were compared.Results The amputation field was clearer in the tourniquet group(χ^(2)=42.385,P<0.001),with less bleeding(Z=-2.082,P<0.05).No tourniquet-related local damages,such as nerve damage and skin injuries,was observed in the limbs using tourniquets.The incidence of grade A of incision healing was not significantly different(χ^(2)=0.028,P=0.624).Conclusion Application of tourniquet can improve the amputation field clearness and reduce bleeding during amputation for lower limb gangrene,without affecting incision healing.

关 键 词：下肢坏疽 截肢 止血带 

分 类 号：R687.5[医药卫生—骨科学]