止血带在下肢坏疽截肢术中的应用

doi:10.3969/j.issn.1006-9771.2024.05.009

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (5): 560-564.doi: 10.3969/j.issn.1006-9771.2024.05.009

止血带在下肢坏疽截肢术中的应用

田罡¹^,^2a^,³, 张皓媛¹, 宋佳佳^2b^,³, 唐鹏¹^,^2a, 闵红巍¹^,^2a^,³, 顾蕊¹^,^2a^,³(), 刘克敏¹^,^2a^,³

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，a.骨科；b.假肢矫形部，北京市 100068
3.北京截肢者康复会诊中心，北京市 100068

收稿日期:2024-02-29 修回日期:2024-04-01 出版日期:2024-05-25 发布日期:2024-06-12
通讯作者: 顾蕊(1981-)，女，满族，北京市人，博士，副主任医师，主要研究方向：骨与关节损伤康复、截肢康复等。E-mail： jj6567@icloud.com
作者简介:田罡(1972-)，男，汉族，山西晋中市人，主治医师，主要研究方向：截肢与截肢者康复。
基金资助:
中国康复研究中心科研基金项目(2023ZX-13)

Application of tourniquet in amputation for lower limb gangrene

TIAN Gang¹^,^2a^,³, ZHANG Haoyuan¹, SONG Jiajia^2b^,³, TANG Peng¹^,^2a, MIN Hongwei¹^,^2a^,³, GU Rui¹^,^2a^,³(), LIU Kemin¹^,^2a^,³

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. a. Department of Orthopaedics; b. Department of Prosthetics and Orthotics, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Beijing Amputee Rehabilitation Center, Beijing 100068, China

Received:2024-02-29 Revised:2024-04-01 Published:2024-05-25 Online:2024-06-12
Contact: GU Rui, E-mail: jj6567@icloud.com
Supported by:
China Rehabilitation Research Center Research Fund(2023ZX-13)

摘要/Abstract

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(χ² = 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(χ² = 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。

关键词: 下肢坏疽, 截肢, 止血带

Abstract:

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 (χ² = 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 (χ² = 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.

Key words: lower limb gangrene, amputation, tourniquet

中图分类号:

R687.5

田罡, 张皓媛, 宋佳佳, 唐鹏, 闵红巍, 顾蕊, 刘克敏. 止血带在下肢坏疽截肢术中的应用[J]. 《中国康复理论与实践》, 2024, 30(5): 560-564.

TIAN Gang, ZHANG Haoyuan, SONG Jiajia, TANG Peng, MIN Hongwei, GU Rui, LIU Kemin. Application of tourniquet in amputation for lower limb gangrene[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 560-564.

图/表 5

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组别	n	性别 (男/女)/n	年龄/岁	吸烟 (无/戒烟/有)/n	高血压 (有/无)/n	术式(TTA/KD/TFA)/n	坏死范围 (踝上/踝下)/n	术前血糖 /(mmol·L^-1)
非止血带组	28	21/7	64.96±14.08	17/6/5	22/6	6/13/9	21/7	8.68±4.86 6.32±2.07
止血带组	16	15/1	58.31±12.69	6/5/5	8/8	6/8/2	9/7	8.68±4.86 6.32±2.07
t/χ²值		1.311	1.971	2.259	3.831	2.563	1.650	-1.841 0.073
P值		0.252	0.055	0.323	0.050	0.312	0.199	-1.841 0.073

项目	非止血带组(n = 28)	止血带组(n = 16)	Z/χ²值	P值
术中出血量/mL	200.00 (100.00, 387.50)	125.00 (50.00, 200.00)	-2.082	0.037
切口愈合等级(甲/其他)/n	24/4	14/2	0.028	0.624
术后30 d内再手术(有/无)/n	1/27	1/15	0.168	0.600

项目	止血带使用前	止血带使用中	止血带去除后	F值	P值
收缩压/mmHg	124.50±18.81	121.81±18.84	121.56±14.90	0.137	0.873
舒张压/mmHg	74.63±9.38	72.88±10.16	71.19±9.87	0.491	0.615
心率/(次·min^-1)	78.56±13.61	76.86±11.98	75.13±12.88	0.287	0.752

手术方式	组别	n	$\bar{x} \pm s$	t值	P值
TTA	非止血带组	6	104.17±25.38	-1.639	0.132
	止血带组	6	123.33±13.29
KD	非止血带组	13	113.08±31.13	-0.760	0.457
	止血带组	8	123.75±31.48

止血带在下肢坏疽截肢术中的应用

Application of tourniquet in amputation for lower limb gangrene

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组别	n	清晰度
组别	n	1分	2分	3分	4分
非止血带组	28	1	7	20	0
止血带组	16	0	0	1	15
χ²值		42.385
P值		< 0.001

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