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

Abstract

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

CLC Number:

R687.5

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.

Figures/Tables 5

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References 33

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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

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

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

Application of tourniquet in amputation for lower limb gangrene

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