金平湖　　丁健　　高伟阳　　祝崇雪

[摘要] 目的 探讨如何在幼儿上肢矫形手术中规范化使用气囊止血带。 方法 经过纳入和排除标准的筛选，最终选择2019年1—12月在我院行上肢矫形的60例患儿，分为三组，对照组、研究组1和研究组2分别使用上臂5 cm、上臂7 cm和前臂5 cm气囊止血带。记录止血压力、止血效果、止血带压迫以及是否对手术造成干扰，并进行组间对比。记录各组术中止血效果不佳时的处理情况。记录并对比三组收缩压以及术中变化的情况，评估使用肢体闭塞压力（LOP）作为止血带压力的总体有效率。 结果 三组LOP和实际使用的压力：研究组2<研究组1<对照组（P<0.01）;对照组、研究组1和研究组2止血效果的优良率分别为89.7%，92.9%和100.0%;三组均未出现严重的止血带压迫;研究组2前臂气囊止血带引发肌腱张力高，对手术存在一定干擾，其他两组未对手术造成干扰。对照组和研究组1止血效果差的病例，通过增加边缘压力或者改用前臂气囊止血带达到良好止血效果。各组收缩压无明显变化，直接使用LOP加压总体有效率为93.3%。 结论 幼儿上肢矫形手术首先考虑选用7 cm的上臂气囊止血带，术前预测并使用LOP加压在大部分病例可达到满意的止血效果，部分病例需要增加边缘压力，或者改用5 cm前臂气囊止血带以满足手术野无血的需求。

[关键词] 气囊止血带;儿童;先天畸形;充气压力;上肢;重建术

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2021）13-0172-05

Standardized use of pneumatic tourniquets in children's upper limb orthopedic surgery

JIN Pinghu   DING Jian   GAO Weiyang   ZHU Chongxue

Operating Room， the Second Affiliated Hospital of Wenzhou Medical University， Wenzhou   325000， China

[Abstract] Objective To explore how to standardize the use of pneumatic tourniquets in children's upper limb orthopedic surgery. Methods After screening by inclusion and exclusion criteria，a total of 60 children who underwent upper limb orthopedics in our hospital from January to December 2019 were finally selected. They were divided into three groups，including the control group， study group 1， and study group 2， with pneumatic tourniquets of 5 cm，7 cm in the upper arm， and 5 cm in the forearm. The hemostatic pressure， hemostatic effect， tourniquet compression， interfering with the operation were recorded. The comparison between groups was performed. The treatment situation of each group was recorded when the intraoperative hemostatic effect was not good. The systolic blood pressure and intraoperative changes between the three groups were recorded and compared. The overall effectiveness of using limb occlusion pressure（LOP） as tourniquet pressure was evaluated. Results The LOP and actual pressure of study group 2 were smaller than study group 1， and those of study group 1 were smaller than the control group（P<0.01）. The excellent and good hemostatic effect in the control group， study group 1 and study group 2 was 89.7%， 92.9%， and 100.0%， respecturely. None of the three groups appeared severe tourniquet compression.The forearm′s tourniquet compression in study group 2 caused high tendon tension， which interfered with the operation. The other two groups did not interfere with the operation. The good hemostatic effect can be achieved by increasing the edge pressure or switching to forearm pneumatic tourniquet in cases with the poor hemostatic effect of the control group and study group 1.There was no significant change in each group′s systolic blood pressure， and the overall effective rate of direct LOP compression was 93.3%. Conclusion In children′s upper limb orthopedic surgery，a 7 cm upper limb pneumatic tourniquet should be first considered. Preoperative prediction and use of LOP compression can achieve satisfactory hemostasis in most cases， and some cases need to increase marginal pressure or switch to 5 cm forearm pneumatic tourniquets to meet the needs of no blood in the surgical field.

[Key words] Pneumatic tourniquets; Children; Congenital malformations; Inflation pressure; Upper limbs; Reconstruction

近年来儿童上肢先天畸形的发病率增高，患儿开展手术时间早，往往在1岁左右;对于复杂的畸形，涉及复合组织瓣切取，软组织修复重建及截骨矫形等操作，手术时间长，对无血手术野要求极高[1-3]。目前儿童上肢气囊止血带在临床的使用极不规范，儿童止血带指南长久未更新，研究大多针对大龄儿童，而且手术时间短、对无血手术野要求不高[4-6]。因此在臨床上医护人员往往不加选择的直接使用最细的气囊止血带（宽度5 cm），将其应用于上臂，使用经验或者仪器建议压力25～35 kPa，如果效果不佳再反复增加压力直至有效止血[4]。有时甚至弃用气囊止血带，改为前臂橡皮止血带[7-9]。如此操作会导致止血带的使用压力偏高，而且橡皮止血带压力无法监测，安全性低，无法长时间使用。……