止血带不良反应的预防
1、烦躁不安 是由于止血带疼痛引起。如果止血带充气压力过大时间过久,尤其在臂丛神经麻醉、硬膜外麻醉时,据研究66%以上此类患者 出现止血带部位的疼痛。一般在止血带充气30~60min后出现,患者表现出难以忍受,烦躁不安,即使使用镇静和镇痛药也难以控制。研究表明,皮肤和深部组织如血管和肌肉受压后都可导致止血带疼痛,且由于缺血-再灌注损伤造成缺血后水肿。止血带充气应在麻醉效果彻底后进行。止血带压力不可过大,时间不可过长。定时通知手术医生做止血准备,松止血带5~10min后,可再次充气使用,重新记时。
1, irritable Was caused by a tourniquet pain. Time is too long if a tourniquet inflation pressure is too high, especially in brachial plexus anesthesia and epidural anesthesia, according to a study by more than 66% of such patients tourniquet parts of the pain. Generally in 30 ~ 60 min after the tourniquet inflatable, patients showed unbearable, dysphoria, even the use of sedation and analgesia medicine is difficult to control. Research shows that after the compression of skin and deep tissues such as blood vessels and muscles pain can lead to a tourniquet, and caused by ischemia-reperfusion injury edema after ischemia. A tourniquet inflatable should be performed after the anesthesia effect completely. Tourniquet pressure is too big, time is too long. Regularly inform surgeons for hemostasis, loose tourniquet after 5 ~ 10 min, can be used inflatable again, time again.
2、止血带休克 止血带休克是止血带放松后,大量血液迅速充盈驱血后的肢体,血液再分配,血容量不足,有效循环血量突然减少,加上手术切口出血或渗血,引起休克。另外,松止血带时由于驱血肢体血管床突然扩大及无氧代谢产物经静脉回流循环,抑制心肌收缩,可出现“止血带休克”。骨科四肢手术中,在放松止血带前后应密切观察血压、脉搏变化,注意补充血容量,放松止血带前适当加快输液、输血的速度。对下肢应用止血带者尤其应注意,在放松止血带时应缓慢减压放松,以防血液的突然充盈。同时应注意创面的压迫止血。
2, a tourniquet shock Tourniquet shock is a tourniquet to relax after a large number of blood filling rapidly flooding body after blood, blood redistribution, insufficient blood volume, effective circulating blood volume suddenly decreases, and the incision bleeding or oozing, shock. In addition, pine tourniquet limb blood vessels due to flooding bed suddenly expanded and anaerobic metabolism products by venous reflux circulation, inhibit myocardial contraction, can appear "tourniquet shock". Orthopedics limbs, in relax tourniquet should closely observe the blood pressure, pulse before and after the change, pay attention to supplement the blood volume, relax tourniquet before appropriate accelerate the rate of infusion, blood transfusion. Applied a tourniquet in the lower extremities, especially, should be paid attention to in when relax tourniquet should slow decompression to relax, to prevent suddenly filled with blood. At the same time we should pay attention to oppression hemostasis of the wound.