止血带不良反应的预防与处理 Prevention and treatment of side effects of tourniquet 1、止血带充气应在麻醉效果彻底后进行。严格掌握止血带应用的压力和时间，正确选择止血带的缚扎部位。。袖带应远离手术部位10-15cm的近心端；上肢：选择上臂近心端1/3（或上肢中上1/3）；下肢：选择大腿上1/3（或中下1/3交界处）一般健康成人上肢压力为收缩压+50-75mmHg，下肢压力为收缩压+100-150mmHg;50岁以下的健康成人：上肢应少于60min；下肢少于90min；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，重新计时。 1. The tourniquet should be inflated after the anesthetic effect is complete. The pressure and time of tourniquet application should be strictly controlled, and the tie and tie position of the tourniquet should be selected correctly.. The cuff should be away from the surgical site 10-15cm proximal; upper limb: upper arm proximal 1/3 (or in the upper 1/3); lower extremity: thigh (1/3 or lower 1/3 junction) general health adult upper limb pressure systolic pressure +50-75mmHg, pressure for lower limb systolic blood pressure +100-150mmHg; healthy adults under the age of 50. The upper limb should be less than 60min; lower extremity surgery less than 90min; inform doctor hemostatic tourniquet release preparation, 5 ~ 10min, can be inflated again, re timing. 2、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 、 during the operation of limbs in Department of orthopedics, the blood pressure and pulse changes should be closely observed before and after relaxing tourniquet, and the blood volume should be paid attention to. The speed of transfusion and transfusion should be accelerated before loosening the tourniquet. The tourniquet should be paid more attention to when the tourniquet is relaxed, so as to prevent the sudden filling of the blood. At the same time attention should be paid to the compression of the wound. 3、使用医用袖套或袜套代替绷带缠绕，剪短一段宽度稍>止血带3 cm。上肢手术，把剪短的袖套套在上肢上1/3处，再平整绑扎止血带，两边宽出1.5cm的袖套向止血带边缘挽起，保护皮肤避免皮肤直接接触止血带；下肢用袜套，方法同上肢。皮肤消毒改用0.5%碘伏消毒皮肤，因其对组织和黏膜无刺激、无过敏、无腐蚀，兼有消毒、灭菌作用。多余的消毒液用无菌纱布沾干。 3, the use of medical cuff or socks instead of bandage, cut a width slightly > 3 cm. The short sleeve cuff upper limb surgery in the upper 1/3, and smooth strapping tourniquet, wide on both sides of 1.5cm to the edge of the tourniquet cuff rolled up, protect the skin to avoid direct skin contact with tourniquet; lower extremity with socks with upper limb. The skin disinfection uses 0.5% Iodophor to disinfect the skin, because it does not have the stimulation to the organization and the mucous membrane, has no allergy, does not have the corrosion, simultaneously has disinfection, the sterilization function. The excess disinfectant is dried with sterile gauze. 4.右美托咪定配合罗哌卡因局部用药可通过抑制细胞膜超级化，降低神经元的去极化速度而发挥非受体依赖性镇痛作用，直接抑制不能被局麻药完全阻滞的无髓C纤维，完善神经阻滞效果右美托咪定的抗交感作用可减少儿茶酚胺的释放，从而降低应激反应，稳定血流动力学。 4. dexmedetomidine combined with topical administration of ropivacaine can inhibit the cell membrane hyperpolarization, decreased neuronal depolarization velocity and play a non receptor dependent analgesic effect, direct inhibition of unmyelinated C fibers can not be completely block local anesthetics, improve nerve block effect of dexmedetomidine sympatholytic effect can be reduced catecholamine the release, thereby reducing the stress response, stable hemodynamics. 5.伤肢远端明显缺血或有严重挤压伤时禁用此种方法止血 。 5. when the injured limb is obviously ischemic or has severe crush injury, disable this method to stop bleeding.