术前要对止血带进行仔细检查
术前要对止血带进行仔细检查,如气囊是否漏气,打气筒是否好用,气压表是否准确。
Before operation, the tourniquet should be carefully checked, such as
whether the air bag leaks, whether the air pump is good to use and
whether the barometer is accurate.
根据患者年龄、肢体周径、病人体质等因素选用合适的气压止血带。放置止血带的部位应正确,止血带要绑于肢体肌肉较丰富部位,以防损伤神经。上肢者放在上臂中上1/3处,下肢者应放在大腿根近腹股沟部。
The appropriate pneumatic tourniquet was selected according to the
patient's age, limb circumference and constitution. Place the tourniquet
in the right place. The tourniquet should be tied to the muscles of the
limbs in order to prevent nerve damage. The upper limb should be placed
in the upper 1/3 of the upper arm, and the lower limb should be placed
near the groin of the thigh root.
绑止血带时,止血带下要垫一个小单(布),并使接触皮肤面保持平整。止血带要绑的松紧适宜,通气管要放在肢体近端,即可防止污染手术野,又便于打气。气压止血带外最好再缠固定带或绷带加压固定,防止充气后滚动。
When binding the tourniquet, a small sheet (cloth) should be padded
under the tourniquet, and the contact surface of the skin should be kept
smooth. The tourniquet should be tied tightly and properly, and the
ventilation tube should be placed near the limb, which can prevent
contamination of the operating field and facilitate ventilation. It is
better to wrap the fixing bandage or bandage outside the pneumatic
tourniquet to press and fix it to prevent rolling after inflating.
止血带充气前应先抬高肢体,驱血带驱血彻底后,再将止血带的通气管接于压气表上,缓慢将气打入止血带内。上肢压力成人不超40.0kPa(300mmHg),小儿不超过26.7kPa(200mmHg),下肢压力成人不超过80kPa(600mmHg),小儿不超过33.3kPa(250mmHg)。准确记录气压止血带充气时间,上肢以1h,下肢以1.5h为限,时间到时,需提前通知手术医生做好放气准备,如需继续使用,应先放气5~10min后再充气并重新记录时间。
Before inflating the tourniquet, lift the limbs first, drive the
tourniquet thoroughly, then connect the ventilation tube of the
tourniquet to the pressure gauge, and slowly inflate the air into the
tourniquet. The upper limb pressure in adults is no more than 40.0 kPa
(300 mmHg), in children it is no more than 26.7 kPa (200 mmHg), in
adults it is no more than 80 kPa (600 mmHg) and in children it is no
more than 33.3 kPa (250 mmHg). Accurate recording of pneumatic
tourniquet inflation time, upper limbs to 1 h, lower limbs to 1.5 h
limit, when the time arrives, the surgeon should be informed in advance
to prepare for deflation, if need to continue to use, should first
deflate 5-10 minutes before inflating and re-recording time.
松止血带时,放气要缓慢,以免血压急剧下降引起休克。手术完毕去除止血带后,检查病人皮肤有无损伤,必要时局部按摩数分钟。
When loosening tourniquet, deflate slowly, so as not to cause shock when
blood pressure drops sharply. After removal of tourniquet after
surgery, check the patient's skin is not damaged, if necessary, local
massage for several minutes.
止血带的使用误区
Misuse of tourniquet
1 手术台上捆扎的误区
1 Misconception of strapping on operating table
(1)肱骨及股骨中下段手术中,为减少出血,往往需要无菌止血带,由主刀医生在手术台上捆扎,因而致使止血带的松紧度没有保证,充气量也无法确定,造成出血,甚至出现皮肤坏死及神经麻痹等并发症;
(1) In order to reduce bleeding, aseptic tourniquet is often needed in
the operation of humerus and and
lower femur. The tourniquet is tied on the operating table by the master
knife doctor, so that the tightness of the tourniquet is not guaranteed
and the inflatable volume is uncertain, resulting in bleeding, even
skin necrosis and nerve paralysis and other complications.
(2)驱赶血液时,驱血带每周圈间都留有大小不等的距离,形成间断驱血,效果极差;
(2) When expelling blood, there are different distances between the
circles of the blood strip every week, which results in intermittent
expelling blood, and the effect is very poor.