| 止血带运用的常见不良反应 |
| 添加时间：2017/8/16 14:20:49 浏览次数： |
| 1、神经系统 1. Nervous system 止血带下方可能会发生皮肤末梢神经损伤，使用止血带在30min以内躯体感觉电位消失，神经传导中断；使用超过60min即可引起疼痛和高血压。止血带突然放松通常会出现中心静脉压和动脉压降低，有时还可因 In the lower part of the tourniquet, the peripheral nerve injury may occur, and the somatic sensory potential disappeared within 30min and the nerve conduction was disrupted. Using more than 60 minutes can cause pain and high blood pressure. Sudden relaxation of the tourniquet usually occurs with central venous pressure and decreased arterial pressure, sometimes due to 血管阻力突然下降、急性失血、代谢产物对循环的抑制而心跳骤停。止血带反应常见的临床表现有上止血带一定时间后出现烦躁不安、冷汗、疼痛难怨、局部有压迫感、血压升高，局部出现水疱，放止血带后大多缓解，但水疱不会马上消失。放止血带后出现血压下降甚至休克。手术后出现肢体麻木、无力、感觉减退等神经症状。 The sudden drop of vascular resistance, acute loss of blood, and metabolic products have a cardiac arrest. Tourniquet reaction on the common clinical manifestations are a tourniquet agitated, cold sweat, pain after a certain time to hatred, local feeling, blood pressure, local a blister, put a tourniquet mostly ease, after but the blister will not disappear immediately. Blood pressure drops and even shock after a tourniquet. After the operation, there were numbness, weakness, loss of feeling and other neurological symptoms. 2、血液系统 主要为凝血及纤溶状态的改变。止血带对组织的直接压迫、止血带痛起儿茶酚胺的释放，皆可导致血小板聚集增加。而缺血组织内的血流淤滞，又进一步促进了微血管内血栓形成。已有多篇文献报道了在使用止血带后发生的深静脉血栓形成。另外，组织酸中毒也引起纤溶酶原激活物的释放，所以止血带放气后可导致短暂的纤溶过程。 2. Blood system mainly changes in coagulation and fibrinolysis. The release of the tourniquet in the direct pressure of the tissue and the pain of the tourniquet, can lead to the increase of platelet aggregation. The blood clots in the ischemic tissues further promote the formation of microvascular thrombosis. Multiple reports have been reported on the formation of deep venous thrombosis after use of tourniquet. In addition, the tissue acidosis also causes the release of fibrinolytic activator, so the temporary fibrinolysis process can be caused by the release of the hemostasis. 3、 止血带充气时的局部反应 3. Local reaction when the tourniquet is inflated 血带的直接压迫及长时间的缺血可以导致局部的皮肤、血管、神经和肌肉的损害。肢体缺血的时间同组织损伤的严重程度正相关。止血带充气后8分钟细腻线粒体内的氧分压降为零，以而引起无氧代谢。在T道后的30—60分钟内。烟酰胺腺嘌呤二酸（NAD）降低，磷酸肌酸酶明显增高且在肌肉中积蓄，很快产生细胞内酸中毒缺氧和酸中离导致肌红蛋白、细胞内酶和钾离子的释放.如果止血带时间超过60分钟，血管内皮完整性受到损害，会产生组织水肿，以致切口缝合困难.随时间延长肢体温度下降，可与室温相同。由于止血带下面的肌肉受压，可能延迟病人康复。 Direct compression of the blood belt and prolonged ischemia can lead to localized damage to the skin, blood vessels, nerves and muscles. The time of ischemia was positively correlated with the severity of tissue injury. The oxygen partial pressure in the mitochondria was reduced to zero in 8 minutes after the tourniquet was aerated, which caused anaerobic metabolism. Within 30 to 60 minutes after T lane. Nicotinamide adenine diacid (NAD), creatine phosphate significantly higher and savings in the muscle enzymes, soon in intracellular acidosis of oxygen and acid produced from myoglobin, enzyme and the release of potassium ions in the cell. If a tourniquet time more than 60 minutes, damage to vascular endothelial integrity, can produce tissue edema, incision suture difficulty. With the extension of time body temperature to drop, can be the same as the room temperature. Because the muscles under the tourniquet are under pressure, the patient may be delayed. |
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