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预防止血带疼痛的研究进展
作者:林天成  崔德荣 
单位:上海交通大学附属第六人民医院 麻醉科, 上海 200233
关键词:止血带 疼痛 预防 发展 综述 
分类号:R614.3
出版年·卷·期(页码):2021·49·第九期(1111-1115)
摘要:

止血带在手术救治中具有十分重要的作用。止血带的使用为医生给患者进行手术提供了清晰的手术视野,降低了患者失血损失。然而,止血带的使用也给患者造成了疼痛等并发症,严重影响了患者的治疗效果和感受。如何有效地发挥止血带功能,预防和规避止血带疼痛风险成为止血带研究的主要方向。本文阐述止血带疼痛的机制,综述预防止血带疼痛的相关措施,包括止血带疼痛的物理性使用优化以及化学药物添加两类预防对策,展望预防止血带疼痛在未来的发展前景和方向,以期为止血带的疼痛预防研究提供理论指导。

参考文献:

[1] WELLING D R, MCKAY P L, RASMUSSEN T E, et al. A brief history of the tourniquet[J]. J Vasc Surg, 2012, 55(1):286-290.
[2] CHOKSY S A, CHONG P L, SMITH C, et al. A Randomised controlled trial of the use of a tourniquet to reduce blood loss during transtibial amputation for peripheral arterial disease[J]. Eur J Vasc Endovasc, 2006, 31(6):646-650.
[3] AGLIETTI P, BALDINI A, VENA L M, et al. Effect of tourniquet use on activation of coagulation in total knee replacement[J]. Clin Orthop Relat R, 2000, 371:169-177.
[4] BLACKBOURNE L H, BAER D G, EASTRIDGE B J, et al. Military medical revolution:prehospital combat casualty care[J]. J Trau Acute Care Surg, 2012, 73(6):S372-S377.
[5] KUMAR N, YADAV C, SINGH S, et al. Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial[J]. J Clin Orthop Trau, 2015, 6(2):85-88.
[6] 冷传礼, 王青竹, 王东英.上肢手术中止血带疼痛的预防[J]. 青岛医药卫生, 1999(5):379.
[7] 李伟, 夏仁云.止血带疼痛机制[J]. 中国矫形外科杂志, 2000, 4(1):60-62.
[8] MCMILLAN T E, GARDNER T, JOHNSTONE A J.Current concepts in tourniquet uses[J]. Surgery, 2020, 38(3):139-142.
[9] ESTōBE J, KEREBEL Anesthesiol C, BRICE C, et al. Pain and tourniquet in orthopedic surgery[J]. Cah Anesthesiol, 1995, 43(6):573-578.
[10] 杨晓初.上肢止血带的压力选择[J]. 中华创伤杂志, 2002, 18(2):121.
[11] MACLVER M B, TANELIAN D L.Activation of C fibers by metabolic perturbations associated with tourniquet ischemia[J]. Anesthesiology, 1992, 76(4):617-623.
[12] RAMAIOLI F, DE-AMICI D, CERIANA P.Tourniquet pain:anatomic-physiological notes and clinical aspects[J]. Minerva Anestesiol, 1996, 62(7-8):265-270.
[13] TAI T W, CHANG C W, LAI K A, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty a randomized controlled trial[J]. J Bone Joint Surg Am, 2012, 94(24):2209-2215.
[14] MCMILLAN T E, JOHNSTONE A J.Tourniquet uses and precautions[J]. Surgery (Oxford), 2017, 35(4):201-203.
[15] KHAN A L, GRAY A.Tourniquet uses and precautions[J]. Surgery (Oxford), 2014, 32(3):131-133.
[16] 高玉镭, 李佩佳, 田敏, 等.人工全膝关节置换术隐性失血的发生机制及影响因素分析[J]. 中国矫形外科杂志, 2012, 20(3):209-212.
[17] 李炳林, 李展, 卓荣锋, 等.上肢手术气压式止血带最佳压力值的探讨[J]. 中国矫形外科杂志, 2020, 28(18):1670-1673
[18] 雷英歌, 李惠萍, 张金陵, 等.全膝关节置换术个性化止血带压力设置[J]. 中国矫形外科杂志, 2019, 27(15):1385-1389
[19] TUNCALI B, KARCI A, TUNCALI B E, et al. A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure[J]. Anesth Analg, 2006, 102(6):1752-1757.
[20] 马骏, 李国庆, 曹力.全膝关节置换术中不同压力止血带对术后肿胀及疼痛影响的临床研究[J]. 中国矫形外科杂志, 2013, 21(13):1297-1301.
[21] KRAGH J J F, BAER D G, WALTERS T J.Extended (16-hour) tourniquet application after combat wounds:a case report and review of the current literature[J]. J Orthop Trau, 2007, 21(4):274-278.
[22] GANGADHARAN R, ROSLEE C, KELSALL N, et al. Retrospective review of complications following long tourniquet time in foot and ankle surgery[J]. J Clin Orthop Trau, 2021, 16:189-194.
[23] FITZGIBBONS P G, DIGIOVANNI C, HARES S, et al. Safe tourniquet use:a review of the evidence[J]. J Am Acad Orthop Sur, 2012, 20(5):310-319.
[24] OLIVECRONA C, LAPIDUS L J, BENSON L, et al. Tourniquet time affects postoperative complications after knee arthroplasty[J]. Int Orthop, 2013, 37(5):827-832.
[25] 马卫华, 张树栋, 王诗军, 等.止血带的使用方式对膝关节置换术失血量和手术时间的影响[J/OL].中华关节外科杂志(电子版), 2011, 5(6):728-732.
[26] 黎笔熙, 郭文军, 崔桂林, 等.不同止血带压力对血流动力学和代谢及再灌注损伤的影响[J]. 华南国防医学杂志, 2008(4):36-39.
[27] RAMA K, APSINGI S, POOVALI S, et al. Timing of tourniquet release in knee arthroplasty.Meta-analysis of randomized, controlled trials[J]. J Bone Joint Surg, 2007, 89(4):699-705.
[28] ZHANG W, LIU A, HU D, et al. Effects of the timing of tourniquet release in cemented total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials[J]. J Orthop Surg Res, 2014, 9(1):125-126.
[29] 王瑞玉, 刘尧, 赵伟, 等.硫酸镁对全麻下止血带相关高血压和术后疼痛的影响[J]. 临床麻醉学杂志, 2019, 35(7):676-679.
[30] SHIN H J, KIM E Y, NA H S, et al. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty:a randomized, double-blinded, placebo-controlled trial[J]. Brit J Anaesth, 2016, 117(4):497-503.
[31] CHEN C, TAO R.The impact of magnesium sulfate on pain control after laparoscopic cholecystectomy:a meta-analysis of randomized controlled studies[J]. Surg Laparosc Endosc Percutan Tech, 2018, 28(6):349-353.
[32] KIM E M, JEON J H, CHUNG M H, et al. The effect of nefopam infusion during laparascopic cholecystectomy on postoperative Pain[J]. Int J Med Sci, 2017, 14(6):570-577.
[33] BOYER J.Treating agitation with dexmedetomidine in the ICU[J]. Dimens Crit Care Nurs, 2009, 28(3):102-109.
[34] 张晓侠, 聂明辉, 王志学, 等.右美托咪定预防超声引导臂丛神经阻滞止血带疼痛效果观察[J]. 现代仪器与医疗, 2017, 23(1):35-37.
[35] 王辉, 吴元琼, 郭琳宝.右美托咪定预防超声引导臂丛神经阻滞止血带疼痛效果评价[J]. 基层医学论坛, 2020, 24(13):1823-1825.
[36] 陈美银, 万宗明, 徐朴, 等.臂丛神经阻滞麻醉下右美托咪定静脉给药对止血带引起疼痛的预防效果[J]. 上海医学, 2015, 38(10):767-770.
[37] 朱玲丽.盐酸右美托咪定在肢体止血带疼痛中的应用[J]. 当代医学, 2012, 18(28):12-14.
[38] KANAZI G E, AOUAD M T, JABBOUR-KHOURY S I, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block[J]. Acta Anaesth Scand, 2010, 50(2):222-227.
[39] ABOSEDIRA M A.Adding clonidine or dexmedetomidine to lidocaine during Bier's block:a comparative study[J]. Pak J Med Sci, 2008, 8(7):660-664.
[40] TAKADA M, FUKUSAKI M, TERAO Y, et al. Preadministration of flurbiprofen suppresses prostaglandin production and postoperative pain in orthopedic patients undergoing tourniquet inflation[J]. J Clin Anesth, 2007, 19(2):97-100.
[41] CORPATAUX J B, GESSEL E V, DONALD F A, et al. Effect on postoperative analgesia of small-Dose lysine acetylsalicylate added to prilocaine during intravenous regional anesthesia[J]. Anesth Analg, 1997, 84(5):1081-1085.
[42] 卫琰, 朱刚, 周晓鸣, 等.帕瑞昔布钠超前镇痛对下肢骨科手术止血带疼痛控制的影响[J]. 中国疼痛医学杂志, 2012, 18(1):59-60.
[43] 徐阳, 罗辉宇, 张振.瑞芬太尼用于四肢手术止血带疼痛的效果观察[J]. 现代中西医结合杂志, 2015, 24(5):543-545.
[44] 李静, 董补怀, 吴续才, 等.股神经-坐骨神经联合阻滞在全膝关节置换术中对止血带反应及术后疼痛的影响[J]. 中国医学科学院学报, 2015, 37(6):641-644.
[45] LIU D, GRAHAM D, GILLIES K, et al. Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty[J]. Knee Surg Relat R, 2014, 26(4):207-213.
[46] 向娟, 张霞.四子散热熨治疗下肢骨折术后止血带所致疼痛肿胀临床研究[J]. 实用中医药杂志, 2020, 36(12):1642-1643.
[47] KAMATH K, KAMATH S U, TEJASWI P.Incidence and factors influencing tourniquet pain[J]. Chinese J Traumatol, 2021, 12(5):12-18.
[48] MATEU VICENT D, SOLA RUANO L, CABRÉ SERRÉS J L, et al. Lower tourniquet pressure does not affect pain nor knee-extension strength in patients after total knee arthroplasty:a randomized controlled trial[J]. Knee Surg Sports Traumatol, Arthroscopy, 2021, 3(4):1-7.
[49] PINSORNSAK P, PINITCHANON P, BOONTANAPIBUL K.Effect of different tourniquet pressure on postoperative pain and complications after total knee arthroplasty:a prospective, randomized controlled trial[J]. J Arthroplasty, 2021, 36(5):1638-1644.

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