Karalezli Nazim, Ogun Cemíle Oztin, Ogun Tunç Cevat, Yildirim Serhat, Tuncay Ibrahim
Department of Orthopedics and Traumatology, Selçuk University Meram School of Medicine, Turkey.
J Trauma. 2007 Mar;62(3):750-4. doi: 10.1097/01.ta.0000249076.11239.96.
The literature is scarce on wrist tourniquets. In this study, three well-established locations of tourniquet setting including upper arm, proximal forearm, and wrist were compared on the same limb using both clinical as well as biochemical variables in paramedical volunteers.
Twenty unmedicated, healthy, paramedical, right-hand dominant volunteers participated in the study. The left upper arms were used for monitoring. Blood pressures and heart rates were monitored and recorded before (baseline) and immediately after the application of the tourniquet, every 5 minutes, and at the time the patient requested deflation. An intravenous cannula (22 G) was placed on the right hand to obtain samples, which were taken at baseline and immediately after deflation of the tourniquet to evaluate the levels of pO2, pCO2, O2 saturation, pH, bicarbonate, blood sugar, lactate, hematocrit, and electrolytes. The tourniquets were applied to the right upper arm, forearm, and wrist of each subject with 5-day intervals between each trial. Subjective discomfort and tourniquet pain levels were recorded. For each trial, tourniquet tolerance and details of discomfort were recorded. Statistical analysis was performed as appropriate.
Twenty volunteers aged 20 to 44 years were included. For each trial, in the first 10 minutes after inflation of the tourniquet, the heart rate and systolic blood pressure were increased compared with baseline values. Diastolic blood pressure was elevated immediately after inflation and remained so until deflation in each trial. Diastolic blood pressure values were higher in the upper-arm tourniquet group compared with wrist. Then pH, pO2, and O2 saturation values were decreased and pCO2 and lactate levels were increased compared with baseline values in each trial. Blood sugar was decreased significantly in the arm group. The decrease in pH, pO2, O2 saturation, and blood sugar in the upper arm group was significantly higher compared with wrist and forearm groups. The lactate value was higher in the upper arm group compared with wrist. Visual analog scale and numerical rating scores were lower in the wrist group compared with others at all times. The longest tourniquet tolerance was in the wrist group. In the wrist group, curling was observed in all subjects but the fingers could easily be extended.
The wrist tourniquet is the most comfortable technique of bloodless surgery for procedures limited to the hand region.
关于腕部止血带的文献较少。在本研究中，在辅助医疗志愿者的同一肢体上，使用临床和生化变量对三个公认的止血带设置部位（上臂、前臂近端和腕部）进行了比较。
20名未用药、健康的辅助医疗志愿者（惯用右手）参与了本研究。使用左上臂进行监测。在止血带应用前（基线）、应用后立即、每5分钟以及患者要求放气时监测并记录血压和心率。在右手放置一根静脉留置针（22G）以获取样本，在基线和止血带放气后立即采集样本，以评估氧分压（pO2）、二氧化碳分压（pCO2）、氧饱和度、pH值、碳酸氢盐、血糖、乳酸、血细胞比容和电解质水平。对每个受试者的右上臂、前臂和腕部应用止血带，每次试验间隔5天。记录主观不适和止血带疼痛程度。对于每次试验，记录止血带耐受性和不适细节。进行适当的统计分析。
纳入了20名年龄在20至44岁之间的志愿者。对于每次试验，在止血带充气后的前10分钟内，心率和收缩压与基线值相比有所增加。每次试验中，舒张压在充气后立即升高，并一直保持到放气。上臂止血带组的舒张压值高于腕部。然后，与每次试验的基线值相比，pH值、pO2和氧饱和度值降低，pCO2和乳酸水平升高。手臂组的血糖显著降低。上臂组pH值、pO2、氧饱和度和血糖的降低明显高于腕部和前臂组。上臂组的乳酸值高于腕部。在所有时间点，腕部组的视觉模拟评分和数字评分得分均低于其他组。腕部组的止血带耐受性最长。在腕部组中，所有受试者均观察到手指卷曲，但手指可轻松伸展。
对于仅限于手部区域的手术，腕部止血带是最舒适的无血手术技术。
