Middleton S D, Jenkins P J, Muir A Y, Anakwe R E, McEachan J E
Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
Orthopaedic Department, Queen Margaret Hospital, Dunfermline, UK.
J Hand Surg Eur Vol. 2014 Jul;39(6):637-41. doi: 10.1177/1753193413492059. Epub 2013 Jun 3.
The UK National Patient Safety Agency issued a rapid response report in 2009 following reports of complications related to digital tourniquet use and inadvertent retention. In their guidance, they recommend the use of CE marked digital tourniquets and advise against the use of surgical gloves. There are a number of different commercially available non-pneumatic digital tourniquets, but little clear data relating to their comparable physical properties, clinical efficacy or safety. The aim of this study was to investigate the variability of pressures exerted by non-pneumatic digital tourniquets. A Tekscan FlexiForce(®) force sensor was used to measure applied force and to calculate the surface pressures under: the Toe-niquet™; T-Ring™ and surgical glove 'roll down' tourniquets in finger models. The lowest mean pressures were produced by the larger glove sizes (size 8) (25 mmHg), while the highest pressures were produced by the Toe-niquet (1560 mmHg). There was a significant overall difference in pressures exerted under tourniquets when comparing tourniquet type (p<0.001) and finger size (p<0.001) with these techniques. It is difficult to anticipate and regulate pressures generated by non-pneumatic tourniquets. Safe limits for application time and surface pressures are difficult to define. Further work is required to model the pressure effects of commercially available digital tourniquets and to identify which are most effective but safe.
2009年，英国国家患者安全机构在收到与数字止血带使用及意外留置相关的并发症报告后，发布了一份快速反应报告。在其指南中，他们建议使用带有CE标志的数字止血带，并建议不要使用外科手套。市面上有多种不同的非充气式数字止血带，但关于它们可比的物理特性、临床疗效或安全性的明确数据很少。本研究的目的是调查非充气式数字止血带施加压力的变异性。使用Tekscan FlexiForce(®)力传感器测量施加的力，并计算在手指模型中Toe-niquet™、T-Ring™和外科手套“卷下”式止血带下的表面压力。较大尺寸手套（8号）产生的平均压力最低（25 mmHg），而Toe-niquet产生的压力最高（1560 mmHg）。在比较止血带类型（p<0.001）和手指尺寸（p<0.001）时，这些技术在止血带下施加的压力存在显著的总体差异。非充气式止血带产生的压力难以预测和调节。应用时间和表面压力的安全限度难以确定。需要进一步开展工作，对市售数字止血带的压力效应进行建模，并确定哪些止血带最有效且安全。
