Lynn A M, Fischer T, Brandford H G, Pendergrass T W
Anesth Analg. 1986 Aug;65(8):865-72.
The hemodynamic and metabolic effects of deflation of pneumatic tourniquets were assessed in 15 children, seven of whom had bilateral tourniquets applied. Systemic acidosis from release of lactate and PaCO2 after tourniquet deflation did not cause adverse effects in these healthy children. Larger increases in lactate were seen with longer tourniquet inflation times (greater than 75 min) or with bilateral tourniquets. The greatest decrease in pH was seen with simultaneous deflation of bilateral tourniquets. Heart rate did not change with tourniquet deflation, whereas systolic blood pressure decreased 8-10 mm Hg with deflation. Blood pressure returned to control values within 5-10 min; no arrhythmias were seen. Recommendations to minimize the systemic metabolic effects after release of tourniquets in children under general anesthesia include the following: 1) attempt to limit tourniquet inflation times to less than 75 min; 2) use controlled ventilation prior to and after tourniquet deflation to remove the respiratory component of acidosis; 3) check blood gas tensions within 5 min of tourniquet deflation in children with long tourniquet inflation times (greater than 75 min), and where bilateral tourniquets are deflated simultaneously or within 30 min of each other.
在15名儿童中评估了充气止血带放气的血流动力学和代谢效应，其中7名儿童使用了双侧止血带。止血带放气后乳酸释放和动脉血二氧化碳分压导致的全身酸中毒在这些健康儿童中未引起不良反应。止血带充气时间较长（超过75分钟）或使用双侧止血带时，乳酸升高幅度更大。双侧止血带同时放气时，pH值下降幅度最大。止血带放气时心率未改变，而收缩压放气时下降8 - 10 mmHg。血压在5 - 10分钟内恢复到对照值；未观察到心律失常。关于在全身麻醉下儿童止血带放气后尽量减少全身代谢效应的建议如下：1）尝试将止血带充气时间限制在75分钟以内；2）在止血带放气前后使用控制通气以消除酸中毒的呼吸成分；3）对于止血带充气时间较长（超过75分钟）且双侧止血带同时放气或彼此间隔30分钟内放气的儿童，在止血带放气后5分钟内检查血气张力。
