止血带运用的常见不良反应 A tourniquet use common adverse reactions 1、 止血带充气时的局部反应 The local reaction of 1, a tourniquet inflatable 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。 8 minutes after a tourniquet inflatable exquisite and the oxygen partial pressure of zero in the mitochondria, caused by anaerobic metabolism. Within 30 to 60 minutes after T way. 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. As the muscle under the tourniquet pressure, could delay the patient recovery. 2、放止血带的全身反应 2, put a tourniquet systemic reactions 放止血带后，肢体得到灌注，代谢产物进入循环。静脉氧饱和度在30—60秒内下降20%，中心体温在90秒内降低0.7，呼气末二氧化碳明显增高，但是，除非有显著的肺内分流，一般很少发生动脉血氧饱和度下降的现象。 Put a tourniquet, limb perfusion, metabolites into the loop. Venous oxygen saturation in 30-60 seconds fell by 20%, the core body temperature within 90 seconds to reduce 0.7, significantly higher and breathe out carbon dioxide at the end of the, however, unless there is a significant pulmonary shunt, general decline in spo2 occur rarely. 3、血流动力学反应 3, hemodynamic response 血流动力学改变发生止血带充气，持续充气及放气衙（1）充气期：肢体驱血和止血带反气时，回心血量增多，外周血管阻力增加，临床上表现为中心静脉压或动脉压轻微增高。然而当病人有严重的静脉曲张或心室顺应性极差时。脉动压会显著升高。若双侧下肢止血带同时充气，可导致中心静脉压明显增高。 Hemodynamic change tourniquet inflatable, inflatable and deflated my official (1) the gas phase: body blood drive and a tourniquet anti air pressure, the change of blood volume increase in the number of peripheral vascular resistance increased, clinically characterized by central venous pressure or arterial pressure increased slightly. However, when a patient had severe varicose veins or ventricular compliance is poor. Pulse pressure will rise significantly. If bilateral lower limb tourniquet air at the same time, can lead to increased central venous pressure is obvious. （2）放气期：止血带放松时缺血的肢体发生现灌注，通常会导致中心静脉压和动脉压降低，若血压下降极其明显时可导致心跳骤停，发生因素包括，外周血管阻力突然下降，急性失血以及代谢产物时循环的抑制。 (2) deflated stage: relax tourniquet ischemia limbs occur now perfusion, usually leads to central venous pressure and arterial pressure is reduced, when blood pressure drops extremely obvious can lead to cardiac arrest, factors including, peripheral vascular resistance suddenly fell, the inhibition of acute blood loss and metabolic product cycle. （3）持续充气期：在全身麻醉时，持续充气15—60分钟可引起高血压，其原因尚不清楚，有人认为这可能反映了肌肉或神经细胞缺血已达到临界水平。有时加深麻醉也不能使血压降低，需加用血管扩张剂旭肼苯哒嗪、哨苯地平、拉贝洛尔等才起效。 (3) continuous aeration time: in general anesthesia, inflatable 15-60 minutes can cause high blood pressure, the reason is unclear, some people think that this may reflect the muscle or nerve cells in ischemia has reached a critical level. Sometimes deepen anesthesia can reduce blood pressure, need to add a vasodilator xu hydralazine, whistle benzene horizon, bello as enforced.