围手术期关节镜止血带的使用：AANA会员的实践和趋势各不相同

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101106

Brian Day M.B., M.Sc., F.R.C.P.(Lon), F.R.C.S.(Eng and C)

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引用次数: 0

摘要

目的调查北美关节镜协会（AANA）成员目前使用止血带的做法，包括止血带的次数、适应症和其他围手术期应用，并确定是否可以提出更安全使用止血带的建议。方法本研究的参与者是在AANA医生社区接受调查的AANA会员。该调查是根据DocMatter中的讨论提示进行的。调查包括4个核心主题的28个问题，包括人口统计学特征、对止血带安全性的一般认识、止血带在关节镜中的应用以及止血带技术在围手术期的应用。该调查从2023年9月至11月为期7周。对选择题的回答进行统计，并根据关键词对简短的回答进行审查和汇总。采用定性分析来理解数据。结果共有59名AANA医生社区成员参与了调查。80%的受访者从业10年以上，20%的受访者从业3年至10年。在关节镜检查中止血带的使用是不同的，尽管检测到一些模式。例如，91%的应答者在所有肢体手术中都使用止血带，但许多人只在需要时充气，还有一些人宁愿不使用止血带。当通过选择性充气袖口来减少止血带时间时，止血带时间平均在15到20分钟之间，而连续充气则为20到60分钟。然而，76%的参与者报告了当使用止血带但没有充气时遇到静脉充血。围手术期止血带的使用也各不相同。几乎一半的答复者在其护理方案中使用止血带进行血流限制治疗。在另一个可能的趋势中，大多数受访者对使用止血带相关技术来帮助解决术后淋巴水肿感兴趣。结论：尽管报道的止血带使用适应症和关键止血带参数的控制存在很大差异，但在关节镜手术的特定方面，通过选择性充气来优化止血带时间，其使用正在不断发展。安全使用止血带的标准化方法及其不断发展的应用是研究的重要领域。

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Perioperative Arthroscopic Tourniquet Usage: Practices and Trends of the AANA Membership Are Varied

Purpose

To investigate current practices for tourniquet use, including tourniquet times, indications, and other perioperative applications, among Arthroscopy Association of North America (AANA) members and to determine whether recommendations can be made for safer tourniquet use.

Methods

Participants in this study were AANA members who responded to our survey in the AANA DocMatter Community. The survey was developed based on discussion prompts in DocMatter. The survey consisted of 28 questions on 4 core themes, including demographic characteristics, general understanding of tourniquet safety, applied tourniquet use in arthroscopy, and tourniquet technology in perioperative applications. The survey was open for responses for 7 weeks from September to November 2023. Multiple-choice responses were counted, and short-form responses were reviewed and aggregated based on keywords. Qualitative analysis was used to understand the data.

Results

A total of 59 AANA DocMatter Community Members participated in the survey. Eighty percent of respondents had been in practice for more than 10 years, whereas 20% had been in practice for between 3 and 10 years. Tourniquet usage in arthroscopy was varied, although some patterns were detected. For example, 91% of responders applied tourniquets for all limb procedures, but many inflated them only as needed, and some preferred not to use a tourniquet. When tourniquet times were minimized by selectively inflating cuffs, tourniquet times averaged between 15 and 20 minutes compared with 20 to 60 minutes for continuous inflation. However, 76% of participants reported encountering venous congestion when a tourniquet was applied but not inflated. Perioperative tourniquet uses were also varied. Almost half of respondents used tourniquets for blood flow restriction therapy in their care protocols. In a separate possible trend, a majority of respondents were interested in using tourniquet-related technology to help resolve postsurgical lymphedema.

Conclusions

Despite large reported variation in the indications for tourniquet use and the control of key tourniquet parameters, use is evolving through a focus on optimizing tourniquet times through selective inflation for specific aspects of arthroscopic procedures.