Application effect of pneumatic tourniquet with individualized pressure setting in orthopaedic surgery of extremities: A meta‐analysis

• Published in: Journal of advanced nursing 2019-12, Vol.75 (12), p.3424-3433
• Main Authors: Ding, Lei, Ding, Cai‐yun, Wang, Yun‐lei, Wang, Mei‐lan, Qian, Xiao‐hong, Huang, Ling, Xie, Xing‐er, Ji, Han‐zhen
• Format: Article
• Language: English
• Subjects: accessory injuries; Blood pressure; Clinical trials; complication; haemostatic effect; individualized pressure setting; inflation pressure; inflation time; Medical dressings; Meta-analysis; Nursing; Operating theatres; orthopaedic surgery; Orthopedic surgery; Orthopedics; pneumatic tourniquet; Surgery
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14196

Aims To evaluate the application effect of individualized pressure setting strategy of pneumatic tourniquet in orthopaedic surgery. Background Some individualized setting pressures of pneumatic tourniquet are lower than the standard pressure recommended in the textbook (Nursing of Operating Room, People's Military Publishing House, 2008). Design Meta‐analysis. Data Sources CL, WOS, PubMed, CNKI, CBM, VIP and Wan‐fang DATA. Review Methods We searched studies on the application effect of individualized pressure of pneumatic tourniquet from the establishment date of the databases to September 2017. Study quality was assessed using the quality evaluation method recommended in the Cochrane Handbook 5.1.0 (Higgins, 2011). The primary outcome was inflation pressure. Results We identified nine studies including 1,200 patients. The individualized pressure setting strategy can provide a lower inflation pressure (four studies), improve haemostatic effect (six studies) and reduce the incidence of related complications (eight studies). Conclusions An individualized inflation pressure is recommended when using the tourniquet in orthopaedic surgery. And the setting pressure might be a minimum and efficiency one, by accessing the the systolic blood pressure and limb circumferences of the patient. Impact This study addressed that the individualized pressure setting strategy of pneumatic tourniquet can provide a lower inflation pressure and a higher application value in orthopaedic limb surgery. However, greater attention should be focused on how to unify the individualized pressure setting strategy. Meanwhile, the instructions for use from manufacturers need to be updated. Therefore, it is recommended to conduct a large‐sample multi‐centre high‐quality randomized controlled trial in strict accordance with the CONSORT standard. 目的 在于评估个性化压力设置策略气压止血带在骨科四肢手术中的应用效果。 背景 气压止血带的个性化设置压力低于教材(《手术室护理》(人民军事出版社,2008年))中推荐的标准压力。 设计 荟萃分析。 资料来源 CL、WOS、PubMed、CNKI、CBM、VIP 和 Wan‐fang DATA。 综述方法 数据库建立之日起到2017年9月,我们搜索了个性化气压止血带应用效果的相关研究。使用Cochrane Handbook5.1.0(Higgins,2011)中推荐的质量评估方法来评估研究的质量。主要结果是膨胀压力。 结果 我们确定了9项研究,包括1200名患者。个性化压力设置策略可提供较低的膨胀压力(四项研究),改善止血效果(六项研究)并降低相关并发症的发生率(八项研究)。 结论 在骨科手术中使用止血带时,建议采用个性化膨胀压力。通过测量患者的收缩压和四肢周长,设置压力可能是最小和最有效的压力。 影响 本研究旨在探讨气压止血带的个性化压力设置策略在骨科四肢手术中能提供较低的膨胀压力和较高的应用价值。然而,应更加关注如何统一个性化压力设置策略。同时,需要更新制造商的使用说明书。因此,建议严格按照CONSORT标准进行大样本多中心高质量随机对照试验。