不同体重指数对成年患者下肢手术腰麻后止血带耐受性的临床研究文献综述

A Review of Clinical Studies on the Tolerance of Tourniquet after Spinal Anesthesia for Lower Limb Surgery in Adult Patients with Different Body Mass Indexes

摘要: 下肢骨科手术中，止血带的应用对于创造无血手术视野至关重要，而腰麻或腰硬联合麻醉因其良好的神经阻滞效果被广泛采用。然而，止血带引发的缺血再灌注损伤及疼痛反应显著影响患者围术期的舒适度与安全，尤其可能因患者体质差异呈现不同耐受性。体重指数(BMI)作为反映人体成分构成的关键指标，其与止血带耐受性及麻醉管理效果的关系尚未得到系统研究，深入探讨此问题对实现精准化、个体化的麻醉管理及改善患者预后具有重要临床意义。本研究聚焦于探究不同BMI对成年患者下肢手术腰麻后止血带耐受性的影响。文献来源于专业医学数据库(包括PubMed、Cureus、Medicine、World Journal of Clinical Cases以及中文数据库如中国知网、万方等)，通过系统检索关键词组合(如“止血带耐受性/tourniquet tolerance”、“腰麻/spinal anesthesia”、“体重指数/body mass index”、“BMI”、“下肢手术/lower limb surgery”、“血流动力学/hemodynamics”、“并发症/complications”、“右美托咪定/dexmedetomidine”)共获得相关文献18篇。文献类型涵盖临床随机对照研究、观察性研究、回顾性分析及病例报告，其中近五年发表的国际期刊研究及探讨药物干预(如右美托咪定)对血流动力学影响的文献为本研究提供了核心参考框架。英文文献主要探讨止血带应用的生理影响(如颅内压变化)及药物相关风险因素，中文文献则更侧重于临床麻醉方法的比较及药物对血流动力学的具体效应。

Abstract: In lower limb orthopedic surgeries, the application of tourniquets is crucial for creating a blood-free surgical field. Lumbar or combined spinal-epidural anesthesia is widely used due to its excellent nerve block effects. However, ischemia-reperfusion injury and pain responses caused by tourniquets significantly affect patients’ perioperative comfort and safety, particularly as their tolerance may vary depending on individual physical conditions. Body mass index (BMI), a key indicator reflecting body composition, has not yet been systematically studied in relation to tourniquet tolerance and anesthesia management efficacy. A thorough exploration of this issue holds significant clinical importance for achieving precise, personalized anesthesia management and improving patient outcomes. This study focuses on investigating how different BMI levels influence postoperative tourniquet tolerance in adult patients undergoing lower limb surgery under spinal anesthesia. The literature was sourced from specialized medical databases including PubMed, Cureus, Medicine, World Journal of Clinical Cases, and Chinese databases such as China National Knowledge Infrastructure (CNKI) and Wanfang. Through systematic keyword searches (e.g., “tourniquet tolerance”, “spinal anesthesia”, “body mass index (BMI)”, “lower limb surgery”, “hemodynamics”, “complications”, “dextromethoridine”), 18 relevant studies were identified. The literature types included clinical randomized controlled trials, observational studies, retrospective analyses, and case reports. Notably, international journal articles published within the past five years that explored pharmacological interventions (e.g., dextromethoridine) on hemodynamic effects formed the core reference framework for this study. English-language literature primarily investigated physiological impacts of tourniquet application (e.g., intracranial pressure changes) and drug-related risk factors, while Chinese literature focused more on comparative clinical anesthesia methods and specific pharmacodynamic effects of medications.