Avaro Jean-Philippe, Mardelle Vincent, Roch Antoine, Gil Celine, de Biasi Cécile, Oliver Manuela, Fusai Therry, Thomas Pascal
Service de Chirurgie Thoracique, Hôpital d'Instruction des Armées A. Laveran, Marseille, France.
J Trauma. 2011 Sep;71(3):720-5; discussion 725-6. doi: 10.1097/TA.0b013e318221a94a.
To evaluate the feasibility of aortic balloon catheter occlusion in intra-abdominal hemorrhage.
Effects of transfemoral diaphragmatic aortic balloon occlusion (ABO) have been evaluated in 25 pigs. The animals were submitted to incontrollable hemorrhage by a splenic trauma. Group 1 (n = 9) received fluid resuscitation with normal saline (NS) without aortic occlusion; group 2 (n = 8) underwent 60 minutes ABO and NS. Groups 3 (n = 4) and 4 (n = 4) underwent ABO during 40 minutes and 60 minutes, respectively, NS, and splenectomy.
Aortic balloon location was adequate in all animals. ABO increased the portion of 2-hour survivors significantly (7/16 vs. 0/9; p = 0.03). ABO increased mean arterial blood pressures (p < 0.05). There was a significant decrease of bleeding and volume of fluid resuscitation (p < 0.05) in ABO groups. Blood potassium and lactate levels at death were significantly higher in groups 2 and 4 compared with those of the control group: 29 ± 0.54 and 6.08 mmol/L ± 0.44 mmol/L versus 4.16 mmol/L ± 0.35 mmol/L (p < 0.02), and 11.39 mmol/L ± 0.37 mmol/L and 9.59 mmol/L ± 1.19 mmol/L versus 6.43 mmol/L ± 0.57 mmol/L (p < 0.001), respectively. There were no significant differences between group 3 and the control group: 4.83 mmol/L ± 0.32 mmol/L versus 6.43 mmol/L ± 0.57 mmol/L and 5.2 mmol/L ± 0.13 mmol/L versus 4.16 mmol/L ± 0.35 mmol/L, respectively. At necropsy, there were no significant differences in terms of visceral (bowel and kidney) ischemia between the different experimental groups.
A 40-minute ABO followed by surgical damage control improved survival in this animal model of uncontrolled hemorrhagic shock caused by abdominal trauma. ABO could be considered for the management of severe abdominal trauma.
评估主动脉球囊导管阻塞术在腹腔内出血中的可行性。
对25头猪评估经股动脉膈下主动脉球囊阻塞（ABO）的效果。通过脾脏创伤使动物发生难以控制的出血。第1组（n = 9）接受生理盐水（NS）液体复苏，未进行主动脉阻塞；第2组（n = 8）进行60分钟的ABO并给予NS。第3组（n = 4）和第4组（n = 4）分别在40分钟和60分钟内进行ABO，给予NS，并进行脾切除术。
所有动物的主动脉球囊位置均合适。ABO显著增加了2小时存活者的比例（7/16对0/9；p = 0.03）。ABO增加了平均动脉血压（p < 0.05）。ABO组的出血量和液体复苏量显著减少（p < 0.05）。与对照组相比，第2组和第4组死亡时的血钾和乳酸水平显著更高：分别为29 ± 0.54和6.08 mmol/L ± 0.44 mmol/L，而对照组为（p < 0.02）4.16 mmol/L ± 0.35 mmol/L；以及11.39 mmol/L ± 0.37 mmol/L和9.59 mmol/L ± 1.19 mmol/L，而对照组为（p < 0.001）6.43 mmol/L ± 0.57 mmol/L。第3组与对照组之间无显著差异：分别为4.83 mmol/L ± 0.32 mmol/L对6.43 mmol/L ± 0.57 mmol/L，以及5.2 mmol/L ± 0.13 mmol/L对4.16 mmol/L ± 0.35 mmol/L。尸检时，不同实验组之间在内脏（肠和肾）缺血方面无显著差异。
在这种由腹部创伤引起的非控制性失血性休克动物模型中，40分钟的ABO随后进行手术损伤控制可提高存活率。ABO可考虑用于严重腹部创伤的治疗。
