主动脉复苏性血管内球囊阻断术的安全性和可行性评估。
Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta.
作者信息
Saito Nobuyuki, Matsumoto Hisashi, Yagi Takanori, Hara Yoshiaki, Hayashida Kazuyuki, Motomura Tomokazu, Mashiko Kazuki, Iida Hiroaki, Yokota Hiroyuki, Wagatsuma Yukiko
机构信息
From the Shock and Trauma Center (N.S., H.M., T.Y., Y.H., K.H., T.M., K.M., H.I.), Nippon Medical School Chiba Hokusoh Hospital, Inzai; Emergency and Critical Care Medicine (H.Y.), Nippon Medical School, Tokyo; and Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine (Y.W.), University of Tsukuba, Tsukuba, Japan.
出版信息
J Trauma Acute Care Surg. 2015 May;78(5):897-903; discussion 904. doi: 10.1097/TA.0000000000000614.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the ultimately invasive procedures for managing a noncompressive torso injury. Since it is less invasive than resuscitative open aortic cross-clamping, its clinical application is expected.
METHODS
We retrospectively evaluated the safety and clinical feasibility of REBOA (intra-aortic occlusion balloon, MERA, Tokyo, Japan) using the Seldinger technique to control severe hemorrhage. Of 5,230 patients admitted to our trauma center in Japan from 2007 to 2013, we included 24 who underwent REBOA primarily. The indications for REBOA were a pelvic ring fracture or hemoperitoneum with hemodynamically instability and impending cardiac arrest. Emergency hemostasis was performed during REBOA in all patients.
RESULTS
All 24 patients had a blunt injury, the median age was 59 (interquartile range, 41-71 years), the median Injury Severity Score (ISS) was 47 (interquartile range, 37-52), the 30-day survival rate was 29.2% (n = 7), and the median probability survival rate was 12.5%. Indications for REBOA were hemoperitoneum and pelvic ring fracture in 15 cases and overlap in 8 cases. In 10 cases of death, the balloon could not be deflated in 5 cases. In 19 cases in which the balloon was deflated, the median duration of aortic occlusion was shorter in survivors than in deaths (21 minutes vs. 35 minutes, p = 0.05). The mean systolic blood pressure was significantly increased by REBOA (from 53.1 [21] mm Hg to 98.0 [26.6] mm Hg, p < 0.01). There were three cases with complications (12.5%), one external iliac artery injury and two lower limb ischemias in which lower limb amputation was necessary in all cases. Acute kidney injury developed in all three cases, but failure was not persistent.
CONCLUSION
REBOA seems to be feasible for trauma resuscitation and may improve survivorship. However, the serious complication of lower limb ischemia warrants more research on its safety.
LEVEL OF EVIDENCE
Therapeutic/care management, level V.
背景
复苏性血管内主动脉球囊阻断术（REBOA）是处理非压迫性躯干损伤的最终侵入性操作之一。由于其侵入性低于复苏性开放性主动脉交叉钳夹术，因此有望得到临床应用。
方法
我们回顾性评估了使用Seldinger技术通过REBOA（主动脉内阻断球囊，MERA，日本东京）控制严重出血的安全性和临床可行性。在2007年至2013年期间入住日本我们创伤中心的5230例患者中，我们纳入了24例主要接受REBOA治疗的患者。REBOA的适应证为骨盆环骨折或伴有血流动力学不稳定及即将发生心脏骤停的腹腔积血。所有患者在REBOA期间均进行了紧急止血。
结果
所有24例患者均为钝性损伤，中位年龄为59岁（四分位间距，41 - 71岁），中位损伤严重度评分（ISS）为47分（四分位间距，37 - 52），30天生存率为29.2%（n = 7），中位概率生存率为12.5%。REBOA的适应证为腹腔积血和骨盆环骨折15例，两者重叠8例。在10例死亡病例中，5例球囊无法放气。在19例球囊放气的病例中，幸存者的主动脉阻断中位持续时间短于死亡者（21分钟对35分钟，p = 0.05）。REBOA使平均收缩压显著升高（从53.1[21]mmHg升至98.0[26.6]mmHg，p < 0.01）。有3例发生并发症（12.5%），1例髂外动脉损伤和2例下肢缺血，所有病例均需进行下肢截肢。所有3例均发生急性肾损伤，但均未持续出现肾功能衰竭。
结论
REBOA似乎对创伤复苏可行，且可能提高生存率。然而，下肢缺血这一严重并发症需要对其安全性进行更多研究。
证据水平
治疗/护理管理，V级。
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