Ogura Takayuki, Lefor Alan Kawarai, Nakamura Mitsunobu, Fujizuka Kenji, Shiroto Kousuke, Nakano Minoru
Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan; Department of Emergency Medicine, Jichi Medical University, Tochigi, Japan.
Department of Surgery, Jichi Medical University, Tochigi, Japan.
J Emerg Med. 2017 May;52(5):715-722. doi: 10.1016/j.jemermed.2017.01.014. Epub 2017 Feb 17.
In trauma resuscitation with resuscitative endovascular balloon occlusion of the aorta (REBOA), urgent and accurate placement of the catheter in the resuscitation area without fluoroscopy can shorten the time from admission to REBOA, allowing rapid, temporary control of bleeding.
The experience-based protocol in our center for ultrasound-guided REBOA in the resuscitation area without fluoroscopy is as follows: the femoral artery is punctured and a guidewire inserted; sonography is used to verify that the guidewire is in the abdominal aorta; the position of the balloon is confirmed with ultrasound after estimating the distance to the clavicle, and the pressure in the radial artery and sheath is used to monitor correct positioning; connect the pressure transducer to the catheter sheath for continuous monitoring of the blood pressure in the sheath, and inflate the balloon until the blood pressure tracing at the sheath has disappeared; check the pulse in the left radial artery, and withdraw the catheter slightly if the pulse in the radial artery is not palpable or is decreased (if this pulse is not palpable or decreased, the balloon is in the aortic arch). In this retrospective review of our REBOA protocol, between April 2012 and March 2016, 34 patients were enrolled. Two patients had complications, including dissection of the femoral artery in one and difficult percutaneous vascular access in another. Median time needed to complete the procedure was 8 min. Overall, 24 of 34 patients survived more than 24 h (72%), and overall mortality was 47%. Patients who lived more than 24 h, and then died had severe traumatic brain injury or septic shock.
Ultrasound-guided REBOA is presented. Monitoring the blood pressure in the left radial artery allows us to determine adequate positioning of the balloon, and the blood pressure in the catheter sheath located in the femoral artery should also be monitored to prevent aortic injuries caused by the overinflation of the balloon.
在采用主动脉内球囊阻断术（REBOA）进行创伤复苏时，在无荧光透视的情况下于复苏区域紧急且准确地放置导管可缩短从入院到实施REBOA的时间，从而实现对出血的快速、临时控制。
我们中心在无荧光透视的复苏区域进行超声引导下REBOA的基于经验的方案如下：穿刺股动脉并插入导丝；使用超声检查以确认导丝位于腹主动脉内；在估计到锁骨的距离后，用超声确认球囊位置，并利用桡动脉和鞘管内的压力监测正确的定位；将压力传感器连接至导管鞘管以持续监测鞘管内的血压，然后充盈球囊直至鞘管处的血压波形消失；检查左桡动脉搏动，若桡动脉搏动未触及或减弱（若该搏动未触及或减弱，则球囊位于主动脉弓内），则将导管稍作回撤。在对我们的REBOA方案进行的这项回顾性研究中，2012年4月至2016年3月期间纳入了34例患者。2例出现并发症，其中1例为股动脉夹层，另1例为经皮血管穿刺困难。完成该操作所需的中位时间为8分钟。总体而言，34例患者中有24例存活超过24小时（72%），总死亡率为47%。存活超过24小时后死亡的患者患有严重创伤性脑损伤或感染性休克。
介绍了超声引导下的REBOA。监测左桡动脉血压可使我们确定球囊的合适位置，还应监测位于股动脉的导管鞘管内的血压，以防止球囊过度充盈导致主动脉损伤。
