Maruhashi Takaaki, Minehara Hiroaki, Takeuchi Ichiro, Kataoka Yuichi, Asari Yasushi
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
J Med Case Rep. 2017 Dec 14;11(1):347. doi: 10.1186/s13256-017-1511-0.
The resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied.
A 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg. Mild lung contusion, hemopneumothorax, unstable pelvic fracture, and retroperitoneal bleeding with extravasation of contrast media were observed in initial computed tomography. As her vital signs had deteriorated during computed tomography, a 7-French aortic occlusion catheter (RESCUE BALLOON®, Tokai Medical Products, Aichi, Japan) was inserted and inflated for aortic occlusion at the first lumbar vertebra level and transcatheter arterial embolization was performed for the pelvic fracture. Her bilateral internal iliac arteries were embolized with a gelatin sponge; however, the embolized sites presented recanalization as coagulopathy appeared. Her bilateral internal iliac arteries were re-embolized by n-butyl-2-cyanoacrylate. The balloon was deflated 18 minutes later. After embolization, repeat computed tomography was performed and a massive hemothorax, which had not been captured on arrival, had appeared in her left pleural cavity. Thoracotomy hemostasis was performed and a hemothorax of approximately 2500 ml was aspirated to search for the source of bleeding. However, clear active bleeding was not captured; resuscitative endovascular balloon occlusion of the aorta may have been the cause of the increased bleeding of the thoracic injury at the proximal site of the aorta occlusion.
It is necessary to note that the use of resuscitative endovascular balloon occlusion of the aorta may increase bleeding in sites proximal to occlusions, even in the case of minor injuries without active bleeding at the initial diagnosis.
由于其有效性和可行性，复苏性血管内主动脉球囊阻断术已广泛应用于严重躯干创伤患者的治疗。然而，几乎从未对复苏性血管内主动脉球囊阻断术在阻断部位近端周围发生的并发症进行过研究。
一名50岁日本女性从约10米高处坠落。初诊时，她的呼吸频率为24次/分钟，在10升/分钟的氧合水平下血氧饱和度为95%，脉搏率为90次/分钟，血压为180/120毫米汞柱。初次计算机断层扫描显示轻度肺挫伤、血气胸、不稳定骨盆骨折以及造影剂外渗导致的腹膜后出血。由于在计算机断层扫描期间她的生命体征恶化，插入了一根7法国的主动脉阻断导管（RESCUE BALLOON®，东海医疗产品公司，日本爱知县）并在第一腰椎水平充气以进行主动脉阻断，并对骨盆骨折进行了经导管动脉栓塞术。用明胶海绵栓塞了她的双侧髂内动脉；然而，随着凝血功能障碍的出现，栓塞部位出现了再通。用正丁基-2-氰基丙烯酸酯对她的双侧髂内动脉进行了再次栓塞。18分钟后球囊放气。栓塞后，进行了重复计算机断层扫描，发现她的左胸腔出现了初诊时未发现的大量血胸。进行了开胸止血，抽出了约2500毫升血胸以寻找出血源。然而，未发现明显的活动性出血；复苏性血管内主动脉球囊阻断术可能是主动脉阻断近端胸部损伤出血增加的原因。
必须注意的是，即使在初诊时为无活动性出血的轻伤病例中，使用复苏性血管内主动脉球囊阻断术也可能增加阻断部位近端的出血。
