主动脉球囊阻断复苏在骨盆钝性创伤和危及生命的出血中的应用：在一级创伤中心的 20 年经验。
Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: A 20-year experience in a Level I trauma center.
机构信息
From the Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine (A.P., J.B., J.F.P., P.B.), Department of Radiology (F.T., M.R.), Quality of Care Unit (B.B.), Grenoble University Hospital; Grenoble Alps University (B.B., C.A., J.T., J.F.P., P.B.); Department of Emergency Surgery and Visceral Surgery (C.A.), and Department of Orthopaedic Surgery (J.T.), Grenoble University Hospital, Grenoble, France.
出版信息
J Trauma Acute Care Surg. 2018 Mar;84(3):449-453. doi: 10.1097/TA.0000000000001794.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as a noninvasive clamp of the aorta after diverse posttraumatic injuries. Balloon inflation in zone 3 (from the lower renal artery to the aortic bifurcation) can be performed to stop ongoing bleeding after severe pelvic trauma with life-threatening hemorrhage. The aim of our study was to describe our 20-year experience with REBOA in terms of efficacy and safety in patients with a suspicion of severe pelvic trauma and extreme hemorrhagic shock.
METHODS
We performed a retrospective study from 1996 to 2017 in a French Level I trauma center. All consecutive patients who underwent a REBOA procedure were included. REBOA indication relied on (1) extreme hemodynamic instability (systolic arterial blood pressure [SBP] < 60 mm Hg on admission, SBP < 90 mm Hg despite initial resuscitation in the trauma bay or posttraumatic cardiac arrest) and (2) positive pelvic X-ray. Efficacy endpoints were vital signs and coagulation parameters before and after balloon inflation. Safety endpoints were REBOA-related complications: vascular events, acute renal failure, and rhabdomyolysis.
RESULTS
Within the study period, 32 patients underwent a REBOA procedure. Only two patients had technical failure and balloon was not inflated in one patient. Nineteen patients did not survive at day 28. The REBOA significantly improved SBP from 60 (35-73) mm Hg to 115 (91-128) mm Hg (p < 0.001). We also reported a high rate of vascular complications (19%, n = 5 patients) but no amputation. Renal replacement therapy was initiated in 11 patients, and 15 patients had severe rhabdomyolysis.
CONCLUSION
The REBOA is safe and effective in improving hemodynamics after severe pelvic trauma and life-threatening hemorrhage. Our study supports the use of REBOA as a bridge to definitive hemostatic treatment after severe pelvic trauma.
LEVEL OF EVIDENCE
Therapeutic, level IV.
背景
在发生多种创伤后，主动脉腔内球囊阻断复苏术（REBOA）作为一种非侵入性的主动脉夹闭技术，应用日益广泛。在严重骨盆创伤合并危及生命的出血时，可在区域 3（肾动脉以下至主动脉分叉处）充气阻断球囊，以停止持续出血。本研究的目的是描述我们在怀疑严重骨盆创伤和极重度出血性休克的患者中应用 REBOA 的 20 年经验，包括其疗效和安全性。
方法
我们进行了一项 1996 年至 2017 年期间法国 1 级创伤中心的回顾性研究。所有连续接受 REBOA 治疗的患者均纳入本研究。REBOA 的适应证为：（1）极度血流动力学不稳定（入院时收缩压[SBP]＜60mmHg，创伤复苏室或创伤后心脏骤停初始复苏后 SBP＜90mmHg）和（2）骨盆 X 线阳性。疗效终点为充气前后的生命体征和凝血参数。安全性终点为与 REBOA 相关的并发症：血管事件、急性肾衰竭和横纹肌溶解。
结果
在研究期间，32 例患者接受了 REBOA 治疗。仅 2 例患者出现技术失败，1 例患者球囊未充气。19 例患者在第 28 天死亡。REBOA 可显著提高 SBP，从 60（35-73）mmHg 提高至 115（91-128）mmHg（p＜0.001）。我们还报告了较高的血管并发症发生率（19%，n=5 例），但无截肢。11 例患者开始进行肾脏替代治疗，15 例患者发生严重的横纹肌溶解。
结论
在严重骨盆创伤和危及生命的出血后，REBOA 安全且有效，可以改善血流动力学。我们的研究支持将 REBOA 作为严重骨盆创伤后确定性止血治疗的桥梁。
证据等级
治疗性，IV 级。
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