位置至关重要：REBOA 在主动脉 1 区与 3 区的血液动力学效应。
Location is everything: The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta.
机构信息
From the Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, California (E.M.T., G.L.H., M.A.S., A.J.D., E.S.D., E.R.F., L.P.N., J.K.G., T.K.W); Department of General Surgery, David Grant USAF Medical Center, Travis Air Force Base, California (E.M.T., A.J.D., E.S.D.); Department of Surgery, University of California Davis Medical Center, Sacramento, California (E.M.T., M.A.S., A.J.D., E.S.D., J.J.D.); Heart, Lung, and Vascular Center, David Grant USAF Medical Center, Travis Air Force Base, California (M.A.S., J.J.D., T.K.W.); Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland (J.J.D.); Department of Surgery, Emory University Hospital, Atlanta, Georgia (L.P.N.); Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (T.K.W.); Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California (M.A.J.).
出版信息
J Trauma Acute Care Surg. 2018 Jul;85(1):101-107. doi: 10.1097/TA.0000000000001858.
OBJECTIVES
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention.
METHODS
Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05.
RESULTS
There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L).
CONCLUSIONS
In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.
目的
在非压缩性躯干出血患者的复苏过程中，主动脉球囊阻断复苏术（REBOA）是一种新兴的技术，可增加近端血压。目前，放置部位（Zone 1 区和 Zone 3 区）取决于损伤模式，但仍存在很大争议。我们旨在比较 Zone 1 区和 Zone 3 区 REBOA 放置对近端血流动力学的支持程度以及干预后再灌注时血流动力学不稳定的程度。
方法
18 只麻醉猪经历了 25%总血容量的控制性出血，随后进行 Zone 1 REBOA、Zone 3 REBOA 或无干预（对照）45 分钟。然后，用放血进行复苏，排空主动脉球囊，然后进行 5 小时的重症监护，最后安乐死。连续记录生理参数，并在指定时间间隔抽取血液进行分析。有意义的定义为 p < 0.05。
结果
在基线或出血的最初 30 分钟内，各组之间没有显著差异。在干预期间，与 Zone 3 动物相比，Zone 1 动物的平均近端 MAP 明显更高（127.9 ± 1.3 与 53.4 ± 1.1 mm Hg），与对照动物相比，Zone 3 动物的平均近端 MAP 也更高（42.9 ± 0.9 mm Hg）。乳酸浓度在 Zone 1 动物中显著升高（9.6 ± 0.4 mmol/L），与 Zone 3 动物（5.1 ± 0.3 mmol/L）和对照动物（4.2 ± 0.8 mmol/L）相比。
结论
在我们的出血性休克猪模型中，与 Zone 1 REBOA 相比，Zone 3 REBOA 提供的近端血流动力学支持最小，尽管再灌注时缺血负担和不稳定性较小。在即将发生血流动力学崩溃的情况下，无论损伤模式如何，Zone 1 REBOA 放置可能更有效，而 Zone 3 应仅保留给持续存在远端出血且相对稳定的患者。
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