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[复苏性血管内主动脉球囊阻断术(REBOA)在骨盆环损伤患者出血抢救中的作用]

[Role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Save Life in Bleeding in a Patient with a Pelvic Ring Injury].

作者信息

Šmejkal K, Šimek J, Kočí J, Renc O, Dědek T, Páral J

机构信息

Department of Military Surgery, Faculty of Military Health Sciences Hradec Králové, Defence University Brno.

出版信息

Acta Chir Orthop Traumatol Cech. 2019;86(3):223-227.

Abstract

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.

摘要

作者介绍了一个病例研究,该研究使用复苏性血管内球囊阻断术(REBOA)作为开胸手术和夹闭降主动脉以控制骨盆损伤患者腹膜后出血的合适替代方法。该患者在车祸后遭受多处创伤,包括C型骨盆损伤和腹膜后出血,在接受院前急救护理后被转运至急诊科,并通过输注儿茶酚胺来维持血流。按照ATLS原则进行初步检查后,患者接受了CT扫描。CT检查还发现了多处腹膜后出血来源。随后,患者被送往手术室,在那里对降主动脉进行了血管内球囊阻断术,以暂时控制腹膜后出血,这为按照损伤控制手术原则治疗患者提供了更多时间。在遭受钝性躯干创伤和严重失血性休克的出血患者或“濒死”患者中,急诊开胸手术后的生存率仅约为1%。迄今为止,在相同适应症下应用REBOA技术的全球结果非常有前景。生存率尤其在低血压患者中提高了数倍,且无需立即进行心肺复苏。关键词:主动脉复苏性球囊阻断术,REBOA,失血性休克,腹膜后出血

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