Marciniuk Piotr, Pawlaczyk Rafał, Rogowski Jan, Wojciechowski Jacek, Znaniecki Łukasz
Klinika Kardiochirurgii i Chirurgii Naczyniowej Gdańskiego Uniwersytetu Medycznego.
Pol Przegl Chir. 2019 Oct 24;92(2):42-47. doi: 10.5604/01.3001.0013.5426.
It is extremely difficult to provide non-compressible torso hemorrhage control particularly in trauma setting. A vast majority of cases present inability of successful exsanguination arrest, leading to cardiovascular collapse, myocardial and cerebral hypoperfusion and death eventually. The only possible treatment for these patients is prompt bleeding control, either open or endovascular. Aortic occlusion seems to be the most rapid and convenient way to restrain blood loss and possibly increase survival. However, it is not proven yet. Traditional aortic occlusion for trauma consisted of supradiaphragmatic thoracic aorta cross-clamping through resuscitative thoracotomy (RT). This complicated and devastating procedure triggered the necessity to work on a simpler, less invasive resuscitation bridge which can be implemented in emergency departments or even in prehospital setting. Resuscitative balloon occlusion of the aorta (REBOA) provides a novel method of hemorrhagic shock stabilization in bleeding below the diaphragm. The mechanism lies in improving myocardial and cerebral perfusion and ceasing major bleeding itself. This method together with invasive endovascular and surgical procedures creates a new approach of choice for trauma patients. It is called Endovascular Hybrid Trauma and Resuscitation Management (EVTM) and introduces this concept to modern clinical practice. Through a detailed review, this article aims to introduce REBOA procedure to a broader recipient and present REBOA details, benefits and limitations.
在创伤情况下，尤其是要控制不可压缩的躯干出血极其困难。绝大多数病例都无法成功制止失血，最终导致心血管衰竭、心肌和脑灌注不足并死亡。对于这些患者，唯一可能的治疗方法是迅速控制出血，无论是通过开放手术还是血管内介入。主动脉阻断似乎是限制失血并可能提高生存率的最迅速、便捷的方法。然而，这一点尚未得到证实。传统的创伤性主动脉阻断是通过复苏性开胸术（RT）进行膈上胸主动脉交叉钳夹。这种复杂且具有破坏性的手术促使人们需要研发一种更简单、侵入性更小的复苏桥梁技术，以便能在急诊科甚至院前环境中实施。主动脉复苏性球囊阻断术（REBOA）为稳定膈肌以下出血的失血性休克提供了一种新方法。其机制在于改善心肌和脑灌注并止住主要出血。这种方法与侵入性血管内和外科手术一起，为创伤患者创造了一种新的首选治疗方法。它被称为血管内混合创伤与复苏管理（EVTM），并将这一概念引入现代临床实践。通过详细综述，本文旨在向更广泛的受众介绍REBOA手术，并阐述REBOA的细节、益处和局限性。
