多学科方法和实施专门的出血控制团队可改善胎盘植入谱系疾病的结局。
A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum.
机构信息
From the Placenta Accreta Spectrum Clinic (A.J.N.-C., F.R., C.A.O., A.F.G., J.V., J.P.C., A.M.B., M.P.E., M.F.E., J.C., J.P.B.-C., J.M.B.), Clinical Research Center (L.M.V.-G., M.C.L., R.M.); Division of Trauma and Acute Care Surgery, Department of Surgery (F.R., C.A.O., A.F.G.); and Interventional Radiology Department (J.V., J.P.C.), Fundación Valle del Lili, Cali, Colombia.
出版信息
J Trauma Acute Care Surg. 2021 May 1;90(5):807-816. doi: 10.1097/TA.0000000000003090.
INTRODUCTION
The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a PAS team.
METHODOLOGY
A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way.
RESULTS
A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise.
CONCLUSION
Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills.
LEVEL OF EVIDENCE
Therapeutic care management, level III.
简介
胎盘植入谱系疾病（PAS）的主要并发症是大量出血。已经将血管内闭塞技术纳入这种病理的治疗中。我们的目的是检查在一个中低收入国家的 9 年期间治疗的 PAS 患者的血管内实践模式，在该国家中，通过创建 PAS 团队提高了跨学科小组的技术技能。
方法
对 2011 年 12 月至 2020 年 11 月期间治疗的所有 PAS 患者进行回顾性队列研究。我们根据使用的血管内装置类型（第 1 组，髂内动脉闭塞球囊；第 2 组，主动脉复苏性球囊；第 3 组，由于出血风险低而不使用动脉球囊）和就诊年份进行了临床结果比较（反映 PAS 团队的经验水平）。第四组比较包括在剖宫产中诊断出并以非协议方式治疗的女性。
结果
共纳入 113 例患者。失血量逐年减少，2014 年（所有患者均使用血管内闭塞球囊时）中位数为 2500ml，2020 年为 1394ml（当时仅 38.5%的患者需要动脉球囊）。整个研究人群中，第 3 组患者（n=16）的出血量（1245ml）和手术时间（173 分钟）最低。第 2 组患者（n=46）的出血量（平均 1700ml）和输血频率（34.8%）略低于第 1 组患者（n=30）（平均 2000ml 和 50%，分别）。尽管确认的 PAS 和 S2 受损的发生率相似，但第 2 组患者的子宫切除术频率（63%比第 1 组的 76.7%）和手术时间（205 分钟比第 1 组的 275 分钟）较低。
结论
随着跨学科小组提高手术和团队协作技能，用于 PAS 患者出血控制的血管内技术的必要性降低。
证据水平
治疗护理管理，III 级。
Zotero 插件