用于计算机断层扫描诊断的复苏性血管内主动脉球囊阻断术是否可行？一项日本单中心回顾性观察研究。

Is resuscitative endovascular balloon occlusion of the aorta for computed tomography diagnosis feasible or not? A Japanese single-center, retrospective, observational study.

作者信息

Otsuka Hiroyuki, Takeda Michihiro, Sai Kisei, Sakoda Naoki, Uehata Atsushi, Sato Toshiki, Sakurai Keiji, Aoki Hiromichi, Yamagiwa Takeshi, Iizuka Shinichi, Inokuchi Sadaki

机构信息

From the Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan.

出版信息

J Trauma Acute Care Surg. 2021 Aug 1;91(2):287-294. doi: 10.1097/TA.0000000000003193.

DOI:10.1097/TA.0000000000003193

PMID:34397952

Abstract

BACKGROUND

Advances in medical equipment have resulted in changes in the management of severe trauma. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in this scenario is still unclear. This study aimed to evaluate the usage of REBOA and utility of computed tomography (CT) in the setting of aortic occlusion in our current trauma management.

METHODS

This Japanese single-tertiary center, retrospective, and observational study analyzed 77 patients who experienced severe trauma and persistent hypotension between October 2014 and March 2020.

RESULTS

All patients required urgent hemostasis. Twenty patients underwent REBOA, 11 underwent open aortic cross-clamping, and 46 did not undergo aortic occlusion. Among patients who underwent aortic occlusion, 19 patients underwent prehemostasis CT, and 7 patients underwent operative exploration without prehemostasis CT for identifying active bleeding sites. The 24-hour and 28-day survival rates in patients who underwent CT were not inferior to those in patients who did not undergo CT (24-hour survival rate, 84.2% vs. 57.1%; 28-day survival rate, 47.4% vs. 28.6%). Moreover, the patients who underwent CT had less discordance between primary hemostasis site and main bleeding site compared with patients who did not undergo CT (5% vs. 71.4%, p = 0.001). In the patients who underwent prehemostasis CT, REBOA was the most common approach of aortic occlusion. Most of the bleeding control sites were located in the retroperitoneal space. There were many patients who underwent interventional radiology for hemostasis.

CONCLUSION

In a limited number of patients whose cardiac arrests were imminent and in whom no active bleeding sites could be clearly identified without CT findings, REBOA for CT diagnosis may be effective; however, further investigations are needed.

LEVEL OF EVIDENCE

Therapeutic/care management study, level V.

摘要

背景

医疗设备的进步导致了严重创伤管理方式的改变。在这种情况下，复苏性血管内主动脉球囊阻断术（REBOA）的作用仍不明确。本研究旨在评估在我们当前的创伤管理中，REBOA的使用情况以及计算机断层扫描（CT）在主动脉阻断情况下的效用。

方法

这项日本单中心、回顾性观察性研究分析了2014年10月至2020年3月期间77例遭受严重创伤并持续低血压的患者。

结果

所有患者均需要紧急止血。20例患者接受了REBOA，11例接受了开放性主动脉交叉钳夹术，46例未进行主动脉阻断。在接受主动脉阻断的患者中，19例患者在止血前进行了CT检查，7例患者未进行止血前CT检查而是接受了手术探查以确定活动性出血部位。接受CT检查的患者的24小时和28天生存率不低于未接受CT检查的患者（24小时生存率，84.2%对57.1%；28天生存率，47.4%对28.6%）。此外，与未接受CT检查的患者相比，接受CT检查的患者在主要止血部位和主要出血部位之间的不一致性更小（5%对71.4%，p = 0.001）。在接受止血前CT检查的患者中，REBOA是最常见的主动脉阻断方法。大多数出血控制部位位于腹膜后间隙。有许多患者接受了介入放射学止血治疗。