儿童专用球囊：小儿复苏性血管内主动脉球囊阻断术的解剖学适应证及最佳导管尺寸
Balloons for kids: Anatomic candidacy and optimal catheter size for pediatric resuscitative endovascular balloon occlusion of the aorta.
作者信息
Sykes Alicia Gaidry, Sisson William B, Wang Lucas J, Martin Matthew J, Thangarajah Hariharan, Naheedy John, Fernandez Nathanial, Nelles Meghan E, Ignacio Romeo C
机构信息
From the Division of Pediatric Surgery, Department of Surgery (A.G.S., W.B.S., H.T., R.C.I.), Rady Children's Hospital San Diego, University of California San Diego, San Diego; University of California Irvine (L.J.W.), Irvine; Department of Trauma, Scripps Mercy Hospital San Diego (M.J.M.); Department of Radiology (J.N.), Rady Children's Hospital San Diego; and Department of Surgery, Naval Medical Center San Diego (A.G.S., W.B.S., N.F., M.E.N.), San Diego, California.
出版信息
J Trauma Acute Care Surg. 2022 Apr 1;92(4):743-747. doi: 10.1097/TA.0000000000003521.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential adjunct in pediatric trauma patients with noncompressible truncal and pelvic hemorrhage; however, there are little data evaluating the anatomic considerations of REBOA in children. We evaluated the vascular dimensions and anatomic limitations of using REBOA in children.
METHODS
Computed tomography scans of pediatric patients performed between February 2016 and October 2019 were retrospectively reviewed by two investigators. Vascular measurements included diameters of aorta zones I and III, common iliac arteries, external iliac arteries, and common femoral arteries (CFAs), and distances between access site (CFA) and aorta zones I and III. Measurements were grouped within Broselow categories, based upon patient height. Interrater reliability for measurements was determined using intraclass correlation coefficients. Vascular dimensions were correlated with the patient's height, weight, and body mass index using linear regression analysis.
RESULTS
A total of 557 computed tomography scans met the inclusion criteria and were reviewed. Measurements of vessel diameter and distance from the CFA to aorta zones I and III were determined and grouped by Broselow category. Patient age ranged from 0 to 18 years, with a male to female ratio of 1:1. Overall interrater reliability of vessel measurements was good (average intraclass correlation coefficient, 0.90). Vessel diameter had greatest correlation with height (R2 = 0.665, aorta zone I; R2 = 0.611, aorta zone III) and poorly correlated with body mass index (R2 = 0.318 and R2 = 0.290, respectively).
CONCLUSION
This study represents the largest compilation of REBOA-related pediatric vessel diameter measurements and the first to provide data on distance between access site and balloon deployment zones. Based on our findings, the 7-Fr REBOA catheter would be appropriate for the Black, Green, and Orange Broselow categories, and a 4-Fr REBOA catheter would be warranted for Yellow, White, and Blue Broselow categories.
LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
背景
主动脉复苏性血管内球囊阻断术（REBOA）是治疗小儿创伤患者不可压迫性躯干和盆腔出血的一种潜在辅助手段；然而，评估儿童REBOA解剖学因素的数据很少。我们评估了儿童使用REBOA的血管尺寸和解剖学限制。
方法
两名研究人员对2016年2月至2019年10月期间进行的儿科患者计算机断层扫描进行了回顾性分析。血管测量包括主动脉I区和III区、髂总动脉、髂外动脉和股总动脉（CFA）的直径，以及穿刺部位（CFA）与主动脉I区和III区之间的距离。测量值根据患者身高按布罗泽洛分类法进行分组。使用组内相关系数确定测量值的评分者间信度。使用线性回归分析将血管尺寸与患者的身高、体重和体重指数相关联。
结果
共有557例计算机断层扫描符合纳入标准并进行了分析。确定了血管直径以及从CFA到主动脉I区和III区的距离测量值，并按布罗泽洛分类法进行分组。患者年龄范围为0至18岁，男女比例为1:1。血管测量的总体评分者间信度良好（平均组内相关系数为0.90）。血管直径与身高的相关性最大（R2 = 0.665，主动脉I区；R2 = 0.611，主动脉III区），与体重指数的相关性较差（分别为R2 = 0.318和R2 = 0.290）。
结论
本研究是与REBOA相关的儿科血管直径测量的最大汇编，也是第一个提供穿刺部位与球囊放置区之间距离数据的研究。根据我们的研究结果，7F REBOA导管适用于布罗泽洛分类法中的黑色、绿色和橙色类别，4F REBOA导管适用于黄色、白色和蓝色类别。
证据级别
预后和流行病学，III级。
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