严重骨盆骨折中主动脉复苏性血管内球囊阻断术的不良结局：一项配对队列研究。
Worse outcomes with resuscitative endovascular balloon occlusion of the aorta in severe pelvic fracture: A matched cohort study.
作者信息
Chien Chih-Ying, Lewis Meghan R, Dilday Joshua, Biswas Subarna, Luo Yong, Demetriades Demetrios
机构信息
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States; Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States.
出版信息
Am J Surg. 2023 Feb;225(2):414-419. doi: 10.1016/j.amjsurg.2022.09.057. Epub 2022 Oct 10.
BACKGROUND
Severe pelvic fracture is the most common indication for resuscitative endovascular balloon occlusion of the aorta (REBOA). This matched cohort study investigated outcomes with or without REBOA use in isolated severe pelvic fractures.
METHODS
Trauma Quality Improvement Program database study, included patients with isolated severe pelvic fracture (AIS≥3), excluded associated injuries with AIS >3 for any region other than lower extremity. REBOA patients were propensity score matched to similar patients without REBOA. Outcomes were mortality and complications.
RESULTS
93 REBOA patients were matched with 279 without. REBOA patients had higher rates of in-hospital mortality (32.3% vs 19%, p = 0.008), higher rates of venous thromboembolism (14% vs 6.5%, p = 0.023) and DVT (11.8% vs 5.4%, p = 0.035). In multivariate analysis, REBOA use was independently associated with increased mortality and venous thromboembolism.
CONCLUSIONS
REBOA in severe pelvic fractures is associated with higher rates of mortality, venous thromboembolism.
背景
严重骨盆骨折是复苏性血管内主动脉球囊阻断术（REBOA）最常见的适应症。这项配对队列研究调查了在孤立性严重骨盆骨折中使用或不使用REBOA的结局。
方法
创伤质量改进计划数据库研究，纳入孤立性严重骨盆骨折（AIS≥3）患者，排除下肢以外任何区域AIS>3的相关损伤。对接受REBOA治疗的患者与未接受REBOA治疗的相似患者进行倾向评分匹配。结局指标为死亡率和并发症。
结果
93例接受REBOA治疗的患者与279例未接受REBOA治疗的患者进行了匹配。接受REBOA治疗的患者院内死亡率更高（32.3%对19%，p = 0.008），静脉血栓栓塞发生率更高（14%对6.5%，p = 0.023），深静脉血栓形成发生率更高（11.8%对5.4%，p = 0.035）。在多变量分析中，使用REBOA与死亡率增加和静脉血栓栓塞独立相关。
结论
严重骨盆骨折中使用REBOA与更高的死亡率、静脉血栓栓塞发生率相关。
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