Gong Seong Chan, Park Ji Eun, Kang Sooyeon, An Sanghyun, Kim Myoung Jun, Kim Kwangmin, Shin In Sik
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Department of Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Healthcare (Basel). 2023 Jun 16;11(12):1784. doi: 10.3390/healthcare11121784.
The aim of this study was to compare the outcomes of preperitoneal pelvic packing (PPP) and angioembolization (AE) for patients with equivocal vital signs after initial resuscitation. This single-centered retrospective study included information from the database of a regional trauma center from April 2014 to December 2022 for patients with pelvic fractures with a systolic blood pressure of 80-100 mmHg after initial fluid resuscitation. The patients' characteristics, outcomes, and details of AE after resuscitative endovascular balloon occlusion of the aorta (REBOA) placed in zone III were collected. The follow-up duration was from hospital admission to discharge. A total of 65 patients were enrolled in this study. Their mean age was 59.2 ± 18.1 years, and 40 were males. We divided the enrolled patients into PPP ( = 43) and AE ( = 22) groups. The median time from emergency department (ED) to procedure and the median duration of ED stay were significantly longer in the AE group than in the PPP group ( ≤ 0.001 for both). The median mechanical ventilation (MV) duration was significantly shorter ( = 0.046) in the AE group. The number of patients with complications, overall mortality, and mortality due to hemorrhage did not differ between the two groups. Three patients (13.6%) were successfully treated with AE after REBOA. AE may be beneficial for patients with hemodynamically unstable pelvic fractures who show equivocal vital signs after initial fluid resuscitation in terms of reducing the MV duration and incidence of infectious complications.
本研究的目的是比较初始复苏后生命体征不明确的患者接受腹膜前盆腔填塞（PPP）和血管栓塞术（AE）的效果。这项单中心回顾性研究纳入了2014年4月至2022年12月期间某地区创伤中心数据库中初始液体复苏后收缩压为80 - 100 mmHg的骨盆骨折患者的信息。收集了患者的特征、结局以及在三区放置复苏性血管内球囊阻断主动脉（REBOA）后AE的详细情况。随访时间为从入院到出院。本研究共纳入65例患者。他们的平均年龄为59.2±18.1岁，男性40例。我们将纳入的患者分为PPP组（n = 43）和AE组（n = 22）。AE组从急诊科（ED）到手术的中位时间和ED停留的中位时长均显著长于PPP组（两者均P≤0.001）。AE组的中位机械通气（MV）时长显著更短（P = 0.046）。两组在并发症患者数量、总体死亡率和出血导致的死亡率方面无差异。3例患者（13.6%）在REBOA后接受AE治疗成功。对于初始液体复苏后生命体征不明确的血流动力学不稳定骨盆骨折患者，AE在缩短MV时长和降低感染并发症发生率方面可能有益。
