主动脉球囊阻断复苏术（REBOA）在病态粘连性胎盘多学科管理中的应用。
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Multidisciplinary Management of Morbidly Adherent Placenta.
机构信息
Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affilliated with the Hebrew University of Jerusalem, Israel.
Vascular Surgery Unit, Shaare Zedek Medical Center, affilliated with the Hebrew University of Jerusalem, Israel.
出版信息
Isr Med Assoc J. 2023 Jul;25(7):462-467.
BACKGROUND
Morbidly adherent placentation (MAP) increases the risk for obstetric hemorrhage. Cesarean hysterectomy is the prevalent perioperative approach. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive and relatively simple endovascular procedure to temporarily occlude the aorta and control below diaphragm bleeding in trauma. It has been effectively used to reduce obstetric hemorrhage.
OBJECTIVES
To evaluate whether REBOA during cesarean delivery (CD) in women with morbidly adherent placentation is a safe and effective treatment modality.
METHODS
We introduced REBOA for CD with antepartum diagnosis of MAP in 2019 and compared these patients (RG) to a standard approach group (SAG) treated in our center over the preceding year, as a control. All relevant data were collected from patient electronic files.
RESULTS
Estimated blood loss and transfusion rates were significantly higher in SAG; 54.5% of SAG patients received four RBC units or more vs. one administered in RG. No fresh frozen plasma, cryoprecipitate, or platelets were administered in RG vs. mean 3.63, 6, and 3.62 units, respectively in SAG. Ten SAG patients (90.9%) underwent hysterectomy vs. 3 RG patients (30%). Five SAG patients (45%) required post-surgical intensive care unit (ICU) admission vs. no RG patients. Bladder injury occurred in five SAG cases (45%) vs. 2 RG (20%). One RG patient had a thromboembolic event. Perioperative lactate levels were significantly higher in SAG patients.
CONCLUSIONS
Use of REBOA during CD in women with MAP is safe and effective in preventing massive bleeding, reducing the rate of hysterectomy, and improving patient outcome.
背景
病态粘连性胎盘（MAP）增加了产科出血的风险。剖宫产子宫切除术是常见的围手术期方法。主动脉球囊阻断复苏术（REBOA）是一种微创且相对简单的血管内手术，可暂时阻断主动脉并控制创伤性膈肌以下出血。它已被有效地用于减少产科出血。
目的
评估在病态粘连性胎盘孕妇的剖宫产（CD）期间使用 REBOA 是否是一种安全有效的治疗方式。
方法
我们在 2019 年引入了 REBOA 用于 MAP 的产前诊断，并将这些患者（RG）与前一年在我们中心接受标准治疗的标准方法组（SAG）进行比较，作为对照组。所有相关数据均从患者电子档案中收集。
结果
SAG 组的估计失血量和输血率明显更高；SAG 组中有 54.5%的患者接受了 4 个单位或更多的红细胞单位，而 RG 组仅 1 个。RG 组未输注新鲜冷冻血浆、冷沉淀或血小板，而 SAG 组分别平均输注 3.63、6 和 3.62 个单位。SAG 组中有 10 名患者（90.9%）接受了子宫切除术，而 RG 组中有 3 名患者（30%）。SAG 组中有 5 名患者（45%）需要术后入住重症监护病房（ICU），而 RG 组无患者。SAG 组中有 5 例（45%）发生膀胱损伤，而 RG 组中有 2 例（20%）。RG 组中有 1 例发生血栓栓塞事件。SAG 患者的围手术期乳酸水平明显更高。
结论
在 MAP 孕妇的 CD 期间使用 REBOA 是安全有效的，可以预防大出血，降低子宫切除术的发生率，并改善患者的预后。
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