采用子宫切除及复苏性血管内球囊阻断主动脉辅助心肺复苏的损伤控制策略成功治疗子宫破裂。
Uterine rupture successfully treated with a damage-control strategy of hysterectomy and resuscitative endovascular balloon occlusion of the aorta-assisted cardiopulmonary resuscitation.
作者信息
Okamoto Yutaro, Ishida Kenichiro, Matsumura Yosuke, Yoshikawa Yoshiaki, Sogabe Taku, Fujikami Yusuke, Ban Kenji, Tatsumi Keiji, Ohnishi Mitsuo
机构信息
Department of Acute Medicine and Critical Care Medical Center Osaka National Hospital, National Hospital Organization Osaka Japan.
Department of Intensive Care Chiba Emergency Medical Center Chiba Japan.
出版信息
Acute Med Surg. 2023 Aug 3;10(1):e881. doi: 10.1002/ams2.881. eCollection 2023 Jan-Dec.
BACKGROUND
Uterine rupture is a major cause of postpartum hemorrhage (PPH) that requires surgery. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is also helpful for PPH. However, the effectiveness of REBOA in PPH with cardiac arrest is unknown.
CASE PRESENTATION
A 40-year-old woman developed hemorrhagic shock due to uterine rupture after an induced delivery. She developed cardiac arrest, but was rescued by cardiopulmonary resuscitation (CPR), REBOA, a hysterectomy, and pelvic gauze packing. The hemodynamics were too unstable to move to the operating room. Then we initiated the CPR assisted with REBOA and decided to activate massive transfusion and perform laparotomy in the emergency room. She was finally discharged home without neurological sequelae.
CONCLUSION
Our damage control strategy, including REBOA-assisted CPR, contributed to saving the life of a patient with a life-threatening PPH.
背景
子宫破裂是产后出血（PPH）需要手术治疗的主要原因。复苏性血管内主动脉球囊阻断术（REBOA）对产后出血也有帮助。然而，REBOA在心脏骤停的产后出血中的有效性尚不清楚。
病例报告
一名40岁女性在引产术后因子宫破裂发生失血性休克。她出现心脏骤停，但通过心肺复苏（CPR）、REBOA、子宫切除术和盆腔纱布填塞得以挽救。血流动力学极不稳定，无法转至手术室。然后我们启动了REBOA辅助的CPR，并决定在急诊室启动大量输血并进行剖腹手术。她最终出院，无神经后遗症。
结论
我们的损伤控制策略，包括REBOA辅助的CPR，有助于挽救一名患有危及生命的产后出血患者的生命。
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