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采用复苏性血管内主动脉球囊阻断术分两阶段治疗破裂性腹主动脉瘤。

Ruptured abdominal aortic aneurysm managed using resuscitative endovascular balloon occlusion of the aorta with a two-stage approach.

作者信息

Ishida Kenichiro, Matsumura Yosuke, Kitabayashi Kai, Ogawa Haruka, Tajiri Masashi, Ochi Koichi, Iehara Takashi, Nakagawa Masaya, Shirasaki Yukie, Nishi Hiroyuki, Ohnishi Mitsuo

机构信息

Department of Acute Medicine and Critical Care Medical Center NHO Osaka National Hospital Osaka Japan.

Department of Intensive Care Chiba Emergency and Psychiatry Medical Center Chiba Japan.

出版信息

Acute Med Surg. 2025 Feb 21;12(1):e70048. doi: 10.1002/ams2.70048. eCollection 2025 Jan-Dec.

DOI:10.1002/ams2.70048
PMID:39989484
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11843153/
Abstract

BACKGROUND

A ruptured abdominal aortic aneurysm (rAAA) is fatal. While Resuscitative endovascular balloon occlusion of the aorta (REBOA) contributes to hemodynamic stability, organ ischemia should be carefully considered.

CASE PRESENTATION

A 69-year-old obese man with untreated hypertension presented with sudden back pain and hypotension. Computed tomography confirmed the presence of an rAAA. REBOA was initially planned in Zone 1 via the left brachial artery but was eventually switched to Zone 3 via the right femoral artery. Hemodynamic stability was achieved through blood transfusion and partial REBOA, followed by surgical intervention. The postoperative recovery was uneventful.

CONCLUSION

Zone 1 REBOA via the left brachial approach provided safe aortic occlusion. Transitioning to Zone 3 REBOA, combined with meticulous organ perfusion management and blood transfusion, prevented ischemia-reperfusion complications.

摘要

背景

腹主动脉瘤破裂（rAAA）是致命的。虽然主动脉复苏性血管内球囊阻断术（REBOA）有助于血流动力学稳定，但应仔细考虑器官缺血问题。

病例介绍

一名69岁未治疗高血压的肥胖男性，出现突发背痛和低血压。计算机断层扫描证实存在rAAA。最初计划经左肱动脉在1区进行REBOA，但最终改为经右股动脉在3区进行。通过输血和部分REBOA实现了血流动力学稳定，随后进行了手术干预。术后恢复顺利。

结论

经左肱动脉途径在1区进行REBOA可提供安全的主动脉阻断。过渡到3区REBOA，结合精心的器官灌注管理和输血，可预防缺血再灌注并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a12/11843153/fa62b1536ad3/AMS2-12-e70048-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a12/11843153/3d9d2a522c59/AMS2-12-e70048-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a12/11843153/fa62b1536ad3/AMS2-12-e70048-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a12/11843153/3d9d2a522c59/AMS2-12-e70048-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a12/11843153/fa62b1536ad3/AMS2-12-e70048-g003.jpg

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本文引用的文献

1
The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge.破裂腹主动脉瘤的管理：一项持续存在的挑战。
J Clin Med. 2023 Aug 25;12(17):5530. doi: 10.3390/jcm12175530.
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Titratable partial aortic occlusion: Extending Zone I endovascular occlusion times.可滴定部分主动脉闭塞：延长区域 I 血管内闭塞时间。
J Trauma Acute Care Surg. 2023 Aug 1;95(2S Suppl 1):S36-S40. doi: 10.1097/TA.0000000000004064. Epub 2023 May 24.
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Location is everything: The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta.
位置至关重要：REBOA 在主动脉 1 区与 3 区的血液动力学效应。
J Trauma Acute Care Surg. 2018 Jul;85(1):101-107. doi: 10.1097/TA.0000000000001858.
4
A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination.一项关于在严重失血管理中使用主动脉复苏性血管内球囊阻断术的系统评价和荟萃分析。
Eur J Trauma Emerg Surg. 2018 Aug;44(4):535-550. doi: 10.1007/s00068-018-0959-y. Epub 2018 May 21.
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Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).美国外科医师学会创伤委员会（ACS COT）和美国急诊医师学会（ACEP）关于主动脉内复苏球囊阻断术（REBOA）临床应用的联合声明。
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.血管外科学会治疗腹主动脉瘤患者的实践指南。
J Vasc Surg. 2018 Jan;67(1):2-77.e2. doi: 10.1016/j.jvs.2017.10.044.
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Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock.失血性休克猪模型中部分复苏性主动脉内球囊阻断术
J Am Coll Surg. 2016 Aug;223(2):359-68. doi: 10.1016/j.jamcollsurg.2016.04.037. Epub 2016 Apr 29.
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The Impact of Aortic Occlusion Balloon on Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Meta-analysis and Meta-regression Analysis.主动脉阻断球囊对破裂腹主动脉瘤血管腔内修复术后死亡率的影响：一项荟萃分析和荟萃回归分析
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Br J Surg. 2013 Oct;100(11):1405-13. doi: 10.1002/bjs.9235.
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Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm.经肱动脉插入主动脉阻断球囊导管用于腹主动脉瘤破裂休克患者。
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