复苏性主动脉球囊阻断术治疗不可压迫性躯干出血效果的系统评价

Systematic review of the effect of resuscitative endovascular balloon occlusion of the aorta in the treatment of noncompressible torso hemorrhage

目的评价复苏性主动脉球囊阻断术(resuscitative endovascular balloon occlusion of the aorta,REBOA)治疗不可压迫性躯干出血的效果,探讨哪些研究领域可能是进一步推进REBOA应用的关键。方法使用“复苏性主动脉球囊阻断术(REBOA)”、“复苏性主动脉血管内球囊闭塞(resuscitation intravascular balloon occlusion of the aorta)”、“球囊闭塞(balloon occlusion)”、“部分主动脉球囊闭塞(partial resuscitative endovascular balloon occlusion of the aorta)”、“部分复苏性主动脉球囊阻断术(partial resuscitation of aortic balloon blockade)”、“部分球囊闭塞(part of the balloon is occluded)”等关键词在PubMed、Embase、Cochrane等数据库中对文献进行回顾。纳入临床研究文献,排除数据集重叠、缺少2个以上变量的文章,分为院前和院内环境下两组。采用SPSS 20.0统计软件进行分析。结果16篇临床文献表明,院前环境下进行REBOA手术共47例(存活率为87.2%),穿透伤19例(40.4%),钝性损伤28例(59.6%),接受REBOAⅠ区治疗26例(55.3%),Ⅲ区治疗21例(44.7%),球囊扩张时间为36.8min。院内环境进行REBOA手术共705例(存活率为41%),穿透伤138例(19.6%),钝性损伤549例(77.9%),其他损伤18例(2.6%),接受REBOAⅠ区治疗493例(74.3%),Ⅱ区治疗16例(2.4%),Ⅲ区治疗155例(23.3%),球囊扩张时间36min。院前组军事环境下此手术者共31例(存活率为96.8%),民用环境下此手术者共16例(存活率为68.8%),在院前环境、穿透伤和区域(Zone)分区为I区患者接受REBOA紧急止血后的存活率明显升高。结论REBOA具有微创、操作相对简单的优点,非常适合军事战争或灾害救援等特定条件下创伤急救的需求。但病情诊断困难与插管时间限制了院前REBOA的使用,因此该技术距离真正走向实际应用,还需要对最适宜的对象、优化的阻断技术和阻断持续的时间等问题进行进一步的研究。

Objective To evaluate the effect of resuscitative endovascular balloon occlusion of the aorta(REBOA)on the treatment of noncompressible torso hemorrhage during pre-hospital and in-hospital settings;to discuss which research areas may be the key to further promote the application of REBOA.Methods The keywords of"resuscitative endovascular balloon occlusion of the aorta","resuscitation intravascular balloon occlusion of the aorta","balloon occlusion","partial resuscitation endovascular balloon occlusion of the aorta","partial resuscitation of aortic balloon blockade","part of the balloon is occluded"were used for literature search in the databases of PubMed,Embase,Cochrane and others.Only clinical research articles were included,and those with overlapping data or data loss for more than two variables were excluded.REBOA data were divided into two groups:pre-hospital and in-hospital.SPSS 20.0 was used for statistical analysis.Results Altogether 16 clinical articles were included,with 47 patients received pre-hospital REBOA and 705 patients received in-hospital REBOA.Among the pre-hospital group(n=47),there were 19(40.4%)penetrating injuries and 28(59.6%)blunt injuries,with the total survival rate being 87.2%.REBOA location was zoneⅠ:26 cases(55.3%);zoneⅢ:21 cases(44.7%).The balloon dilatation time was 36.8 min.As for the in-hospital group(n=705),there were 138(19.6%)penetrating injuries,549(77.9%)blunt injuries,and 18(2.6%)others.The survival rate was 41%.REBOA location was zoneⅠ:493 cases(74.3%);zoneⅡ16 cases(2.4%);zoneⅢ:155 patients(23.3%).The balloon dilatation time was 36 min.In the pre-hospital,31 patients underwent REBOA in military setting who achieved a survival rate of 96.8%,and 16 patients underwent REBOA in civilian setting and the survival rate was lower,i.e.,68.8%.Statistical analysis revealed that patients’survival can be significantly improved after emergency hemostasis with pre-hospital REBOA.Also penetrating injuries and REBOA in Zone I showed a better survival rate.Conclusion REBOA is simple and minimally invasive,making it an ideal technique for trauma care under some specific conditions such as military warfare or disaster relief.However,the difficulty in injury diagnosis and time needs for intubation limit its use in pre-hospital settings.To promote the application of REBOA,further research targeting at the indication(most suitable objects),occlusion technique optimization and suitable occlusion duration is of vital significance.