复苏性主动脉球囊阻断术在创伤大出血紧急救治中的应用

Application of resuscitative endovascular balloon occlusion of the aorta in emergency treatment of traumatic hemorrhage

不可压迫性躯干及四肢交界部位大出血是现代军事冲突、自然灾害以及突发创伤事故中潜在的可预防性死亡的主要原因。由于不能有效直接压迫止血,因此,主动脉阻断可减少出血量,并为损伤复苏和确切控制出血提供短暂的时间。复苏性主动脉球囊阻断术(REBOA)作为一种有效的辅助止血手段,在军民用医院甚至院前创伤急救中显示出初步潜力。随着导管导丝等介入器材及相关技术的不断发展,REBOA有望实现战伤大出血的紧急止血救治。欧美已经开展相关基础和临床前研究,并将该技术应用于部分大出血伤员的救治,而国内却罕见报道。本文对REBOA在创伤出血救治中的应用历史、适用范围、应用改进以及军事应用等方面进行综述,以加强对REBOA的认识。

Incompressible massive hemorrhage at the junction of trunk and limbs is the major cause of the potential preventable death in modern military conflicts,natural disasters and sudden trauma accidents.Because of the failure of direct compression hemostasis,aortic occlusion can reduce the amount of bleeding and provide a short time for injury recovery and accurate control of bleeding.As an effective assistant hemostasis method,resuscitative endovascular balloon occlusion of the aorta(REBOA)has shown initial potential in military and civilian hospitals and even pre-hospital trauma emergency treatment.With the continuous development of catheter guide technology,it is expected to achieve the emergency hemostasis treatment of war wound and massive hemorrhage.Basic and pre-clinical studies have been carried out in Europe and America,and the technology has been applied to the treatment of some patients with massive bleeding,but rarely reported in China.This paper reviews the history,scope,limitations and improvement of application and military application of REBOA in the treatment of traumatic hemorrhage,so as to promote the recognition of REBOA.