BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBO...BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.展开更多
Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta ac...Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.展开更多
Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the bene...Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.展开更多
Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military a...Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.展开更多
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modali...BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.展开更多
目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学...目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学科协作在杂交手术室行剖宫产术,57例常规手术室直接行剖宫产术。根据手术方案将产妇分为观察组(32例)和对照组(57例),观察组剖宫产术前行腹主动脉球囊阻断术;对照组直接行剖宫产术。比较分析2组手术情况、术后并发症发生情况、新生儿健康情况。结果观察组手术出血量、术中输血量、手术时间及住院时间均少于对照组,差异具有统计学意义(t=20.581、20.645、5.345、3.399,P均<0.05)。观察组失血性休克、次全子宫切除及肾功能异常的发生率少于对照组,差异具有统计学意义(χ^(2)=2.739、5.148、4.954,P均<0.001),观察组术后感染、盆腔粘连的发生率与对照组比较差异无统计学意义(P>0.05)。观察组新生儿出生后1 min Apgar评分、5 min Apgar评分与对照组比较差异无统计学意义(P>0.05)。结论多学科协作在杂交手术室行腹主动脉球囊阻断术应用于凶险性前置胎盘并胎盘植入患者剖宫产术能够明显减少术中出血、次全子宫切除、缩短手术时间、减少术后并发症,且不影响新生儿健康情况。展开更多
目的:探究腹主动脉球囊临时阻断术对凶险性前置胎盘产妇子宫切除率、术后恢复以及母婴结局的影响。方法:于2020年1月至2022年5月,选取凶险性前置胎盘产妇98例进行倾向值匹配研究,根据其治疗方式进行分组。采用常规剖宫产术47例,为对照组...目的:探究腹主动脉球囊临时阻断术对凶险性前置胎盘产妇子宫切除率、术后恢复以及母婴结局的影响。方法:于2020年1月至2022年5月,选取凶险性前置胎盘产妇98例进行倾向值匹配研究,根据其治疗方式进行分组。采用常规剖宫产术47例,为对照组;剖宫产合并超声引导下腹主动脉球囊临时阻断术51例,为观察组。收集2组产妇的临床资料,比较2组产妇围产期指标、预后、新生儿结局以及新生儿脐动脉血气指标,同时记录观察组腹主动脉球囊临时阻断术相关参数。结果:与对照组相比,观察组产妇手术时间和住院时间更短,输血量、出血量以及输液量更少(均P<0.05),手术前后Hb水平差值更小(P<0.05),子宫切除率以及转ICU率更低(均P<0.05)。2组产妇产后外周血活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体以及并发症总发生率差异均无统计学意义(均P>0.05)。观察组新生儿娩出后1 min阿氏评分(Activity,Pulse,Grimace,Appearance and Respiration Score,Apgar评分)≤7的比例低于对照组,且血氧分压(partial pressure of oxygen,PO_(2))高于对照组,二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))低于对照组(均P<0.05)。结论:腹主动脉球囊临时阻断术可有效减少前置胎盘产妇术后出血量,有利于产妇术后恢复,改善母婴结局。展开更多
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)”、...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。展开更多
目的:比较腹主动脉与双侧髂内动脉球囊阻断术对胎盘植入剖宫产产后出血的预防效果。方法:回顾性分析2018年12月至2021年12月该院收治的105例胎盘植入剖宫产产妇的临床资料,根据球囊阻断术方法不同分为对照组52例与观察组53例。对照组行...目的:比较腹主动脉与双侧髂内动脉球囊阻断术对胎盘植入剖宫产产后出血的预防效果。方法:回顾性分析2018年12月至2021年12月该院收治的105例胎盘植入剖宫产产妇的临床资料,根据球囊阻断术方法不同分为对照组52例与观察组53例。对照组行双侧髂内动脉球囊阻断术,观察组行腹主动脉球囊阻断术。比较两组球囊阻断手术时间、剖宫产术中和术后2 h出血量,胎儿受到辐射剂量、术后并发症发生率及新生儿窒息情况。结果:观察组球囊阻断手术时间短于对照组,术中、术后2 h出血量及胎儿受到辐射剂量均少于对照组,差异有统计学意义(P<0.05);两组术后并发症发生率及新生儿出生1、5 min Apgar评分比较,差异均无统计学意义(P>0.05)。结论:与双侧髂内动脉球囊阻断术相比,采用腹主动脉球囊阻断术预防胎盘植入剖宫产产后出血效果更好,手术时间较短,可减少术中、术后出血量和胎儿受到辐射剂量,不会增加并发症和新生儿窒息发生风险。展开更多
基金supported by military logistics scientific research project(AHJ16J004)。
文摘BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.
文摘Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.
基金2018 Applied Medicine Research Projects of Health and Family Planning Commission of Hubei(No.WJ2018H0139 and No.WJ2018H0133).
文摘Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.
文摘Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.
文摘BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.
文摘目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学科协作在杂交手术室行剖宫产术,57例常规手术室直接行剖宫产术。根据手术方案将产妇分为观察组(32例)和对照组(57例),观察组剖宫产术前行腹主动脉球囊阻断术;对照组直接行剖宫产术。比较分析2组手术情况、术后并发症发生情况、新生儿健康情况。结果观察组手术出血量、术中输血量、手术时间及住院时间均少于对照组,差异具有统计学意义(t=20.581、20.645、5.345、3.399,P均<0.05)。观察组失血性休克、次全子宫切除及肾功能异常的发生率少于对照组,差异具有统计学意义(χ^(2)=2.739、5.148、4.954,P均<0.001),观察组术后感染、盆腔粘连的发生率与对照组比较差异无统计学意义(P>0.05)。观察组新生儿出生后1 min Apgar评分、5 min Apgar评分与对照组比较差异无统计学意义(P>0.05)。结论多学科协作在杂交手术室行腹主动脉球囊阻断术应用于凶险性前置胎盘并胎盘植入患者剖宫产术能够明显减少术中出血、次全子宫切除、缩短手术时间、减少术后并发症,且不影响新生儿健康情况。
文摘目的:探究腹主动脉球囊临时阻断术对凶险性前置胎盘产妇子宫切除率、术后恢复以及母婴结局的影响。方法:于2020年1月至2022年5月,选取凶险性前置胎盘产妇98例进行倾向值匹配研究,根据其治疗方式进行分组。采用常规剖宫产术47例,为对照组;剖宫产合并超声引导下腹主动脉球囊临时阻断术51例,为观察组。收集2组产妇的临床资料,比较2组产妇围产期指标、预后、新生儿结局以及新生儿脐动脉血气指标,同时记录观察组腹主动脉球囊临时阻断术相关参数。结果:与对照组相比,观察组产妇手术时间和住院时间更短,输血量、出血量以及输液量更少(均P<0.05),手术前后Hb水平差值更小(P<0.05),子宫切除率以及转ICU率更低(均P<0.05)。2组产妇产后外周血活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体以及并发症总发生率差异均无统计学意义(均P>0.05)。观察组新生儿娩出后1 min阿氏评分(Activity,Pulse,Grimace,Appearance and Respiration Score,Apgar评分)≤7的比例低于对照组,且血氧分压(partial pressure of oxygen,PO_(2))高于对照组,二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))低于对照组(均P<0.05)。结论:腹主动脉球囊临时阻断术可有效减少前置胎盘产妇术后出血量,有利于产妇术后恢复,改善母婴结局。
文摘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。
文摘目的:比较腹主动脉与双侧髂内动脉球囊阻断术对胎盘植入剖宫产产后出血的预防效果。方法:回顾性分析2018年12月至2021年12月该院收治的105例胎盘植入剖宫产产妇的临床资料,根据球囊阻断术方法不同分为对照组52例与观察组53例。对照组行双侧髂内动脉球囊阻断术,观察组行腹主动脉球囊阻断术。比较两组球囊阻断手术时间、剖宫产术中和术后2 h出血量,胎儿受到辐射剂量、术后并发症发生率及新生儿窒息情况。结果:观察组球囊阻断手术时间短于对照组,术中、术后2 h出血量及胎儿受到辐射剂量均少于对照组,差异有统计学意义(P<0.05);两组术后并发症发生率及新生儿出生1、5 min Apgar评分比较,差异均无统计学意义(P>0.05)。结论:与双侧髂内动脉球囊阻断术相比,采用腹主动脉球囊阻断术预防胎盘植入剖宫产产后出血效果更好,手术时间较短,可减少术中、术后出血量和胎儿受到辐射剂量,不会增加并发症和新生儿窒息发生风险。
