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
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
当前置胎盘合并胎盘穿透时,血液供应极其丰富,手术视野难以暴露,常规止血方法难以有效控制出血,术中出血量可以达到上万毫升,甚至危及患者生命。Sumigama等[1]报道胎盘植入平均出血量3 630 m L,而胎盘穿透出血量达12 140 m L。球囊阻断...当前置胎盘合并胎盘穿透时,血液供应极其丰富,手术视野难以暴露,常规止血方法难以有效控制出血,术中出血量可以达到上万毫升,甚至危及患者生命。Sumigama等[1]报道胎盘植入平均出血量3 630 m L,而胎盘穿透出血量达12 140 m L。球囊阻断是指应用球囊导管阻断供血血管,Hughes[2]报道可以利用球囊控制腹部创伤患者的大出血,并获得成功,术中膨胀球囊暂时性阻断动脉血流,展开更多
目的探讨超声导引下腹主动脉球囊预置新方法在预防前置胎盘剖宫产术后出血的临床价值。方法 16例孕产妇经彩色超声、MR诊断为凶险性前置胎盘或中央型前置胎盘伴胎盘植入,剖宫产前通过超声导引预置下腹主动脉球囊,术中间歇阻断腹主动脉...目的探讨超声导引下腹主动脉球囊预置新方法在预防前置胎盘剖宫产术后出血的临床价值。方法 16例孕产妇经彩色超声、MR诊断为凶险性前置胎盘或中央型前置胎盘伴胎盘植入,剖宫产前通过超声导引预置下腹主动脉球囊,术中间歇阻断腹主动脉。记录术中出血量、输血量及子宫缝合时间。结果 16例均成功接受超声导引下预置球囊阻断腹主动脉,剖宫产术中平均出血量(756±222) m L,输血量(440±219) m L,子宫缝合时间(28.4±7.9) min。胎儿娩出后DSA下检查球囊置放位置准确,无明显移位。结论超声导引下腹主动脉球囊阻断术操作简单、安全,在前置胎盘伴胎盘植入产妇剖宫产术中控制出血效果显著,避免了X射线和对比剂对胎儿的不良影响。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。
文摘当前置胎盘合并胎盘穿透时,血液供应极其丰富,手术视野难以暴露,常规止血方法难以有效控制出血,术中出血量可以达到上万毫升,甚至危及患者生命。Sumigama等[1]报道胎盘植入平均出血量3 630 m L,而胎盘穿透出血量达12 140 m L。球囊阻断是指应用球囊导管阻断供血血管,Hughes[2]报道可以利用球囊控制腹部创伤患者的大出血,并获得成功,术中膨胀球囊暂时性阻断动脉血流,
文摘目的探讨超声导引下腹主动脉球囊预置新方法在预防前置胎盘剖宫产术后出血的临床价值。方法 16例孕产妇经彩色超声、MR诊断为凶险性前置胎盘或中央型前置胎盘伴胎盘植入,剖宫产前通过超声导引预置下腹主动脉球囊,术中间歇阻断腹主动脉。记录术中出血量、输血量及子宫缝合时间。结果 16例均成功接受超声导引下预置球囊阻断腹主动脉,剖宫产术中平均出血量(756±222) m L,输血量(440±219) m L,子宫缝合时间(28.4±7.9) min。胎儿娩出后DSA下检查球囊置放位置准确,无明显移位。结论超声导引下腹主动脉球囊阻断术操作简单、安全,在前置胎盘伴胎盘植入产妇剖宫产术中控制出血效果显著,避免了X射线和对比剂对胎儿的不良影响。
