气球上升:在1区的REBOA可能优于复苏性胸腔切除术
Megan Brenner1, Bishoy Zakhary2, Raul Coimbra2
1From the Department of Surgery, UCLA Medical Center, Los Angeles, CA (Brenner).
Journal of the American College of Surgeons
|December 11, 2023
概括
在创伤患者中,复苏性内血管气球阻塞大动脉 (REBOA) 显示出高于复苏性胸切除术 (RT) 的存活率. 将大动脉封闭时间限制在30分钟以下对于改善形和穿透性损伤的结果至关重要.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 血管外科 血管外科
背景情况:
- 对于危及生命的创伤,Zone 1 REBOA的应用有显著增加.
- 在REBOA和复苏胸腔切除术 (RT) 之间的比较结果需要在不同的伤害模式上进一步调查.
研究的目的:
- 为了比较REBOA与RT在患有严重重和穿透创伤的患者中的有效性.
- 分析损伤特征和大动脉封闭持续时间对患者存活时间的影响.
主要方法:
- 对创伤和急性护理手术复苏的大动脉闭塞数据库 (2013-2021) 的回顾性分析.
- 包括患有形和穿透创伤的患者,检查损伤机制和组合的结果,包括创伤性脑损伤和胸部损伤 (缩写损伤量表 (AIS) 分数>2).
- 使用反向概率加权来调整REBOA和RT组之间的基线差异.
主要成果:
- 在531名患者中使用了REBOA,而1,603人接受了RT.
- 在调整后,REBOA在 (OR 4.7) 和穿透 (OR 4.9) 伤害方面表现出比RT更好的生存率.
- 超过90分钟的大动脉封闭与形和穿透创伤中的死亡率显著增加有关. 长时间封闭 (>60分钟) 恶化了透腹部和头部损伤的结果.
结论:
- 与RT相比,接受REBOA治疗的患者在所有受伤模式中住院生存率更高.
- 通过REBOA或RT完全阻塞大动脉应限制在不到30分钟以优化生存.
- 医院体积和创伤验证水平对REBOA或RT的结果没有显著影响.
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