普雷波亚与ER-REBOA对血液利用和复苏需求的影响:试点分析
Courtney H Meyer1, Andrew Beckett, Bradley M Dennis
1From the Department of Surgery (C.H.M.), Emory University School of Medicine, Atlanta, Georgia; Grady Health System (C.H.M., J.N.), Atlanta, Georgia; Rollins School of Public Health (C.H.M.), Emory University, Atlanta, Georgia; Department of Surgery (A.B.), University of Alberta, Edmonton, Alberta, Canada; Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Department of Surgery (B.M.D.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (J.D.), Tulane School of Medicine Health Science Center, New Orleans, Louisiana; R Adams Cowley Shock Trauma Center (R.K.), University of Maryland, Baltimore, Maryland; Division of Trauma and Acute Care Surgery (U.P.), OhioHealth Grant Medical Center, Columbus, Ohio; Department of Surgery (R.L.), Orlando Regional Medical Center, Orlando, Florida; Shock Trauma Center at Denver Health (E.M.), Denver, Colorado; Division of Trauma and Acute Care Surgery (C.S.), Mount Carmel Health System, Columbus, Ohio; Department of Surgery (W.M.V.), Northeast Georgia Medical Center, Gainesville, Georgia; and Department of Surgery (J.N.), Morehouse School of Medicine, Atlanta, Georgia.
与ER-REBOA导管相比,pREBOA-PRO导管允许部分大动脉封闭,大大降低了血液制品和复苏的需要. 这种在复苏性内血管气球阻塞大动脉的创新方法显示了改善患者结果的希望.
科学领域:
- 创伤外科 手术 创伤外科
- 血管外科 血管外科
- 关键护理医学 关键护理医学
背景情况:
- 复苏性内血管气球阻塞大动脉 (REBOA) 旨在平衡近道 perfusion 与远部流量以减轻缺血.
- 在REBOA期间,pREBOA-PRO导管可以进行定位输液,但其对血液产品使用和复苏需求的影响尚未得到充分确立.
- 目前的研究缺乏关于pREBOA-PRO与较旧的REBOA技术在资源利用方面的比较有效性的数据.
研究的目的:
- 为了比较使用pREBOA-PRO导管与ER-REBOA导管进行REBOA的患者之间的复苏要求,特别是血液制品的使用.
- 评估使用pREBOA-PRO导管进行部分大动脉闭塞的利用情况.
- 为了确定preboa-pro是否与整体复苏需求的降低有关.
主要方法:
- 美国创伤外科手术协会的分析 创伤和急性护理外科注册中复苏的动脉封闭.
- 在ER-REBOA和pREBOA组之间,复苏策略的比较,包括包装红细胞 (PRBC),新鲜冷血 (FFP),血小板,冷沉积物,晶体和压力器的使用.
- 使用未配对的t试验进行统计分析.
主要成果:
- 与ER-REBOA组 (n=800) 相比,pREBOA组 (n=155) 的部分闭塞率 (85%对11%) 显著更高.
- 接受preboa治疗的患者需要更少的PRBC,FPF,血小板和升的晶体.
- 在preboa组有较低的急性呼吸困难综合征 (ARDS) 和败血症休克的发病率.
结论:
- 在REBOA期间,pREBOA-PRO导管有助于增加部分大动脉封闭的使用.
- 这项研究是第一个表明pREBOA,部分闭塞和减少血液产品和晶体管的管理之间的关联.
- 需要进一步的前性研究来证实这些发现,并巩固preboa-pro在创伤复苏中的好处.
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