与完整的REBOA区域1和急诊室胸切除术相比,部分REBOA区域1与较低的死亡率有关:使用AORTA注册表的队列研究
Morgan G Dewey1, Ernest E Moore1,2, Lee Anne Ammons2
1School of Medicine, University of Colorado, Aurora, Colorado, USA.
Transfusion
|March 10, 2025
概括
大动脉的部分复苏内血管气球封闭 (P-REBOA) 显示出改善的结果. 这种大动脉封闭方法提供了更好的血液动力学稳定性和降低死亡率相比完整的REBOA (C-REBOA) 和急诊室胸切除术 (EDT) 在创伤患者没有穿透的胸部损伤.
科学领域:
- 创伤外科手术是什么
- 紧急医疗 紧急医疗
- 这是血管外科手术.
背景情况:
- 复苏性内血管气球阻塞大动脉 (REBOA) 和急诊室胸切除术 (EDT) 在危及生命的出血中对大动脉阻塞 (AO) 至关重要.
- 完全的AO可以导致内脏缺血,促使部分REBOA (P-REBOA) 的发展,以平衡出血控制和 perfusion.
- 在创伤中复苏的大动脉阻塞 (AORTA) 注册表提供了用于比较AO技术的数据.
研究的目的:
- 测试P-REBOA导致比EDT和C-REBOA更好的患者结果的假设.
- 在创伤患者中比较不同大动脉封闭方法的有效性.
- 评估AO技术对死亡率和患者康复的影响.
主要方法:
- 对2017-2023年AORTA注册表数据的分析.
- 在急诊室内包括接受EDT,C-REBOA或P-REBOA的成年患者,但不包括穿透胸部创伤的患者.
- 使用调整的生存率分析和通用线性模型,比较死亡率,无呼吸器日 (VFD) 和无ICU日 (ICUFD).
主要成果:
- 在921名患者中,66.6%接受EDT,24.3%C-REBOA和9.1%P-REBOA,整体死亡率为83.1%.
- 调整后的分析显示,C-REBOA和EDT与P-REBOA相比,与更低的血液动力学改善/稳定性和更高的死亡率有关.
- 与C-REBOA和P-REBOA患者相比,EDT患者的VFD和ICUFD较少;然而,EDT与幸存者的并发症有关.
结论:
- 与C-REBOA和EDT相比,P-REBOA显示出优越的血液动力稳定性和降低的死亡率.
- 对于没有穿透胸部损伤的创伤患者,P-REBOA可能是首选的大动脉封闭策略.
- 对优化P-REBOA应用的进一步研究是有必要的.
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