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中华卫生应急电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 35 -40. doi: 10.3877/cma.j.issn.2095-9133.2023.01.007

论著

急诊床旁复苏性腹主动脉球囊阻断技术在严重创伤患者急救中的效果
李峰1, 祁峰1, 明志兵2, 金杰3, 刘颖1,(), 唐志和1, 顾鹏1   
  1. 1. 226001 江苏南通,南通大学第二附属医院急诊科
    2. 226001 江苏南通,南通大学第二附属医院血管外科
    3. 226001 江苏南通,南通大学第二附属医院介入科
  • 收稿日期:2022-06-06 出版日期:2023-02-18
  • 通信作者: 刘颖
  • 基金资助:
    2018年南通市科技项目-新型临床诊疗技术攻关类(MS12018062); 2018年南通市科技项目-临床医学中心类(HS2018002)

Clinicaleffects of emergency bedside resuscitation balloon occlusion of abdominal aorta technique in patients with severe trauma

Feng Li1, Feng Qi1, Zhibing Ming2, Jie Jin3, Ying Liu1,(), Zhihe Tang1, Peng Gu1   

  1. 1. Department of Emergency, Second Affiliated Hospital of Nantong University, Nantong 226001, China
    2. Vascular Surgery, Second Affiliated Hospital of Nantong University, Nantong 226001, China
    3. Interventional Department, Second Affiliated Hospital of Nantong University, Nantong 226001, China
  • Received:2022-06-06 Published:2023-02-18
  • Corresponding author: Ying Liu
引用本文:

李峰, 祁峰, 明志兵, 金杰, 刘颖, 唐志和, 顾鹏. 急诊床旁复苏性腹主动脉球囊阻断技术在严重创伤患者急救中的效果[J]. 中华卫生应急电子杂志, 2023, 09(01): 35-40.

Feng Li, Feng Qi, Zhibing Ming, Jie Jin, Ying Liu, Zhihe Tang, Peng Gu. Clinicaleffects of emergency bedside resuscitation balloon occlusion of abdominal aorta technique in patients with severe trauma[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2023, 09(01): 35-40.

目的

研究急诊床边实施复苏性腹主动脉球囊阻断(REBOA)技术对血流动力学不稳定骨盆骨折或下肢毁损伤患者的临床意义。

方法

选取2018年1月至2019年12月南通大学第二附属医院急诊室收治的骨盆骨折和(或)下肢毁损伤为主要出血部位的失血性休克患者为研究对象,分为研究组(在急诊床边实施REBOA)10例和对照组(因各种原因未能行急诊床边REBOA但进行了损伤控制性手术治疗)13例。观察两组患者入急诊室后1、2 h、转手术室前、控制性手术后6 h内及研究组患者实施REBOA前后的血压、输注晶体液量及输血量、血管活性药物使用量、超声测量下腔静脉变异度等情况;两组患者入急诊6、24 h和7 d病死率。

结果

研究组患者实施REBOA后即刻血压较实施REBOA前血压明显上升(P<0.05);两组患者入急诊室1 h后,研究组患者行REBOA后在各时相点多巴胺和去甲肾上腺素用量,与对照组相比明显减少(P<0.05);两组患者在接受控制性手术后6 h内输血量,研究组较对照组明显减少(P<0.05)。两组患者在6、24 h及7 d的病死率比较差异无统计学意义。

结论

针对血流动力学不稳定或下肢毁损伤患者,急诊床旁开展REBOA可快速控制或减少阻断平面以下的损伤出血,有助于快速稳定血压和恢复血容量。

Objective

To study the clinical effect of emergency implementation of resuscitation balloon occlusion of abdominal aorta (REBOA) technique at the bedside in patients with hemodynamics instability of pelvic fractures and/or lower extremity destructive injuries.

Methods

Patients with hemorrhagic shock with pelvic fracture and/or lower limb destruction injury as the main bleeding site admitted to the emergency room of the Second Affiliated Hospital of Nantong University from January 2018 to December 2019 were selected as the research subjects. There were 10 cases in the REBOA group (REBOA was performed at the emergency bedside)and 13 cases in the control group (the emergency bedside REBOA could not be performed for various reasons but damage control surgery was performed). The blood pressure, infusion volume, vasoactive drug usage, and the variability of the inferior vena cava measured by ultrasound were observed at the multiple time points including 1, 2 h after entering the emergency room, before transferring to the operating room, within 6 h after control surgery, before and after REBOA in the study group. And 6, 24h and 7d mortality was also recorded.

Results

The blood pressure of the patients in the REBOA group increased significantly immediately after the implementation of REBOA, compared with that before the implementation of REBOA (P<0.05); At 1 h after the patients entered the emergency room, the doses of dopamine and norepinephrine in the REBOA group at each time point after REBOA were significantly decreased compared with the control group (P<0.05); compared with the control group, in the REBOA group, the blood transfusion volume of the two groups of patients within 6h after receiving the controlled operation was significantly reduced (P<0.05). There was no significant difference in mortality at 6, 24 h and 7 days between the two groups.

Conclusion

Urgent implementation of REBOA can quickly reduce bleeding, restore blood volume and increase blood pressure in a short time in the emergency treatment of patients with hemodynamics instability of pelvic fractures and lower extremity destructive injuries.

表1 两组患者一般资料比较(±s)
表2 研究组10例患者实施REBOA后5 min血压变化(mmHg,±s)
表3 两组患者入ED紧急救治后血压变化对比(mmHg,±s)
表4 入ED后输血输液及升压药物使用情况(mL,±s)
表5 两组患者入ED后床边超声测量下腔静脉变异度比较(±s)
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