复苏性主动脉球囊阻断术治疗...迫性躯干出血效果的系统评价_刘建.pdf

军事医学复苏性主动脉球囊阻断术治疗不可压迫性躯干出血效果的系统评价刘建1，2，辛梅2，黄虹皓2，杨柯2，李霞2，张文馨2，吴西强1，2，邬晓臣2，戴睿武3，张近宝1，21川北医学院，四川南充637100;2中国人民解放军西部战区总医院心血管外科，成都610083;3中国人民解放军西部战区总医院普通外科，成都610083【基金项目】四川省科技创新苗子工程(2022094);高原胸部战创伤一站式紧急止血及损伤控制技术应用(2021XZYGB30)【通信作者】张近宝，E-mail:jinbaozhang001 163com戴睿武，E-mail:dairuiwu swjtueducn【摘要】目的评价复苏性主动脉球囊阻断术(resuscitative endovascular balloon occlusion of the aorta，EBOA)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 EBOA 应用的关键。方法使用“复苏性主动脉球囊阻断术(EBOA)”、“复苏性主动脉血管内球囊闭塞(resuscitation intravascularballoon occlusion of the aorta)”、“球囊闭塞(balloon occlusion)”、“部分主动脉球囊闭塞(partial resuscitativeendovascular balloon occlusion of the aorta)”、“部分复苏性主动脉球囊阻断术(partial resuscitation of aortic bal-loon 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 200 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 EBOA 手术共 47 例(存活率为 872%)，穿透伤 19 例(404%)，钝性损伤 28 例(596%)，接受 EBOA 区治疗 26 例(553%)，区治疗 21 例(447%)，球囊扩张时间为 368min。院内环境进行 EBOA 手术共 705 例(存活率为 41%)，穿透伤 138 例(196%)，钝性损伤 549 例(779%)，其他损伤 18 例(26%)，接受 EBOA 区治疗493 例(743%)，区治疗 16 例(24%)，区治疗 155 例(233%)，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 968%)，民用环境下此手术者共 16 例(存活率为 688%)，在院前环境、穿透伤和区域(Zone)分区为 I 区患者接受 EBOA 紧急止血后的存活率明显升高。结论EBOA 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 EBOA 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。【关键词】复苏性主动脉球囊阻断术;部分主动脉球囊闭塞;不可压迫性躯干出血;院前环境;急救【中图分类号】641【文献标识码】A【DOI】103969/jissn10094237202302003Systematic review of the effect of resuscitative endovascular balloon occlusion of the aorta inthe treatment of noncompressible torso hemorrhageLiu Jian1，2，Xin Mei2，Huang Honghao2，Yang Ke2，Li Xia2，Zhang Wenxin2，Wu Xiqiang1，2，Wu Xiaochen2，Dai uiwu3，Zhang Jinbao1，21North Sichuan Medical College，Nanchong，Sichuan637100，China;2Department of Cardiovascular Surgery，The General Hospitalof Western Theater Command PLA，Chengdu610083，China;3Department of General Surgery，The General Hospital of WeseternTheater Command PLA，Chengdu610083，China【Abstract】ObjectiveTo evaluate the effect of resuscitative endovascular balloon occlusion of the aorta(EBOA)on the treatment of noncompressible torso hemorrhage during prehospital and in-hospital settings;todiscuss which research areas may be the key to further promote the application of EBOAMethodsThe keywordsof resuscitative endovascular balloon occlusion of the aorta，resuscitation intravascular balloon occlusion of the a-orta，balloon occlusion，partial resuscitation endovascular balloon occlusion of the aorta，partial resuscitationof aortic balloon blockade，part of the balloon is occluded were used for literature search in the databases ofPubMed，Embase，Cochrane and others Only clinical research articles were included，and those with overlapping39创伤外科杂志 2023 年第 25 卷第 2 期J Trauma Surg，2023，Vol25，No2data or data loss for more than two variables were excluded EBOA data were divided into two groups:pre-hospitaland in-hospital SPSS 200 was used for statistical analysis esultsAltogether 16 clinical articles were included，with 47 patients received pre-hospital EBOA and 705 patients received in-hospital EBOA Among the pre-hospitalgroup(n=47)，there were 19(404%)penetrating injuries and 28(596%)blunt injuries，with the total survivalrate being 872%EBOA location was zone:26 cases(553%);zone:21 cases(447%)The balloon dil-atation time was 368 min As for the in-hospital group(n=705)，there were 138(196%)penetrating injuries，549(779%)blunt injuries，and 18(26%)others The survival rate was 41%EBOA location was zone:493 ca-ses(743%);zone 16 cases(24%);zone:155 patients(233%)The balloon dilatation time was 36 minIn the pre-hospital，31 patients underwent EBOA in military setting who achieved a survival rate of 968%，and 16patients underwent EBOA in civilian setting and the survival rate was lower，ie，688%Statistical analysis re-vealed that patients survival can be significantly improved after emergency hemostasis with pre-hospital EBOA Al-so penetrating injuries and EBOA in Zone I showed a better survival rateConclusionEBOA is simple and min-imally invasive，making it an ideal technique for trauma care under some specific conditions such as military warfareor disaster relief However，the difficulty in injury diagnosis and time needs for intubation limit its use in pre-hospitalsettings To promote the application of EBOA，further research targeting at the indication(most suitable objects)，occlusion technique optimization and suitable occlusion duration is of vital significance【Key words】esuscitative endovascular balloon occlusion of the aorta;Partial resuscitative endovascularballoon occlusion of the aorta;Noncompressible torso hemorrhage;Prehospital environment;First aid阿富汗和伊拉克战争研究表明，高达 80%可能存活的患者最终死于难以救治的出血12。损伤后的出血类型分为可压迫性出血和不可压迫性出血，这取决于出血控制措施是否能在损伤后立即应用。可压迫性出血大多源于肢体损伤，可通过直接加压或止血带进行处理。而那些在应急状态下难以采用压迫止血方式处理的出血被称作不可压迫性出血，由于其大多发生在躯干内部部位，因而被称为不可压迫性躯干出血(non(compressible trunk bleeding，NCTH)。NCTH 的发生部位主要为胸腔、腹腔、盆腔内器官或脉管系统。对阿富汗和伊拉克冲突的全面病死率研究报告，91%的潜在可存活患者的死亡与NCTH 有关，控制 NCTH 仍然是军医在战场上为减少可预防死亡关注的焦点3。复苏性主动