重症创伤-损伤控制性复苏课件

主动脉复苏性血笞内气囊阻新的应用与陷阱主动脉复苏性血笞内气囊阻新的1中毒损伤控制性复苏Z创伤三角整体篡略多学科朕合低体温凝血病损伤者允许性低血压损伤控制性手术(控制出血目:最低MAP>角主动脉复苏性血答内气囊阻断50mmHREBOA维持循环及基本组织灌填光降低发生凝血病的风险结扎及死亡率Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity中毒2主动脉复苏性血管内气囊阻新:REBOA通过插入股动脉的赇囊导管提供内在的主动脉控制,并在预定位置将气囊气要求专业技术人员能够插入设各,确保设备的位置(区城)Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity主动脉复苏性血管内气囊阻新:REBOA3ScienceDirectREBOAVS.AAJT方:约克夏猪(每組10只,每组70-90kg)orsurgicalPeseerch,心0全身嶽醉,主动切开术制备未控制出血棋型Comparisonofzone3ResuscitativeEndovascularAorticandJunctionalTourniquetinamodelof分组:随机分为REBOA组及AAT组(腹主动junctionalhemorrhageinswine脉和交界处止血带丿sonM.RellPhD.TheadoreTRedman,MD.EliotJonathanJ.Morrison,MD,PhD,FRCS,andJosephKMaddry,MD血管内气囊及止血帶装置应用究成后,两组均接受500mLHextend推注。1小肘后,结研究方囊扎受伤的股动脉以棋拟确定的止血,然后再次进行Hextend推注和装置去除。观察动物两个多小肘Panam+HF5lo检阓指娠:收集实验动物生理救据并进行组间1-diagramofexperimentalprocedures.Eachgroupconsistedof1aimalsrandomlyallocatedointerrention地软Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityScienceDirect4walazhcIrABwANbEDeRScienceDirectResultsELSEVIERComparisonofzone3ResuscitativeEndovascularPErEmeterREBoaP-valueBalloonocclusionoftheaortaandtheabdominalWewhtIk时了士3.5AorticandJunctionalTourniquetinamodelofP-cerotidmm86350-65+54-057junctionalhemorrhageinswineMAP-moral(mmH33±5637±65079.5±14198±15.60Table2-Postinjuryvalues42.1±184EBOAP-vaueLactateImmEl172±00152±0.23034Uncontroled2士411540E8hemorrhagetimest34+4645+3077251±4.1Pretreatmentbcad1628±3481551±2950sMAPatinertieImmHg422±43332.5±56318±5050Fcst.treatmen:blod79±3,181±73089Hemorrhagetimeis)124=47115*43058ss12EtCC,=endbaalcabendicide256±17.537,0±81018Spontaneous103%61363hemostasisOverallsurvi1091(009Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversitywalazhcIrABwANbEDeR5SciencedirectACarotidMAPELSEVIERALactateBSpO2结景:雨种术都实现了10%的止血数景,除了REBOA组一只实验动物死亡之外,其他动物在整个实验中存活Cn油mAT组平均动脉压高于REBOA组(分别为599±161和446±98mmHg,P<0.05)。AAJT治疗组乳酸水平较高与REBOA治疗组相比(分别为45±2.0和3.2±1.3mg/d;P<0.05)nowmlREBOA:不好?Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversitySciencedirect6AAST2015PLENARYPAPEIREBOA装置动物及分组:14只成年猪(35Efficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesetting50kg)ofuncontrolledjunctionalhemorrhage出血&抉血/再灌注损伤kyleKSokol,MD),GeorgeE.Black,MD,RobertShanhan,\D),ShamonT.;Marko,Matthew1.Eckert,Mn.产生休克生理学和稀释性凝血病NamT.Tran,MD,BenjaminW.Starnes,MD,andMatthewJMartin,MDTamana,Hashingto随机分配至REBOA(n=8丿或标谁GP(n=6)组实验才囊:建立复杂的对側腹股沟软组织和血莟损伤,30秒的自由流血及GP5分钟。REBOA组将主动脉赇囊在主动脉区城Ⅲ中充气,直到释效阀门打开,然后进行45分钟后囊封存活Cookmedical(布卢明頓,印笫安纳州)生产的新型REBOA装置。刚收集未经处狸的和球囊暴露的主动脉用于组织生护套导管有助于首(A和带有压力放的寒类置,该阀在6学分析mhg咐杆开(B丿。三口存庄于运以允许耋尔丁格线,球衾充气和压力释放能力(CThefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityAAST2015PLENARYPAPEI7C。l基线Hearrate,b9]±18MPmmmH士PCWPmmHgHematologicdataHemxocrit.%o16±221±50.062±50.j49thermitanalnormabrrio13±412±0201542Baseexcess,mmol53±lL10408减少的出血农量生存肘间pitalofmedicalschool,ShiheziUniversityC。l8AAST2015PLENARYPAPEIEfficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesettingofuncontrolledjunctionalhemorrhage非常好?kyleKSokol,MD,GeorgeEBlack,MD,RobertShawhan,\D),ShamonT.Marko,MatthewEckert,MD),结票:对照纽和ReBOAS组具有相似的基线血流动力学,凝血障碍水平和出血/缺血/再灌注损伤。朱发现组织学气压伤,88%的REBOA装置已成功置入主劲脉Ⅲ区。REBOA组出血量显着降低(0.5Lw.0.2L,p=0.014)生存时间延长(45分钟与8分钟,p<0.01結论:本研究强化了以前研究中的结果,即REBOA是一种在不可压迫躯干出血的情况下增加存活率的有效方法,并且首次表朋这种特定的REBOA装置可以盲目引导进入主动脉的适当区域而不会产生未测量的气球充气期间的主动脉壁损伤Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityAAST2015PLENARYPAPEI9asystematicreviewoftheuseofresuscitativeendovascularballoonocclusionoftheaortainthemanagementofhemorrhagicshock条统评价是旨在述目前JTraumaAcuteCareSurg.2016:80:324Y334REBOA临床使用及其对血流动JonathanJamesMorrison,MD,PhD,RichardE,calgon,MD,Ms,JanOlafansen,FRCS,FFICMJeremyW,Cannon,MD,S.M.TIddErikRasmussen,MD力学特征和死亡率的影响方法:进行糸统评价(1946-2015年丿;头于人体应用REBOA的原始硏究;分析研究掇告的血动力学特征和死亡率数据结杲:总共83项研究;41符合纳入标准:产后出血(5),上消化道出血(3),盆腔手术(8),创伤(15)和破裂的主动脉瘤(10)857例患者死亡423例(49.4%);643(750%)有明显的休克。汇总分析显示使用REBOA后平均收縮压增加53mmHg(95%Cl,4461ImmHg)。数据表现出中等非均质性,1为35.5Thefirstaffiliatedhospit