重症创伤损伤控制性复苏课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,50mmH,REBOA,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,The first affiliated hospital of medical school, Shihezi University,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),The first affiliated hospital of medical school, Shihezi University,主动脉复苏性血管内气囊阻新: REBOA,3,Science Direct,REBOA VS. 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,Comparison of zone 3 Resuscitative Endovascular,Aortic and Junctional Tourniquet in a model of,分组:随机分为 REBOA组及AAT组(腹主动,junctional hemorrhage in swine,脉和交界处止血带丿,son M. Rell PhD. Theadore T Redman, MD. Eliot,Jonathan J. Morrison, MD, PhD, FRCS, and Joseph K Maddry, MD,血管内气囊及止血帶装置应用究成后,两组,均接受500 mL Hextend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+ HF5l o,检阓指娠:收集实验动物生理救据并进行组间,1- diagram of experimental procedures. Each group consistedof1 aimals randomly allocated o interrention地软,The first affiliated hospital of medical school, Shihezi University,Science Direct,4,wa laz h c IrA B wAN bEDeR,Science Direct,Results,ELSEVIER,Comparison of zone 3 Resuscitative Endovascular,PErEmeter,REBoa P-value,Balloon occlusion of the aorta and the abdominal,Wewht Ik时,了士3.5,Aortic and Junctional Tourniquet in a model of,P-cerotid mm86350-65+54-057,junctional hemorrhage in swine,MAP- moral (mm H335637650,79.51419815.60,Table 2-Post injury values,42.1184,EBOA P-vaue,Lactate ImmEl,172001520.23034,Uncontroled,2士411540E8,hemorrhage time st,34+4645+3077,2514.1,Pretreatment bcad162834815512950s,MAP at inertie,I mm Hg,422433,32.5563185050,Fcst. treatmen:blod793,18173089,Hemorrhage time is) 124=47115*43058,ss 12,EtCC,=end baal caben dic ide,25617.537,081018,Spontaneous,103%613,63,hemostasis,Overall survi,1091(009,The first affiliated hospital of medical school, Shihezi University,wa laz h c IrA B wAN bEDeR,5,Sciencedirect,A Carotid MAP,ELSEVIER,A Lactate,B SpO2,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599161和,44698mmHg,P0.05)。AAJT治疗组乳酸水平较,高与 REBOA治疗组相比(分别为452.0和3.21.3mg/d;,P0.05),now ml REBOA:不好?,The first affiliated hospital of medical school, Shihezi University,Sciencedirect,6,AAST 2015 PLENARY PAPEI,REBOA装置,动物及分组:14只成年猪(35,Efficacy of a novel fluoroscopy-free endovascular balloon,device with pressure release capabilities in the setting,50kg),of uncontrolled junctional hemorrhage,出血&抉血/再灌注损伤,kyle K Sokol, MD), George E. Black, MD, Robert Shanhan, D), Shamon T.; Marko, Matthew 1. Eckert, Mn.产生休克生理学和稀释性凝血病,Nam T. Tran, MD, Benjamin W. Starnes, MD, and Matthew J Martin, MD Tamana, 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中充气,直到释,效阀门打开,然后进行45分钟后囊封存活,Cook medical(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(C,The first affiliated hospital of medical school, Shihezi University,AAST 2015 PLENARY PAPEI,7,C。l,基线,Hear rate, b,918,MP mmm H,士,PCWP mm Hg,Hematologic data,Hemxocrit. %o,162,2150.06,250.j49,thermit anal norma br rio134,120201542,Base excess, mmol,53lL10408,减少的出血农量,生存肘间,pital of medical school, Shihezi University,C。l,8,AAST 2015 PLENARY PAPEI,Efficacy of a novel fluoroscopy-free endovascular balloon,device with pressure release capabilities in the setting,of uncontrolled junctional hemorrhage,非常好?,kyle K Sokol, MD, George E Black, MD, Robert Shawhan, D), Shamon T. Marko, Matthew Eckert, 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,p0.01,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,The first affiliated hospital of medical school, Shihezi University,AAST 2015 PLENARY PAPEI,9,a systematic review of the use of resuscitative endovascular,balloon occlusion of the aorta in the management,of hemorrhagic shock,条统评价是旨在述目前,J Trauma Acute Care Surg. 2016: 80: 324Y334,REBOA临床使用及其对血流动,Jonathan James Morrison, MD, PhD, Richard E, calgon, MD, Ms, Jan Olaf ansen, FRCS, FFICM,Jeremy W, Cannon, MD, S.M. TIdd Erik Rasmussen, 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,4461 I mmHg)。数据表现出中,等非均质性,1为35.5,The first affiliated hospital of medical school, Shihezi University,a systematic review of the use,10,重症创伤损伤控制性复苏课件,11,重症创伤损伤控制性复苏课件,12,重症创伤损伤控制性复苏课件,13,重症创伤损伤控制性复苏课件,14,重症创伤损伤控制性复苏课件,15,重症创伤损伤控制性复苏课件,16,重症创伤损伤控制性复苏课件,17,重症创伤损伤控制性复苏课件,18,重症创伤损伤控制性复苏课件,19,