重癥創(chuàng)傷-損傷控制性復(fù)蘇課件

主動(dòng)脈復(fù)蘇性血笞內(nèi)氣囊阻新的應(yīng)用與陷阱主動(dòng)脈復(fù)蘇性血笞內(nèi)氣囊阻新的1中毒損傷控制性復(fù)蘇Z創(chuàng)傷三角整體篡略多學(xué)科朕合低體溫凝血病損傷者允許性低血壓損傷控制性手術(shù)(控制出血目:最低MAP>角主動(dòng)脈復(fù)蘇性血答內(nèi)氣囊阻斷50mmHREBOA維持循環(huán)及基本組織灌填光降低發(fā)生凝血病的風(fēng)險(xiǎn)結(jié)扎及死亡率Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity中毒2主動(dòng)脈復(fù)蘇性血管內(nèi)氣囊阻新:REBOA通過(guò)插入股動(dòng)脈的賕囊導(dǎo)管提供內(nèi)在的主動(dòng)脈控制,并在預(yù)定位置將氣囊氣要求專(zhuān)業(yè)技術(shù)人員能夠插入設(shè)各,確保設(shè)備的位置(區(qū)城)Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity主動(dòng)脈復(fù)蘇性血管內(nèi)氣囊阻新:REBOA3ScienceDirectREBOAVS.AAJT方:約克夏豬(每組10只,每組70-90kg)orsurgicalPeseerch,心0全身嶽醉,主動(dòng)切開(kāi)術(shù)制備未控制出血棋型Comparisonofzone3ResuscitativeEndovascularAorticandJunctionalTourniquetinamodelof分組:隨機(jī)分為REBOA組及AAT組(腹主動(dòng)junctionalhemorrhageinswine脈和交界處止血帶丿sonM.RellPhD.TheadoreTRedman,MD.EliotJonathanJ.Morrison,MD,PhD,FRCS,andJosephKMaddry,MD血管內(nèi)氣囊及止血帶裝置應(yīng)用究成后,兩組均接受500mLHextend推注。1小肘后,結(jié)研究方囊扎受傷的股動(dòng)脈以棋擬確定的止血,然后再次進(jìn)行Hextend推注和裝置去除。觀察動(dòng)物兩個(gè)多小肘Panam+HF5lo檢阓指娠:收集實(shí)驗(yàn)動(dòng)物生理救據(jù)并進(jìn)行組間1-diagramofexperimentalprocedures.Eachgroupconsistedof1aimalsrandomlyallocatedointerrention地軟Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityScienceDirect4walazhcIrABwANbEDeRScienceDirectResultsELSEVIERComparisonofzone3ResuscitativeEndovascularPErEmeterREBoaP-valueBalloonocclusionoftheaortaandtheabdominalWewhtIk時(shí)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結(jié)景:雨種術(shù)都實(shí)現(xiàn)了10%的止血數(shù)景,除了REBOA組一只實(shí)驗(yàn)動(dòng)物死亡之外,其他動(dòng)物在整個(gè)實(shí)驗(yàn)中存活Cn油mAT組平均動(dòng)脈壓高于REBOA組(分別為599±161和446±98mmHg,P<0.05)。AAJT治療組乳酸水平較高與REBOA治療組相比(分別為45±2.0和3.2±1.3mg/d;P<0.05)nowmlREBOA:不好?Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversitySciencedirect6AAST2015PLENARYPAPEIREBOA裝置動(dòng)物及分組:14只成年豬(35Efficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesetting50kg)ofuncontrolledjunctionalhemorrhage出血&抉血/再灌注損傷kyleKSokol,MD),GeorgeE.Black,MD,RobertShanhan,\D),ShamonT.;Marko,Matthew1.Eckert,Mn.產(chǎn)生休克生理學(xué)和稀釋性凝血病NamT.Tran,MD,BenjaminW.Starnes,MD,andMatthewJMartin,MDTamana,Hashingto隨機(jī)分配至REBOA(n=8丿或標(biāo)誰(shuí)GP(n=6)組實(shí)驗(yàn)才囊:建立復(fù)雜的對(duì)側(cè)腹股溝軟組織和血莟損傷,30秒的自由流血及GP5分鐘。REBOA組將主動(dòng)脈賕囊在主動(dòng)脈區(qū)城Ⅲ中充氣,直到釋效閥門(mén)打開(kāi),然后進(jìn)行45分鐘后囊封存活Cookmedical(布盧明頓,印笫安納州)生產(chǎn)的新型REBOA裝置。剛收集未經(jīng)處貍的和球囊暴露的主動(dòng)脈用于組織生護(hù)套導(dǎo)管有助于首(A和帶有壓力放的寒類(lèi)置,該閥在6學(xué)分析mhg咐桿開(kāi)(B丿。三口存莊于運(yùn)以允許耋爾丁格線(xiàn),球衾充氣和壓力釋放能力(CThefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityAAST2015PLENARYPAPEI7C。l基線(xiàn)Hearrate,b9]±18MPmmmH士PCWPmmHgHematologicdataHemxocrit.%o16±221±50.062±50.j49thermitanalnormabrrio13±412±0201542Baseexcess,mmol53±lL10408減少的出血農(nóng)量生存肘間pitalofmedicalschool,ShiheziUniversityC。l8AAST2015PLENARYPAPEIEfficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesettingofuncontrolledjunctionalhemorrhage非常好?kyleKSokol,MD,GeorgeEBlack,MD,RobertShawhan,\D),ShamonT.Marko,MatthewEckert,MD),結(jié)票:對(duì)照紐和ReBOAS組具有相似的基線(xiàn)血流動(dòng)力學(xué),凝血障礙水平和出血/缺血/再灌注損傷。朱發(fā)現(xiàn)組織學(xué)氣壓傷,88%的REBOA裝置已成功置入主勁脈Ⅲ區(qū)。REBOA組出血量顯著降低(0.5Lw.0.2L,p=0.014)生存時(shí)間延長(zhǎng)(45分鐘與8分鐘,p<0.01結(jié)論:本研究強(qiáng)化了以前研究中的結(jié)果,即REBOA是一種在不可壓迫軀干出血的情況下增加存活率的有效方法,并且首次表朋這種特定的REBOA裝置可以盲目引導(dǎo)進(jìn)入主動(dòng)脈的適當(dāng)區(qū)域而不會(huì)產(chǎn)生未測(cè)量的氣球充氣期間的主動(dòng)脈壁損傷Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityAAST2015PLENARYPAPEI9asystematicreviewoftheuseofresuscitativeendovascularballoonocclusionoftheaortainthemanagementofhemorrhagicshock條統(tǒng)評(píng)價(jià)是旨在述目前JTraumaAcuteCareSurg.2016:80:324Y334REBOA臨床使用及其對(duì)血流動(dòng)JonathanJamesMorrison,MD,PhD,RichardE,calgon,MD,Ms,JanOlafansen,FRCS,FFICMJeremyW,Cannon,MD,S.M.TIddErikRasmussen,MD力學(xué)特征和死亡率的影響方法:進(jìn)行糸統(tǒng)評(píng)價(jià)(1946-2015年丿;頭于人體應(yīng)用REBOA的原始硏究;分析研究掇告的血?jiǎng)恿W(xué)特征和死亡率數(shù)據(jù)結(jié)杲:總共83項(xiàng)研究;41符合納入標(biāo)準(zhǔn):產(chǎn)后出血(5),上消化道出血(3),盆腔手術(shù)(8),創(chuàng)傷(15)和破裂的主動(dòng)脈瘤(10)857例患者死亡423例(49.4%);643(750%)有明顯的休克。匯總分析顯示使用REBOA后平均收縮壓增加53mmHg(95%Cl,4461ImmHg)。數(shù)據(jù)表現(xiàn)出中等非均質(zhì)性,1為35.5Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityasystematicreviewoftheuse10重癥創(chuàng)傷-損傷控制性復(fù)蘇課件11重癥創(chuàng)傷-損傷控制性復(fù)蘇課件12重癥創(chuàng)傷-損傷控制性復(fù)蘇課件13重癥創(chuàng)傷-損傷控制性復(fù)蘇課件14重癥創(chuàng)傷-損傷控制性復(fù)蘇課件15重癥創(chuàng)傷-損傷控制性復(fù)蘇課件16重癥創(chuàng)傷-損傷控制性復(fù)蘇課件17重癥創(chuàng)傷-損傷控制性復(fù)蘇課件18重癥創(chuàng)傷-損傷控制性復(fù)蘇課件19主動(dòng)脈復(fù)蘇性血笞內(nèi)氣囊阻新的應(yīng)用與陷阱主動(dòng)脈復(fù)蘇性血笞內(nèi)氣囊阻新的20中毒損傷控制性復(fù)蘇Z創(chuàng)傷三角整體篡略多學(xué)科朕合低體溫凝血病損傷者允許性低血壓損傷控制性手術(shù)(控制出血目:最低MAP>角主動(dòng)脈復(fù)蘇性血答內(nèi)氣囊阻斷50mmHREBOA維持循環(huán)及基本組織灌填光降低發(fā)生凝血病的風(fēng)險(xiǎn)結(jié)扎及死亡率Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity中毒21主動(dòng)脈復(fù)蘇性血管內(nèi)氣囊阻新:REBOA通過(guò)插入股動(dòng)脈的賕囊導(dǎo)管提供內(nèi)在的主動(dòng)脈控制,并在預(yù)定位置將氣囊氣要求專(zhuān)業(yè)技術(shù)人員能夠插入設(shè)各,確保設(shè)備的位置(區(qū)城)Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversity主動(dòng)脈復(fù)蘇性血管內(nèi)氣囊阻新:REBOA22ScienceDirectREBOAVS.AAJT方:約克夏豬(每組10只,每組70-90kg)orsurgicalPeseerch,心0全身嶽醉,主動(dòng)切開(kāi)術(shù)制備未控制出血棋型Comparisonofzone3ResuscitativeEndovascularAorticandJunctionalTourniquetinamodelof分組:隨機(jī)分為REBOA組及AAT組(腹主動(dòng)junctionalhemorrhageinswine脈和交界處止血帶丿sonM.RellPhD.TheadoreTRedman,MD.EliotJonathanJ.Morrison,MD,PhD,FRCS,andJosephKMaddry,MD血管內(nèi)氣囊及止血帶裝置應(yīng)用究成后,兩組均接受500mLHextend推注。1小肘后,結(jié)研究方囊扎受傷的股動(dòng)脈以棋擬確定的止血,然后再次進(jìn)行Hextend推注和裝置去除。觀察動(dòng)物兩個(gè)多小肘Panam+HF5lo檢阓指娠:收集實(shí)驗(yàn)動(dòng)物生理救據(jù)并進(jìn)行組間1-diagramofexperimentalprocedures.Eachgroupconsistedof1aimalsrandomlyallocatedointerrention地軟Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityScienceDirect23walazhcIrABwANbEDeRScienceDirectResultsELSEVIERComparisonofzone3ResuscitativeEndovascularPErEmeterREBoaP-valueBalloonocclusionoftheaortaandtheabdominalWewhtIk時(shí)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,ShiheziUniversitywalazhcIrABwANbEDeR24SciencedirectACarotidMAPELSEVIERALactateBSpO2結(jié)景:雨種術(shù)都實(shí)現(xiàn)了10%的止血數(shù)景,除了REBOA組一只實(shí)驗(yàn)動(dòng)物死亡之外,其他動(dòng)物在整個(gè)實(shí)驗(yàn)中存活Cn油mAT組平均動(dòng)脈壓高于REBOA組(分別為599±161和446±98mmHg,P<0.05)。AAJT治療組乳酸水平較高與REBOA治療組相比(分別為45±2.0和3.2±1.3mg/d;P<0.05)nowmlREBOA:不好?Thefirstaffiliatedhospitalofmedicalschool,ShiheziUniversitySciencedirect25AAST2015PLENARYPAPEIREBOA裝置動(dòng)物及分組:14只成年豬(35Efficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesetting50kg)ofuncontrolledjunctionalhemorrhage出血&抉血/再灌注損傷kyleKSokol,MD),GeorgeE.Black,MD,RobertShanhan,\D),ShamonT.;Marko,Matthew1.Eckert,Mn.產(chǎn)生休克生理學(xué)和稀釋性凝血病NamT.Tran,MD,BenjaminW.Starnes,MD,andMatthewJMartin,MDTamana,Hashingto隨機(jī)分配至REBOA(n=8丿或標(biāo)誰(shuí)GP(n=6)組實(shí)驗(yàn)才囊:建立復(fù)雜的對(duì)側(cè)腹股溝軟組織和血莟損傷,30秒的自由流血及GP5分鐘。REBOA組將主動(dòng)脈賕囊在主動(dòng)脈區(qū)城Ⅲ中充氣,直到釋效閥門(mén)打開(kāi),然后進(jìn)行45分鐘后囊封存活Cookmedical(布盧明頓,印笫安納州)生產(chǎn)的新型REBOA裝置。剛收集未經(jīng)處貍的和球囊暴露的主動(dòng)脈用于組織生護(hù)套導(dǎo)管有助于首(A和帶有壓力放的寒類(lèi)置,該閥在6學(xué)分析mhg咐桿開(kāi)(B丿。三口存莊于運(yùn)以允許耋爾丁格線(xiàn),球衾充氣和壓力釋放能力(CThefirstaffiliatedhospitalofmedicalschool,ShiheziUniversityAAST2015PLENARYPAPEI26C。l基線(xiàn)Hearrate,b9]±18MPmmmH士PCWPmmHgHematologicdataHemxocrit.%o16±221±50.062±50.j49thermitanalnormabrrio13±412±0201542Baseexcess,mmol53±lL10408減少的出血農(nóng)量生存肘間pitalofmedicalschool,ShiheziUniversityC。l27AAST2015PLENARYPAPEIEfficacyofanovelfluoroscopy-freeendovascularballoondevicewithpressurereleasecapabilitiesinthesettingofuncontrolledjunctionalhemorrhage非常好?kyleKSokol,MD,GeorgeEBlack,MD,RobertShawhan,\D),ShamonT.Marko,MatthewEckert,MD),結(jié)票:對(duì)照紐和ReBOAS組具有相似的基線(xiàn)血流動(dòng)力學(xué),凝血障礙水平和出血/缺血/再灌注損傷。朱發(fā)現(xiàn)組織學(xué)氣壓傷,88%的REBOA裝置已成功置入主勁脈Ⅲ區(qū)。REBOA組出血量顯著降低(0.5Lw.0.2L,p=0.014)生存時(shí)間延長(zhǎng)(45分鐘與8分鐘,p<0.01結(jié)論:本研究強(qiáng)化了以前研究中的結(jié)果,即REBOA是一種在不可壓迫軀干出血的情況下增加存活率的有效方法,并且首次表朋這種特定的REBOA裝置可以盲目引導(dǎo)進(jìn)入主動(dòng)脈的適當(dāng)區(qū)域而不會(huì)產(chǎn)生未測(cè)量的氣球充氣期間的主動(dòng)