REBOA在老年创伤患者中的使用和并发症：来自多中心数据库的见解

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-25 DOI:10.1016/j.jss.2025.03.028

Parvathy Balamurugan BS , Pavan Guduri BA , John P. Hunt MD, MPH , Alan Marr MD, FACS , Patrick Greiffenstein MD, FACS , Jonathan Schoen MD, MPH, FACS , Lance Stuke MD, MPH, FACS , Juan Duchesne MD, FACS , Charles F. Bellows MD, FACS , Alison A. Smith MD, PhD, FACS

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引用次数: 0

摘要

复苏血管内球囊阻塞主动脉（REBOA）在老年人群中的应用尚未得到很好的研究。本研究旨在确定REBOA在老年人群中的使用和并发症。据推测，与年轻患者相比，老年患者可能有更高的并发症发生率，因为老年患者先前存在合并症的可能性更大。方法使用美国创伤主动脉阻塞外科协会创伤和急性护理外科复苏登记数据库，按年龄（18-64岁vs≥65岁）对成人创伤患者进行分层，收集的数据包括人口统计学信息、损伤严重程度评分（ISS）、损伤机制、放置区域、闭塞长度、急性肾损伤的发展和通路部位并发症。单因素分析采用P值<；0.05被认为是显著的。结果1156例患者中，老年性157例（13.6%）。两组的ISS中位数均为34（四分位间距[IQR] 22,43）， P = 0.98，差异无统计学意义。两组REBOA区放置分布相似。闭塞时间与老年中位数30 min （IQR 11,47）和非老年中位数33 min （IQR 21,60）差异无统计学意义，P = 0.18。两组急性肾损伤发生率无显著差异（老年组21.7%，非老年组22.1%,P = 1.0）。下肢缺血发生率明显降低（老年组为0%，非老年组为3.7%,P = 0.006）。血肿、动静脉瘘、狭窄、假性动脉瘤或远端栓塞的发生率无显著差异。结论sage≥65 y时，肢体缺血发生率明显降低。这种差异可能是由于该患者群体先前存在的合并症。未来的前瞻性研究需要进一步研究这一现象。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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REBOA Use and Complications in Geriatric Trauma Patients: Insights From a Multicenter Database

Introduction

Resuscitative endovascular balloon occlusion of the aorta (REBOA) usage in the geriatric population has not been well studied. This study aimed to define REBOA use and complications in the geriatric population. It was hypothesized that geriatric patients may have greater rates of complications compared to younger patients due to geriatric patients having a greater likelihood of preexisting comorbidities.

Methods

Using the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry database, adult trauma patients were stratified by age (18-64 y versus ≥ 65 y). Data collected included demographic information, injury severity score (ISS), mechanism of injury, zone of placement, length of occlusion, development of acute kidney injury, and access site complications. Univariate analyses were performed with P value < 0.05 considered to be significant.

Results

Of the 1156 patients, 157 (13.6%) were geriatric. There was no significant difference in ISS with both groups having a median ISS of 34 (interquartile range [IQR] 22, 43), P = 0.98. The distribution of REBOA zone placement was similar for both groups. The time of occlusion was not significantly different with geriatric median of 30 min (IQR 11,47) and nongeriatric median of 33 min (IQR 21, 60), P = 0.18. There was no significant difference in the rate of acute kidney injury (21.7% geriatric versus 22.1% nongeriatric, P = 1.0). There was a significantly lower rate of extremity ischemia (0% geriatric versus 3.7% nongeriatric, P = 0.006). There was no significant difference in rates of hematoma, arteriovenous fistula, stenosis, pseudoaneurysm, or distal embolism.

Conclusions

Age greater than or equal to 65 y was associated with a significantly lower rate of extremity limb ischemia. This difference could be due to preexisting comorbidities in this patient population. Future prospective studies are needed to further study this phenomenon.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.