Роль эндоваскулярной баллонной окклюзии аорты в тактике контроля повреждений ее ветвей

Шапкин Ю.Г., Селиверстов П.А., Стекольников Н.Ю.

Реанимационная эндоваскулярная баллонная окклюзия аорты (РЭБОА) — инновационный метод временной остановки кровотечения при травмах живота и таза. Частота применения данного метода увеличивается с каждым годом. Между тем, влияние РЭБОА на гемодинамику и физиологию организма недостаточно изучено, ее роль в стратегии контроля повреждений остается неоднозначной.

В обзоре рассмотрена тактика, эффективность и опасности применения РЭБОА при травмах на основе результатов последних клинических и экспериментальных исследований.

РЭБОА эффективна для стабилизации гемодинамики у пациентов с травмами живота и / или таза с продолжающимся кровотечением и имеет приоритет перед реанимационной торакотомией с пережатием аорты. Применение РЭБОА сопряжено с риском опасных осложнений, связанных с артериальным доступом и размещением баллона в аорте, ишемией и реперфузией. Окклюзия аорты может усилить кровотечение из поврежденных печеночных вен, сосудов груди, головного мозга; повысить внутричерепное давление. Методы частичной и прерывистой баллонной окклюзии аорты позволяют пролонгировать окклюзию аорты со значительно меньшими последствиями реперфузионного синдрома и снизить риск летального исхода. Улучшение результатов использования РЭБОА может быть достигнуто в травмоцентрах, в которых выполняется более 10 вмешательств в год, применяется гибридная тактика лечения тяжелых травм с упреждающим ранним доступом к артерии у пациентов с нестабильной гемодинамикой.

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