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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">nmp</journal-id><journal-title-group><journal-title xml:lang="ru">Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь»</journal-title><trans-title-group xml:lang="en"><trans-title>Russian Sklifosovsky Journal "Emergency Medical Care"</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2223-9022</issn><issn pub-type="epub">2541-8017</issn><publisher><publisher-name>“N.V. Sklifosovsky Research Institute for Emergency Medicine”</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.23934/2223-9022-2024-13-1-14-21</article-id><article-id custom-type="elpub" pub-id-type="custom">nmp-1785</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>О целесообразности применения технологии REBOA для лечения пострадавших с политравмой</article-title><trans-title-group xml:lang="en"><trans-title>On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6926-6497</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Жуков</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Zhukov</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Жуков Александр Игоревич - младший научный сотрудник отделения сочетанной и множественной травмы ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».</p><p>129090, Москва, Большая Сухаревская пл., д. 3</p></bio><bio xml:lang="en"><p>Aleksander I. Zhukov - Junior Researcher, Department of Combined and Multiple Trauma.</p><p>3, Bolshaya Sukharevskaya Sq., Moscow 129090</p></bio><email xlink:type="simple">zhukovai@sklif.mos.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4432-9022</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Заднепровский</surname><given-names>Н. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Zadneprovsky</surname><given-names>N. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Заднепровский Никита Николаевич - кандидат медицинских наук, старший научный сотрудник отделения сочетанной и множественной травмы ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».</p><p>129090, Москва, Большая Сухаревская пл., д. 3</p></bio><bio xml:lang="en"><p>Nikita N. Zadneprovsky - Candidate of Medical Sciences, Senior Researcher, Department of Combined and Multiple Trauma.</p><p>3, Bolshaya Sukharevskaya Sq., Moscow 129090</p></bio><email xlink:type="simple">zacuta2011@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2954-6985</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Иванов</surname><given-names>П. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivanov</surname><given-names>P. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Иванов Павел Анатольевич - доктор медицинских наук, заведующий научным отделением сочетанной и множественной травмы ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».</p><p>129090, Москва, Большая Сухаревская пл., д. 3</p></bio><bio xml:lang="en"><p>Pavel A. Ivanov - Doctor of Medical Sciences, Head of the Scientific Department of Combined and Multiple Trauma.</p><p>3, Bolshaya Sukharevskaya Sq., Moscow 129090</p></bio><email xlink:type="simple">ipamailbox@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3167-3692</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Коков</surname><given-names>Л. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Kokov</surname><given-names>L. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Коков Леонид Сергеевич - академик РАН, доктор медицинских наук, профессор, руководитель научного отдела неотложной кардиологии и сердечно­сосудистой хирургии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ», заведующий кафедрой рентгенэндо-васкулярной и сосудистой хирургии ФГБОУ ВО «Российский университет медицины» МЗ РФ.</p><p>129090, Москва, Большая Сухаревская пл., д. 3; 127006, Москва, ул. Долгоруковская, д. 4</p></bio><bio xml:lang="en"><p>Leonid S. Kokov - Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Scientific Department of Emergency Cardiology and Cardiovascular Surgery, N.V. Sklifosovsky Research Institute for Emergency Medicine; Head of the Department of X­ray Endovascular and Vascular Surgery, RUM.</p><p>3, Bolshaya Sukharevskaya Sq., Moscow 129090; 4, Dolgorukovskaya Str., Moscow 127006</p></bio><email xlink:type="simple">lskokov@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru">ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ» Российская Федерация<country>Россия</country></aff><aff xml:lang="en">N.V. Sklifosovsky Research Institute for Emergency Medicine<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru">ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; ФГБОУ ВО «Российский университет медицины» МЗ РФ<country>Россия</country></aff><aff xml:lang="en">N.V. Sklifosovsky Research Institute for Emergency Medicine; Russian University of Medicine<country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>14</day><month>04</month><year>2024</year></pub-date><volume>13</volume><issue>1</issue><fpage>14</fpage><lpage>21</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Жуков А.И., Заднепровский Н.Н., Иванов П.А., Коков Л.С., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Жуков А.И., Заднепровский Н.Н., Иванов П.А., Коков Л.С.</copyright-holder><copyright-holder xml:lang="en">Zhukov A.I., Zadneprovsky N.N., Ivanov P.A., Kokov L.S.</copyright-holder><license license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.jnmp.ru/jour/article/view/1785">https://www.jnmp.ru/jour/article/view/1785</self-uri><abstract><p>Введение По данным отечественных и зарубежных авторов, ведущей причиной смерти у пострадавших с политравмой является кровопотеря. Метод REBOA (реанимационная эндоваскулярная баллонная окклюзия аорты) является одним из новых перспективных способов борьбы с кровотечением у пациентов в состоянии травматического шока. В мировой научной литературе имеется большое число публикаций, свидетельствующих о высокой эффективности данной технологии при лечении кровотечений. Однако в Российской Федерации данный способ пока не вошел в повседневную практику, а научные исследования на этот счет немногочисленны.</p><p>Цель На основе данных литературы и анализа собственной выборки обосновать необходимость использования технологии REBOA для лечения пострадавших с политравмой.</p><p>Материал и методы Проведен ретроспективный анализ медицинской документации пациентов с политравмой, поступивших в НИИ СП им. Н.В. Склифосовского за 2021 год. Были изучены данные историй болезни и Результаты судебно­медицинских экспертиз. В основную выборку включены пострадавшие с политравмой (оценка по шкале ISS более 17 баллов), доставленные с места происшествия в состоянии травматического шока (систолическое артериальное давление (САД) менее 90 мм рт.ст.) и верифицированным источником кровотечения. Для оценки потенциальной выживаемости пострадавших мы использовали шкалу TRISS.</p><p>Результаты Из 92 пострадавших с политравмой показания для REBOA имели 19 пациентов (20,6%). Наиболее часто встречающимися источниками кровотечения были повреждения тазового кольца 14 (73,7%), живота 11 (57,9%) и груди 7 (36,8%). У 6 пострадавших (31,5%) имело место сочетание повреждений живота и таза как области кровопотери. Средний возраст пострадавших составил 48,8±19,9 года, средний балл по ISS — 39,4±20,1. При поступлении среднее САД составляло 62,4±31,5 мм рт.ст., а частота сердечных сокращений — 91,8±43,3 уд./мин. У 8 пострадавших (42,1%) сразу при госпитализации выполняли введение норадреналина в средней в дозе 837,5±537,0 нг/кг/мин. В результате полученных травм 15 пациентов (78,9%) скончались, а 4 были выписаны из стационара. По данным заключений судебно­медицинских экспертов, ведущей причиной смерти была кровопотеря в 11 (61,1%), тяжелая черепно­мозговая травма (ЧМТ) в 4 (22,2%), а инфекционные осложнения — в 3 наблюдениях (16,7%). Каждому пациенту подсчитан показатель по шкале TRISS. Для того чтобы определить наиболее потенциально жизнеспособных пациентов с показаниями к REBOA, мы исключили 5 пострадавших с тяжелой ЧМТ (TRISSсредн. 20,9±11,1%) и 5 пострадавших с показателем выживаемости по TRISS менее 50% (TRISSсредн. 10,0±14,1%), — последние скончались от геморрагического шока. Среди оставшихся 9 пострадавших с высоким прогнозируемым процентом выживаемости 5 умерших (26,3%) имели средний балл TRISS 80,5±15,8%, сопоставимый со средним TRISS 83,3±2,4% у 4 выживших.</p><p>Выводы 1. По данным зарубежных и отечественных публикаций, технология реанимационной эндоваскулярной баллонной окклюзии аорты (REBOA) является эффективной для остановки внутреннего кровотечения у пострадавших с политравмой. 2. При анализе собственной выборки пациентов доказано, что 20,6% пострадавших с политравмой имели показания для применения REBOA. Большинство из них (78,9%) скончались. При этом основной причиной смерти являлся геморрагический шок. 3. Около четверти пациентов (26,3%) с показаниями к REBOA потенциально имели высокие шансы на выживание. В перспективе использование этой технологии может уменьшить число смертельных исходов.</p></abstract><trans-abstract xml:lang="en"><p>Introduction According to domestic and foreign authors, the leading cause of death in victims with polytrauma is blood loss. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the new promising ways to manage bleeding in patients in a state of traumatic shock. There are a large number of publications in the world scientific literature indicating the high effectiveness of this technology in the treatment of bleeding. However, in the Russian Federation, this method has not yet entered into everyday practice, and scientific research on this matter is scarce. AIM Based on literature data and analysis of our own sample, to justify the need to use REBOA technology for the treatment of victims with polytrauma.</p><p>Material and methods A retrospective analysis of the medical records of patients with polytrauma admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021 was carried out. Data from medical records and the Results of forensic medical examinations were studied. The main sample included victims with polytrauma (Injury Severity Score, ISS, of more than 17 points) delivered from the scene of the incident in a state of traumatic shock (systolic blood pressure, SBP, of less than 90 mm Hg) and a verified source of bleeding. To assess the potential survival of victims, we used the Trauma Score and Injury Severity Score (TRISS) scale.</p><p>Results Of the 92 patients with polytrauma, 19 patients (20.6%) had indications for REBOA. The most common sources of bleeding were injuries to the pelvic ring, 14 (73.7%), abdomen, 11 (57.9%), and chest, 7 (36.8%). In 6 victims (31.5%), there were combined abdomen and pelvic injuries as the area of blood loss. The mean age of the victims was 48.8±19.9 years, the mean ISS value was 39.4±20.1. On admission, the mean SBP was 62.4±31.5 mm Hg, and heart rate — 91.8±43.3 beats/min. In 8 victims (42.1%), norepinephrine was administered immediately upon hospitalization at an average dose of 837.5±537.0 ng/kg/min. As a result of their injuries, 15 patients (78.9%) died, and 4 were discharged from the hospital. According to the Conclusions of forensic experts, the leading cause of death was blood loss in 11 (61.1%), severe traumatic brain injury (TBI) in 4 (22.2%), and infectious complications in 3 cases (16.7%).The TRISS was calculated for each patient. In order to identify the most potentially viable patients with indications for REBOA, we excluded 5 patients with severe TBI (the mean TRISS was 20.9±11.1%), and 5 patients with the TRISS of less than 50% (the mean TRISS was 10.0±14.1%), the latter died from hemorrhagic shock. Among the remaining 9 patients with higher TRISS values, 5 (26.3%) who died had the mean TRISS of 80.5±15.8%, comparable to the mean TRISS of 83.3±2.4% in the 4 survivors.</p><p>Conclusion 1. According to foreign and domestic publications, the technology of resuscitation endovascular balloon occlusion of the aorta (REBOA) is effective for stopping internal bleeding in patients with polytrauma. 2. When analyzing our own sample of patients, it was proven that 20.6% of patients with polytrauma had indications for the use of REBOA. Most of them (78.9%) died. The main cause of death was hemorrhagic shock. 3. About a quarter of patients (26.3%) with indications for REBOA had a potentially high chance of survival. In the future, the use of this technology may reduce the number of deaths.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>политравма</kwd><kwd>REBOA</kwd><kwd>кровотечение</kwd><kwd>окклюзия аорты</kwd><kwd>реанимационная эндоваскулярная баллонная окклюзия аорты</kwd></kwd-group><kwd-group xml:lang="en"><kwd>REBOA</kwd><kwd>polytrauma</kwd><kwd>aortic occlusion</kwd><kwd>hemorrhage</kwd><kwd>bleeding</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Коробушкин Г.В., Шигеев С.В., Жуков А.И. Анализ причин смерти в выборке пациентов с политравмой в Москве. Политравма. 2020;(2):47–53. https://doi.org/10.24411/1819-1495-2020-10019</mixed-citation><mixed-citation xml:lang="en">Korobushkin GV, Shigeev SV, Zhukov AI. Analysis of Causes of Death in a Sample of Patients with Polytrauma in Moscow. Polytrauma. 2020;(2):47–53. 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