主動脈復甦性血管球囊閉合術的應用與護理

Resuscitative Endovascular Balloon Occlusion of the Aorta: Implementation and Nursing Care

創傷性損傷主要死因來自於無法控制的出血性休克，主動脈復甦性血管球囊閉合術（resuscitative endovascular balloon occlusion of the aorta, REBOA）是一項能快速執行且侵入性較小的止血技術，依據出血的位置在主動脈放置球囊，以達止血效果。放置REBOA前先評估病人置放適應症，包括創傷後導致的胸、腹、骨盆腔出血的病人，以及產後大出血的非創傷病人都可使用；依據出血部位選擇5–8 French不等大小的鞘管，此管路置放過程可能發生主動脈剝離、破裂或穿孔的血管損傷等併發症，照護措施應隨時監測血液動力學之改變；放置REBOA後應追蹤血流閉合後的缺血併發症，如下肢缺血、急性腎衰竭等；球囊移除後則可能出現再灌流傷害，多重器官衰竭，應密切觀察。在照護接受REBOA術的病人，醫師應先向家屬解釋取得同意，護理師備妥相關用物，放置過程中密切監測低血壓、心律不整及意識改變等危及生命徵象之變化，放置後須詳細評估與記錄神經血管、以及疼痛（pain）、蒼白（pallor）、感覺異常（paresthesia）、無脈搏（pulselessness）、麻痺癱瘓（paralysis）之5P評估末梢肢體等狀況。此項處置未來仍需要更多研究投入，追蹤長期的影響，以提升此類病人的照護品質。

Uncontrolled hemorrhagic shock is the main cause of death in patients with traumatic injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly performed and less-invasive treatment to stop bleeding. The REBOA balloon may be placed at the location of bleeding to achieve hemostasis. Prior to balloon placement, the indications for placement must be evaluated, including non-thoracic aortic trauma and non-traumatic patients with postpartum hemorrhage, and the appropriate sheath size (from 5 to 8 French) must be selected based on the bleeding site. As vascular injury of aortic dissection, rupture, or perforation may occur during the procedure, changes in hemodynamic parameters should be monitored. After balloon placement, ischemic complications due to blood flow occlusion such as lower extremity ischemia and acute renal failure should be tracked. After balloon removal, reperfusion injuries may occur, which can result in multiple organ failure, and should be observed closely. When caring for patients receiving REBOA, physicians should explain the procedure to their families to obtain informed consent. Also, nurses should prepare supplies and closely monitor changes in critical life signs to minimize the risks of hypotension, arrhythmia, and changes in consciousness during the procedure. After placement, the neurovascular and peripheral limbs“5P”(pain, pallor, paresthesia, pulselessness and paralysis) condition should be evaluated and recorded in detail. This treatment approach requires further study and research to assess the long-term impacts of placement and improve quality of care in these patients.