Objective To prepare a self-made compound, hemostatic jelly with polylactic acid(PLA), which has the hemostatic and absorbable effect on injured cancellous bone. Methods Two bone defects of 5 mm in diameter and 4 mm in depth were subjected on 20 health rabbits by drilling through their either outside plate of the iliac, and were filled with hemostatic jelly(group A), bone wax(group B) and blank(group C) respectively. Hemostasis were observed and recorded after 1 and 10 minutes. Five specimens were harvested at 2, 4, 8 and 12 weeks postoperatively for histological observation. Results ① Hemostatic effect: Bleeding of injured spongy bone stopped within 10 minutes after the treatment of hemostatic jelly and bone wax, but bleeding of balnk did not stop. Hemostatic jelly and bone wax adhered to bone defects firmly within 10 minutes was after the treatment. ② Absorbable effect: Hemostatic jelly and bone defects have not changed visibly in the first 2 weeks. With histological observation 4 to 8 weeks after the operation, hemastatic jelly was absorbed gradually and replaced by osteogenous tissue. It was absorbed completely after 8 to 12 weeks. Bone wax was not absorbed after 12 weeks, no new bone tissue was observed at bone wax area. The blank was replaced by connective tissue and osteogenous tissue partially after 12 weeks. Conclusion The compound hemostatic jelly manifests both hemostatic and absorbable effects on injured cancellous bone and may substitute for bone wax in clinical application.
Objective To explore a way to make a new kind of chitosan-basedmicrosphere (MS), which can be used as a novel biodegradable haemostatic powder, and to confirm its haemostatic efficiency. MethodsChitosan(CTS), a haemostatic polysaccharide, was selected as a main material for the haemostatic powder; alginate (ALG), another haemostatic polysaccharide that has been found to be effective in promoting haemostasis in surgical procedures, was selected to be thecostar. The emulsification and the cross-link were chosen as a preparation process based on the interaction between the polysaccharides. The diameter of the prepared MS was determined by SPOS, and the surface of MS was observed under SEM. The swelling characteristics of MS in the simulative wound efflusion were investigated. In a splenic bleeding model in 6 rabbits, MS and Yunnanbaiyao were randomly used as a haemostatic agent, and the corresponding bleeding time was recorded. Results The MS prepared in the above-mentioned process was well proportioned and was similarly shaped. It became a kind of white powder after dehydration, and had a coralloid surface under SEM. The diameter of the MS was 4.05±2.55 μm, which was determined by SPOS. The swelling ratio of the MS was 280.139% within 5 min. The bleeding time was significantly decreased in the MStreated group (2.83±0.17 min) when compared with that in the control group (5.33±0.49 min)(P＜0.01). Conclusion The CTS/ALG-MS, which is made from haemostatic biomaterials (CTS, ALG) by emulsification and the cross-link processes, can be provided with favorable haemostatic efficiency. It can be used as a novel haemostaticpowder.However, its biodegrading rate and mode still remain to be further studied.
ObjectiveTo review trauma-induced coagulopathy and use of tranexamic acid in patients with traumatic hemorrhage. MethodsThe relevant literatures about the definition and pathogenesis of trauma-induced coagulopathy, and the use of tranexamic acid in patients with traumatic hemorrhage were reviewed. ResultsTraumatic-induced coagulopathy was a coagulation disorder in the early stage after injury, which was associated with the anticoagu-lation and increasing activity of fibrinolysis. Tranexamic acid as an anti-fibrinolytic drug, it had a good result in clinical application, which could reduce the mortality due to bleeding in use within 3 h after injury, the effect was the best in use within 1 h after injury, but it had no benefit or even would increase the mortality due to hemorrhage in use >3 h after injury. There was no standardized dosage of tranexamic acid, but the volumes of blood loss and blood transfusion had no difference under the different dosages. However, high dosage or long-term use of tranexamic acid might increase the risk of the thrombosis or epilepsy. ConclusionEmergency traumatic patients face a series of death threats related trauma. Appropriate and timely hemostasis is important for prognosis. Early, short-term, and appropriate dosage of tranexamic acid could obviously reduce mortality and adverse events, but its timing and dosages need to be further optimized.
目的 探讨微波固化在腹膜后肿瘤手术中止血的可行性。方法 对我院2008年7月至2009年8月期间收治的9例腹膜后肿瘤患者手术中应用微波固化止血。手术暴露瘤体后，应用微波治疗仪多点固化瘤体。手术切除肿瘤，不能完整切除者则再次应用微波治疗仪固化瘤床创面，尽量灭活残余肿瘤。结果 9例患者肿瘤切除后创面几乎无渗血，术中失血量（275.56±81.26） ml，手术时间（150.56±36.18） min，住院时间（14.67±2.30） d，无术后并发症发生。术后随访（10±3.97)个月，9例患者均未见复发。结论 腹膜后肿瘤手术过程中应用微波固化止血效果良好。
Objective To improve the flexibil ity and hemostatic properties of chitosan (CS)/carboxymethyl chitosan (CMCS) hemostatic membrane by using glycerol and etamsylate to modify CS/CMCS hemostatic membrane. To investigate themechanical properties and hemostatic capabil ity of modified CS/CMCS hemostatic membrane. Methods The 2% CS solution, 2% CMCS solution, 10%, 15%, 20%, 25%, 30% glycerol with or without 0.5% etamsylate were used to prepare CS/CMCS hemostatic membrane with or without etamsylate by solution casting according to ratio of 16 ∶ 4 ∶ 5. The tensile properties were evaluated by tensile test according to GB 13022-1991. Twenty venous incisions and five arterial incisions hemorrhage of 1 cm × 1 cm in rabbit ears were treated by CS/CMCS hemostatic membrane modified by 15% (group A) and 25% (group B) of glycerol, and a combination of them and 0.5% etamsylate (groups C and D). The bleeding time and blood loss were recorded. Results The pH of yellow CS/ CMCS hemostatic membrane with thickness of 30-50 μm was 3-4. The incorporation glycerol into CS/CMCS hemostatic membrane resulted in decreasing in tensile strength (7.6%-60.2%) and modulus (97%-99%). However, elongation at break and water content increased 5.7-11.6 times and 13%-125% markedly. CS/CMCS hemostatic membrane adhered to wound rapidly, absorbed water from blood and became curly. The bleeding time and blood loss of venous incisions were (70 ± 3) seconds and (117.2 ± 10.8) mg, (120 ± 10) seconds and (121.2 ± 8.3) mg, (52 ± 4) seconds and (98.8 ± 5.5) mg, and (63 ± 3) seconds and (90.3 ± 7.1) mg in groups A, B, C, and D, respectively; showing significant differences (P lt; 0.05) between groups A, B and groups C, D. The bleeding time and blood loss of arterial incision were (123 ± 10) seconds and (453.3 ± 30.0) mg in group C. Conclusion CS/CMCS hemostatic membrane modified by glycerol and etamsylate can improve the flexibil ity, and shorten the bleeding time.
OBJECTIVE: To validate the hemostatic properties of collagen sponge made in China. METHODS: The experimental model of superficial cut of liver was established in 20 Sprague-Dawley adult rats, which were divided into two groups randomly. Collagen sponge or gelatin sponge was used to cover the cut respectively. Hemostatic result was observed. Afterwards, standard liver trauma model by resection left front liver lobe was made, wound was treated with collagen sponge or gelatin sponge respectively. Hemostatic result was observed. Concurrent hemostatic time and bleeding amount were noted. At 7, 14 and 20 days after operation, intra-abdominal adhension, infection and healing state of liver were observed by exploratory laparotomy. The histological changes of regenerate liver tissue were observed by microscopy. RESULTS: Collagen sponge adhered to wound well. Concurrent hemostatic time and bleeding amount in collagen sponge group were superior to those of gelatin sponge (P lt; 0.05). The histological examination showed that collagen sponge was absorbed and degraded rapidly, regenerative hepatocytes could be induced. CONCLUSION: Collagen sponge has fine hemostatic properties and can induce regeneration of hepatocytes effectively. It is worth popularizing for its convenience in clinical application and its properties of rapid degradation and absorption.
Objective To investigate the hemostasis of thermosensitive chitosan hemostatic film. Methods Fifty adult Sprague Dawley rats, male or female and weighing 190-210 g, were made the models of liver injury. The models were randomly divided into 5 groups (n=10) depending on different hemostatic materials. The incision of the liver was covered with the hemostatic materials of 2.0 cm × 1.0 cm × 0.5 cm in size: thermosensitive chitosan hemostatic film (group A), chitosan hemostatic film (group B), cellulose hemostatic cotton (group C), gelatin sponge (group D), and no treatment (group E), respectively. The bleeding time and bleeding amount were recorded. After 4 weeks, the incisions of the liver were observed with HE staining. Results Gross observation showed better hemostatic effect and faster hemostatic time in groups A, B, and C; group D had weaker hemostatic effect and slower hemostatic time; group E had no hemostatic effect. The bleeding time and bleeding amount of groups A, B, C, and D were significantly lower than those of group E (P lt; 0.05). The bleeding time and bleeding amount of groups A, B, and C were significantly lower than those of group D (P lt; 0.05), but no significant difference was found among groups A, B, and C (P gt; 0.05). The liver cells of group A had milder edema and ballooning degeneration than other 4 groups through histological observation. Conclusion The thermosensitive chitosan hemostatic film has good hemostasis effect on the liver incision of rats.