| 摘要: |
| 目的 探讨膨胀止血材料在战创伤急救中的应用价值。方法 体外物理性能评价中，将聚乙烯醇（PVA）和聚醚酯-氨基甲酸乙酯（PEEC）分别置于生理盐水、抗凝兔血及生理盐水与抗凝兔血1 ∶ 1混合液中，记录2种膨胀止血材料的体积、重量变化及体积压缩一半时所需压强。体内止血性能评价中，构建大鼠股动静脉损伤出血模型和兔肝损伤出血模型，观察无菌纱布、PVA和PEEC 3种止血材料对股动静脉损伤出血和肝损伤出血的止血效果,观察记录术后1 h和术后24 h总出血量、取出止血材料后1 min出血量、取出止血材料时粘连程度和难易程度。结果 在3种模拟体液中PVA的体积变化系数、体积变化速率均大于PEEC，重量变化系数小于PEEC（P均＜0.01），在生理盐水和抗凝兔血中PVA体积压缩一半所需的压强小于PEEC体积压缩一半所需的压强（P均＜0.05）。术后1 h，2个动物模型实验中取出PVA时的粘连程度和取出难易程度均优于无菌纱布和PEEC,取出止血材料后1 min内仅无菌纱布组动物见少量出血，PVA组、PEEC组动物均未见活动性出血。在股动静脉损伤出血模型中PVA组的术后1 h总出血量低于PEEC组（P＜0.01），在肝损伤出血模型中术后1 h总出血量PVA组高于PEEC组（P＜0.01）。术后24 h，2个动物模型实验中取出PVA时的粘连程度和取出难易程度均优于无菌纱布，PEEC大部分被降解，无法取出,取出止血材料后1 min内，无菌纱布、PVA、PEEC组动物均未见活动性出血。在股动静脉损伤出血模型中无菌纱布组与PVA组的24 h总出血量差异无统计学意义（P＞0.05），在肝损伤出血模型中PVA组的24 h总出血量高于无菌组纱布组（P＜0.01），在2个动物模型中PEEC组术后24 h总出血量均见少量出血，无法计算出血量。在股动静脉损伤出血模型中，PVA组止血材料附近肌肉组织周边浸润的炎症细胞少于无菌纱布组和PEEC组。结论 PVA和PEEC均可通过吸收包括血液在内的体液使自身体积膨大控制股动静脉损伤出血和肝损伤出血，为战创伤救治新装备的研发提供了新的选择。 |
| 关键词: 战创伤 肝损伤 股动静脉 膨胀止血材料 聚乙烯醇 聚醚酯-氨基甲酸乙酯 |
| DOI：10.16781/j.CN31-2187/R.20230166 |
| 投稿时间：2023-04-01修订日期：2023-07-10 |
| 基金项目:国家自然科学基金青年基金（82102880），上海市卫生健康委员会卫生行业临床研究专项青年项目（20214Y0499），海军军医大学（第二军医大学）第一附属医院“深蓝 123” 军事医学研究专项（2020SLZ016）． |
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| Application of swelling hemostatic materials in first aid of war trauma |
| CAO Zhi1△,LU Xin1△,YANG Yinhui1,ZHAO Lin1,LI Jinfeng2,HOU Jianguo1,CHEN Jikuai2,WANG Linhui1* |
(1. Department of Urology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai, 200433, China;
2. Department of Health Toxicology, Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the application value of swelling hemostatic materials in the first aid of war trauma. Methods Polyvinyl alcohol (PVA) and polyether ester-ethyl carbamate (PEEC) were placed in normal saline, anticoagulant rabbit blood, and 1∶1 mixture of normal saline and anticoagulant rabbit blood to evaluate their physical properties in vitro. The volume, weight changes, and pressure required for half volume compression of the 2 swelling hemostatic materials were recorded. A rat femoral arteriovenous injury model and a rabbit liver injury model were established to evaluate the hemostatic performances of PVA and PEEC in vivo. The hemostatic effects of sterile gauze, PVA, and PEEC on bleeding after femoral arteriovenous injury and liver injury were observed. The blood loss at 1 h and 24 h after operation, the blood loss at 1 min after removing the hemostatic materials, the degree of adhesion and the removal difficulty were observed and recorded. Results The volume change coefficient and volume change rate of PVA in the 3 simulated body fluids were higher than those of PEEC, while the weight change coefficient was lower than that of PEEC (all P＜0.01). In normal saline and anticoagulant rabbit blood, the pressures required for PVA to compress half of its volume were lower than that required for PEEC (both P＜0.05). One hour after surgery, the degree of adhesion and difficulty of removing PVA were better than those of sterile gauze and PEEC in the 2 animal models. One minute after removing the hemostatic materials, only the sterile gauze group showed a small amount of bleeding, while no active bleeding was observed in the PVA or PEEC group. In the femoral arteriovenous injury bleeding model, the blood loss at 1 h after surgery in the PVA group was less than that in the PEEC group (P＜0.01), while in the liver injury bleeding model, the blood loss at 1 h after surgery in the PVA group was more than that in the PEEC group (P＜0.01). At 24 h after surgery, the degree of adhesion and difficulty of removing PVA were better than those of sterile gauze, while most of PEEC was degraded and could not be removed. One minute after removing the hemostatic materials, no active bleeding was observed in the sterile gauze, PVA, or PEEC group. In the femoral arteriovenous injury bleeding model, there was no significant difference in the blood loss at 24 h between the sterile gauze group and the PVA group (P＞ 0.05). In the liver injury bleeding model, the blood loss at 24 h in the PVA group was more than that in the sterile gauze group (P＜0.01). In the 2 animal models, the blood loss at 24 h in the PEEC group was small, and it could not be calculated. In the femoral arteriovenous injury bleeding model, there were fewer inflammatory cells infiltrating around the muscle tissue near the hemostatic materials in the PVA group than in the sterile gauze and PEEC groups. Conclusion Both PVA and PEEC can control bleeding after femoral arteriovenous injury or liver injury by absorbing body fluids (including blood) to enlarge their own volume, providing new choices for the research and development of new equipment for the first aid of war trauma. |
| Key words: war trauma liver injury femoral arteriovenous swelling hemostatic materials polyvinyl alcohol polyether ester-ethyl carbamate |
