自制可注射性明胶基止血剂治疗实验犬肝创伤的有效性

Efficacy of Homemade Hemostatics of Injected Gelatin Matrix for Immediately Treating Blunt Hepatic Trauma in Canine Model without Additional Pressure

目的探讨自制可注射性明胶基止血剂(HIGM)即刻治疗实验犬肝创伤的有效性。方法将27只杂种犬经戊巴比妥钠全身麻醉后开腹暴露肝脏,制作肝创伤模型,然后随机分为治疗组、阳性对照组和阴性对照组3组,每组9只。治疗组病灶处直接注射自制止血剂,阳性对照组病灶处直接注射凝血酶溶液,而阴性对照组病灶处直接注射0.9%生理盐水。记录10 min止血时间及30 min腹腔内总出血量,并在创伤前,创伤后治疗前、后30 min比较平均动脉血压、心率及血常规,并观察治疗后30 min出血情况。结果治疗组止血时间[(1.20±0.33)min]与出血量[(47.22±8.61)ml]均明显少于阳性对照组与阴性对照组(P均<0.05)。治疗后30 min,3组间心率(P=0.026)与平均动脉压(P=0.013)差异均有统计学意义,且治疗组心率与平均动脉压均接近创伤前(P>0.05)。治疗后30 min,肉眼观察治疗组无1例再出血,创伤区HIGM形成的血凝块填充完好,无局部炎症、感染和黏连形成;阳性对照组发现2例(22.22%)再出血;阴性对照组所有动物仍可见出血。结论在无需按压的情况下,HIGM可以有效控制犬肝创伤出血,对野战外科具有潜在的应用价值。

Objective To explore the efficacy of homemade hemostatics of injected gelatin matrix （HIGM） for immediately treating blunt hepatic trauma in canine model without additional pressure. Methods A total of 27 commercial hybrid dogs underwent celiotomy to establish hepatic trauma model after general an- esthesia. The dogs were prospectively randomized into 3 groups ： the treatment group （ n = 9, with the direct ap- plication of homemade hemostat） , the positive control group （ n = 9, with thrombin solution） , and the negative control group （ n = 9, with 0.9% normal saline）. Time to hemostasis and intra-abdominal blood loss were re- corded, and heart rate （HR） , mean arterial pressure （MAP） , and hematological parameters were compared a- mong these three groups. Gross examinations were performed 30 minutes after surgery. Results Significantlyshorter time to hemostasis [ （1.20 ±0.33） mini and less blood loss [ （47.22 ±8.61） ml] were observed in the treatment group than in control groups （ P 〈 0.05 ）. HR and MAP among 3 groups were significantly dif- ferent 30 min after injection （ P 〈 0.05 ） , and HR and MAP in HIGM group were close to the state of pre-trau- ma （ P 〉 0.05 ）. No cases of bleeding occurred in any animals in the treatment group, and no signs of infection and adhesion formation were evident due to exposure to HIGM. Two cases in the positive control group （22.22%） were found to have rebleeding. All animals in the negative control group experienced visible bleed- ing. Conclusion HIGM is effective for controlling bleeding after hepatic trauma without the additional com- pression, and therefore may be valuable in field surgery.