明胶白眉蛇毒凝血酶颗粒在严重肝、脾外伤猪模型上的止血作用

Application of tissue adhesive in the liver and spleen rupture pig

目的评估严重肝、脾外伤导致出血性休克和凝血功能障碍下使用明胶白眉蛇毒凝血酶颗粒(FloSeal)的止血效果。方法研究对象是10只穿透性肝和脾破裂的猪,在接受麻醉及全身性肝素化后出现出血性休克。开腹止血时使用FloSeal对破裂的肝脏和脾脏进行止血。定量检测失血量,止血效果,以及48h的存活率,检测心、肺参数,活化凝血时间以及血浆纤维蛋白原水平变化。在术后1h和48h进行评估,检测术后出血及破裂组织的形态变化。结果使用FloSeal能使所有猪成功止血。FloSeal的平均用量为(14.0±2.5)mL。48h后组织学表现提示血块整合到组织周围,同时不会引起不良反应。结论在出血性休克,回输条件和凝血功能障碍时使用FloSeal是一种有效治疗严重穿透性肝和脾破裂大出血的方法。

Objective To test the hemostatic efficacy of gelatin throm- bin granules（FloSeal） in a standardized severe traumatic liver and spleen rupture model in swine（representing a grade IV - V rupture） during severe hemorrhagic shock and coagulation dis- order. Methods Standardized combined penetrating liver and spleen rupture was inflicted in 10 anesthetized swine. Hemorrhagic shock was induced after heparinization. Gelatin thrombin granules were used to treat both the ruptured liver and the ruptured spleen. Blood loss, hemostasis, and 48 h survival rate were quantified. Cardiorespiratory parameters, activated clotting time, and plas- ma fibrinogen level were monitored. After 1 h and 48 h a second look evaluation was performed to detect any postoperative hemor- rhage. Results Ruptures were then examined macroscopically and histologically. Results： Hemostasis was achieved with FloSeal in all swine. The mean amount of FloSeal used was（14.0±2.5）mL. Macroscopic and histologic findings after 48 h showed excellent clot integration into the surrounding tissue without any adverse effects. Conclusion Gelatin thrombin granules （FloSeal） are effective in treating severe penetrating rupture of the liver and spleen even during hemorrhagic shock, retransfusion conditions, and coagulation disorder.