三种止血材料止血活性的体外实验研究

In vitro experimental study of hemostatic activity of three types of hemostatic agents

目的 比较明胶纤维网 (gelatinfleece ,GF)、氧化纤维素 (oxidizedcellulose ,OC)和明胶海绵 (gelfoam ,GL)的止血效果 ,探讨GF的止血机制。 方法 使 3种止血材料分别与富血小板血浆 (PRP)接触 0 .5 ,1,1.5 ,2 ,2 .5min ,然后通过灌注黏附实验及血小板聚集实验检测血小板黏附率及聚集率 ;使 3种止血材料分别与PRP接触 1,5min ,然后用酶联免疫吸附法检测血小板颗粒膜糖蛋白 - 140 (GMP - 140 )释放的改变 ;用扫描电镜观察 3种止血材料的结构和血小板黏附激活的形态。 结果 PRP与GF接触后血小板的黏附率及聚集率较与OC和GL接触后高 (P <0 .0 5 )。 3种止血材料均能促进血小板释放GMP - 140 ,与未加止血材料时比较 ,差异均有非常显著性意义 (P<0 .0 1) ,其中GF促进血小板释放GMP - 140的能力大于OC和GL(P <0 .0 1)。扫描电镜显示 ,GF呈网络致密状结构 ,而OC和GL的结构间均有较大网眼 ;GF间黏附有较多激活的血小板 ,有伪足形成 ,而GL仅黏附有少量激活的血小板。 结论 GF的止血效果优于OC和GL ,它主要是通过促进血小板黏附、聚集 ,并使激活的血小板释放促凝物来加快血液凝固。

Objective To study hemostatic mechanism of topical hemostatic agents: gelatin fleece (GF), oxidized cellulose (OC) and gelfoam (GL) in vitro tests, and to compare the hemostatic effect of 3 hemostatic agents. Methods The platelet adhesion rate and aggregation rate were detected after platelet rich plasma contacted with 3 types of hemostatic agents for 0.5, 1, 1.5, 2 and 2.5 minutes respectively through experiment of platelet deposition with perfusion and aggregation. ELISA was used to determine the changes of GMP 140 released from platelet after 3 types of hemostatic agents contacted with PRP for 1, 5 minutes respectively. The structure of the hemostatic materials and morphology of activated platelet were observed by scanning electron microscope (SEM). Results Platelet adhesion rate and aggregation rate of GF were significantly higher than that of OC and GL ( P < 0.05 ). Each agent induced significant increase of GMP 140 secretion compared with pro reaction ( P < 0.01 ), while GF was the most obvious one. There was significant variation between GF with OC and GL ( P < 0.01 ). SEM showed that GF was denser compared with OC and GL which had bigger mesh in structure. There was adhesion of activated platelet in GF with pseudopod. There was adhesion of a small number of activated platelet in GL. Conclusions GF has better hemostatic effect than OC and GL mainly by causing platelet adhesion and aggregation and hence inducing activated platelets to release coagulants for a quicker blood coagulation.