多微孔多聚糖止血粉在兔脊柱后路术中止血的实验研究

Microporous polysaccharide hemostatic powder to stop bleeding in posterior spinal surgery: An experimental study

目的多微孔多聚糖止血粉是目前常用的止血材料之一,但在脊柱后路矫形手术的研究报道较少,文中旨在探讨切口内应用多微孔多聚糖止血粉在脊柱后路术中止血的应用价值。方法将成年健康5月龄新西兰大白兔24只随机分为实验组和对照组,每组12只。通过在实验兔背部按照脊柱后路手术方法做一长约8cm腰背肌创面,进而建立脊柱后路手术兔模型,实验组术中出血创面给予喷洒多微孔多聚糖止血粉,对照组出血创面喷洒微孔多聚糖止血粉。对比2组在止血时间、体外凝血时间、术中出血量、术前与术后血常规、组织病理学结果的差异。结果实验组止血时间[(15.23±1.17)s]、凝血时间[(235.49±21.09)s]、出血量[(1.67±0.25)g]较对照组[(19.99±1.27)s、(260.74±26.92)s、(2.29±0.41)g]均明显降低(P<0.05)。实验组术后血小板较对照组明显升高[(150.24±17.82)×109/L vs(129.55±16.43)×109/L],差异有统计学意义(P<0.05)。实验组止血有效率为100%,优良率为91.67%;对照组分别为83.33%、75.00%,差异无统计学意义(P>0.05)。病理学结果显示实验组较对照组肌肉间质及血管官腔内出血较少,可见少量红细胞。结论脊柱后路手术术中局部应用多微孔多聚糖止血粉可减少出血量,并具有止血高效、快速、便捷、不影响切口愈合等优点。

Objective Microporous polysaccharide hemostatic powder（ MPPHP） is a most commonly used hemostatic material,but reports are rarely seen on its application in posterior spinal orthopedic surgery. The present paper aimed to investigate the value of MPPHP in stopping bleeding in posterior spinal surgery. Methods Twenty-four 5-month-old New Zealand rabbits were equally randomized to an experimental and a control group. An 8 cm-long wound was made in the back muscle of animals to establish the model of spinal posterior surgery. MPPHP was applied to the wound of the experimental rabbits but none to that of the controls. Comparisons were made between the two groups of animals in the bleeding time,in vitro coagulation time,intra-operative blood loss,and results of pre- and post-operative blood routine and histopathological examinations. Results Statistically significant differences were observed between the experimental and control groups in the mean bleeding time（ [15. 36 ± 1. 42]s vs [347. 58 ± 32. 43]s,P〈0. 05）,in vitro coagulation time（ [235. 41 ± 21. 08]s vs [722. 16 ± 40. 35]s,P〈0. 05）,and intra-operative blood loss（ [1. 61 ± 0. 24]g vs [2. 86 ±0. 37]g,P〈0. 05）. After operation,the experimental animals showed a significantly higher count of erythrocytes than the controls（ [5. 68 ± 0. 46] × 10^6/ L vs [4. 47 ± 0. 43] × 10^6/ L,P〈0. 05）and a higher level of hemoglobin than the latter（ [12. 67 ± 1. 18]g / L vs [10. 64 ± 1. 05]g / L,P = 0. 00）. There were no significant differences in the effectiveness and excellence rates of hemostasis between the experimental and control groups（ 100% vs 83. 33% and83. 33% vs 66. 67%,P〉0. 05）. Pathological examination revealed mild bleeding and a small number of red blood cells in the muscle interstitium and blood vessel lumen of the experimental rabbits as compared with the controls. Conclusion Intraoperative topical application of MPPHP can reduce blood loss and achieve rapid and efficient hemostasis in posterior spinal surgery without affecting wound healing.