自膨式聚氨酯泡沫在致命性出血模型中的应用

Application of self-expanding polyurethane foam in the model of fatal hemorrhage

目的在致死性肝创伤大出血动物模型中评价自膨式聚氨酯泡沫(self-expanding polyurethane polymer,SPUP)的止血效果。方法建立猪致死性肝创伤大出血模型,进行损伤控制性液体复苏,致伤后30 min将实验动物随机(随机数字法)分为纱布填塞组(gauze packing group,GP),泡沫材料填塞组(foam packing group,FP)和对照组(blank control group,BC),每组各6只。监测48 h记录生存时间、生命体征、失血量、凝血功能及血液指标,并于死亡或处死后行肝创面组织病理学检查。结果建模后三组动物均出现严重的失血性休克,其中FP组、GP组48 h生存率显著高于BC组(6/6vs 4/6vs 0/6)。FP组生存时间与GP组差异无统计学意义[48 hvs(44.58±5.53)h,P>0.05],与BC组相比显著延长[48 hvs(1.64±0.17)h,P<0.01]。FP组出血量明显少于GP组和BC组[(19.2±7.3)g/kgvs(41.3±8.6)g/kg、(51.5±7.3)g/kg,均P<0.01]。与GP组和BC组相比,FP组的心输出量有明显改善[(5.0±0.53)L/minvs(4.13±0.41)L/min、(2.38±0.48)L/min,均P<0.05]。FP组与GP组凝血功能、肝肾功能及血乳酸水平均好于BC组;FP组膀胱压明显高于GP组[(18.83±3.25)cmH2Ovs(3.83±1.47)cmH2O,P<0.05,1 cmH2O=0.098 kPa],BC组未见膀胱压异常增高。FP组组织病理学未见明显继发性损伤。结论应用SPUP行腹腔填塞止血可以有效减少致死性肝创伤大出血模型的出血量,有效维持生命体征,提高短期生存率。

Objective To evaluate the hemostatic effect of self-expanding polyurethane foam in an animal model of fatal hepatic trauma and hemorrhage.Methods The fatal liver trauma hemorrhage model with swine was established.Then the damage-controlled resuscitation was performed.Thirty minutes after injury,the experimental animals were randomly divided into the gauze packing group(GP),foam packing group(FP)and blank control group(BC).The survival time,vital signs,the bleeding volume,coagulation function and other lab indicators were recorded for 48 h.Liver histopathological examination was performed after death or execution.Results All the three groups had severe hemorrhagic shock after modeling.The 48-h survival rate of the FP group and the GP group was significantly higher than that of the BC group(6/6 vs 4/6 vs 0/6).The average survival time of the FP group was not statistically different from that of the GP group[48 h vs(44.58±5.53)h,P>0.05],and was significantly longer than that of the BC group[48 h vs(1.64±0.17)h,P<0.01].The bleeding volume of the FP group was significantly less than the GP group and BC group[(19.2±7.3)g/kg vs(41.3±8.6)g/kg,(51.5±7.3)g/kg,both P<0.01].Compared with the GP group and the BC group,the cardiac output of the FP group was significantly improved[(5.00±0.53)L/min vs(4.13±0.41)L/min,(2.38±0.48)L/min,both P<0.05].The coagulation function,liver and kidney function and blood lactate level of the FP group and the GP group were better than those of the BC group;the intra-abdominal pressure of the FP group was significantly higher than that in the GP group[(18.83±3.25)cmH2O vs(3.83±1.47)cmH2O,P<0.05].There was no abnormal increased in intraabdominal pressure in the BC group.According to the histopathology examination,there was no obvious secondary damage in the FP group.Conclusions The application of self-expanding polyurethane foam for intraperitoneal packing to stop bleeding can effectively reduce the amount of bleeding in the fatal liver trauma hemorrhage model,effectively maintain vital signs,and improve the short-term survival rate.