医用型可吸收止血材料在骨科手术中止血的应用进展

Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery

目的对医用型可吸收止血材料(medical absorbable haemostatic material,MAHM)在骨科手术中止血的应用进展进行综述,以期为临床止血方案提供参考。方法广泛查阅国内外关于MAHM应用于骨科术中止血的研究文献,并对其进行归纳、总结。结果MAHM根据生物相容性可分为氧化纤维素/氧化再生纤维素类材料、壳聚糖及其衍生物类材料、淀粉类材料、胶原蛋白及明胶类材料和纤维蛋白胶类材料等,用于骨科术中止血均能有效减少失血量。每种止血材料具有不同的凝血机制和适用人群,氧化纤维素/氧化再生纤维素、壳聚糖及其衍生物、淀粉类止血材料主要通过刺激血管收缩和聚集血液细胞物理作用止血,适用于凝血功能异常人群。胶原蛋白及明胶、纤维蛋白胶类止血材料主要通过影响人体生理凝血机制止血,适用于凝血功能正常人群。结论合理选用MAHM能有效减少围术期失血量及降低术后并发症风险,但目前单一类型止血材料尚不能满足临床需求,需研发止血效率更高的复合止血材料。

Objective The application progress of medical absorbable haemostatic material(MAHM)in hemostasis during orthoapedic surgery was reviewed,in order to provide reference for clinical hemostasis program.Methods The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized.Results According to biocompatibility,MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials,chitosan and its derivatives materials,starch materials,collagen and gelatin materials,and fibrin glue materials,etc.,which can effectively reduce blood loss when used in orthopedic surgery for hemostasis.Each hemostatic material has different coagulation mechanism and suitable population.Oxidized cellulose/oxidized regenerated cellulose,chitosan and its derivatives,starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells,which is suitable for people with abnormal coagulation function.Collagen,gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding,suitable for people with normal coagulation function.Conclusion Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications,but at present,single hemostatic material can not meet clinical needs,and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.