临时止血装置在猪闭合性致死性肝损伤模型中的止血效果
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摘要
目的:研发以"Celox"和"自膨海绵"联合控制闭合性腹腔出血的一种临时止血装置,并在猪闭合性致死性肝损伤模型上评价其止血效果。方法:建立猪闭合性致死性肝损伤模型,并于肝损伤5 min后进行实验干预,将动物随机分为空白对照组(A)、纱布填塞组(B)、止血装置组(C),每组均为4只;监测各组存活时间、失血量、生命指标、血液指标,并对其行CT检查及死亡后组织学检查。结果:C组存活时间明显长于A组(81±12 min vs 44±14 min,P <0.05),平均出血量与A、B组比较差异无统计学意义(P> 0.05),且B组和C组在损伤30 min后凝血系统功能更亢进,C组死亡后组织学检查未见明显其它脏器继发损伤。结论:该临时止血装置可延长动物猪闭合性肝损伤大出血的死亡时间,保持一定程度的生命体征平稳,且未见明显其它继发损伤。
Objective: To develop the temporary hemostatic device with the combination of"Celox"and"self-expanding sponge"for the control of closed abdominal hemorrhage, and to investigate its hemostatic effect onthe swine model of closed fatal liver injury.Methods:The swine model of closed fatal liver injury was established,and intervention was performed at 5 minutes after injury. The animals were randomly divided into group A(blankcontrol), group B(gauze pack), and group C(hemostatic device), with 4 pigs in each group. Survival time, blood loss,vital indexes, and blood parameters were monitored for all groups, and CT and histological examination after deathwere performed. Results: Group C had a significantly longer survival time than group A(81±12 minutes vs 44 ± 14 minutes, P < 0.05). There was no significant difference in average blood loss between groups A and B(P > 0.05).Groups B and C had coagulation hyperfunction at 30 minutes after injury. Histological examination after deathshowed no obvious secondary injuries in other visceral organs. Conclusion: In the swine model of closed fatal liverinjury and massive hemorrhage, this temporary hemostatic device can prolong survival time and stabilize vital signs,with no obvious secondary injuries.
Objective: To develop the temporary hemostatic device with the combination of"Celox"and"self-expanding sponge"for the control of closed abdominal hemorrhage, and to investigate its hemostatic effect onthe swine model of closed fatal liver injury.Methods:The swine model of closed fatal liver injury was established,and intervention was performed at 5 minutes after injury. The animals were randomly divided into group A(blankcontrol), group B(gauze pack), and group C(hemostatic device), with 4 pigs in each group. Survival time, blood loss,vital indexes, and blood parameters were monitored for all groups, and CT and histological examination after deathwere performed. Results: Group C had a significantly longer survival time than group A(81±12 minutes vs 44 ± 14 minutes, P < 0.05). There was no significant difference in average blood loss between groups A and B(P > 0.05).Groups B and C had coagulation hyperfunction at 30 minutes after injury. Histological examination after deathshowed no obvious secondary injuries in other visceral organs. Conclusion: In the swine model of closed fatal liverinjury and massive hemorrhage, this temporary hemostatic device can prolong survival time and stabilize vital signs,with no obvious secondary injuries.
引文
1. Hoencamp R, Vermetten E, Tan EC, et al. Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan[J]. Injury, 2014, 45(7):1 028-1 034.
2 . Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield(2001-2011):implications for the future of combat casualty care[J]. J Trauma Acute Care Surg, 2012,73 (6 Suppl 5):431-437.
3 . Kelly JF, Ritenour AE, Mclaughlin DF, et al. Injury severity and causes of death from operation Iraqi freedom and operation enduring freedom:2003-2004 versus 2006[J]. Journal of Trauma-Injury Infection and Critical Care,2008, 64(2):21-26.
4 . Astbury A, Hussain M, Kemp MR, et al. Died of wounds on the battlefield:causation and implications for improving combat casualty care[J]. Journal of Trauma, 2011, 71(1Suppl):4-8.
5 . Kisat M, Morrison JJ, Hashmi ZG, et al. Epidemiology and outcomes of non-compressible torso hemorrhage[J]. J Surg Res, 2013, 184(1):414-421.
6 . Stannard A, Brown K, Benson C, et al. Outcome after vascular trauma in a deployed military trauma system[J].Br J Surg, 2011, 98(2):228-234.
7 . Clarke JR, Trooskin SZ, Doshi PJ, et al. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes[J]. J Trauma,2002, 52(3):420-425.
8 . Duggan MJ, Mejaddam AY, Beagle J, et al. Development of a lethal, closed-abdomen grade V hepato-portal injury model in non-coagulopathic swine[J]. J Surg Res, 2013,182(1):101-107.
9 . Bennett BL, Littlejohn LF, Kheirabadi BS, et al. Management of external hemorrhage in tactical combat casualty care:chitosan-based hemostatic gauze dressings--TCCC guidelines-change 13-05[J]. J Spec Oper Med, 2014, 14(3):40-57.
10 . Kragh JF, Parsons DL, Kotwal RS, et al. Testing of junctional tourniquets by military medics to control simulated groin hemorrhage[J]. J Spec Oper Med, 2014, 14(3):58-63.
11 . Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in operation Iraqi freedom:effect on hemorrhage control and outcomes[J]. J Trauma, 2008, 64(2 Suppl):28-37.
12 . Ribeiro Junior MAF, Feng CYD, Nguyen ATM, et al.The complications associated with resuscitative endovascular balloon occlusion of the aorta(REBOA)[J]. World J Emerg Surg, 2018, 13(1):20.
13 . Morrison JJ, Morrison JJ, Galgon RE, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock[J]. J Trauma Acute Care Surg, 2016, 80(2):324-334.
14 . Barnard EB, Morrison JJ, Lendrum R, et al. Resuscitative endovascular balloon occlusion of the aorta(REBOA):a population based gap analysis of trauma patients in England and Wales[J]. Emergency Medicine Journal, 2015, 32(12):926-932.
15 . Burg BD, Dongen TV, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination[J]. European Journal of Trauma b Emergency Surgery, 2018(6 Suppl 5):1-16.
16 . Duggan M, Rago A, Sharma U, et al. Self-expanding polyurethane polymer improves survival in a model of noncompressible massive abdominal hemorrhage[J]. Journal of Trauma and Acute Care Surgery, 2013, 74(6):1462-1 467.
17 . Peev MP, Rago A, Hwabejire JO, et al. Self-expanding foam for prehospital treatment of severe intra-abdominal hemorrhage:dose finding study[J]. J Trauma Acute Care Surg, 2014, 76(3):619-623.
18 . Rago A, Duggan MJ, Marini J, et al. Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury[J]. J Trauma Acute Care Surg, 2014, 77(1):73-77.
19 . Rago AP, Duggan MJ, Beagle J, et al. Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage:28-day survival and safety[J]. Journal of Trauma and Acute Care Surgery, 2014, 77(2):127-133.
20 . Rago AP, Duggan MJ, Hannett P, et al. Chronic safety assessment of hemostatic self-expanding foam:90-day survival study and intramuscular biocompatibility[J]. J Trauma Acute Care Surg, 2015, 79(4 Suppl 2):78-84.
21 . Rago AP, Marini J, Duggan MJ, et al. Diagnosis and deployment of a self-expanding foam for abdominal exsanguination:translational questions for human use[J]. J Trauma Acute Care Surg, 2015, 78(3):607-613.
22 . Mesar T, Martin D, Lawless R, et al. Human dose confirmation for self-expanding intra-abdominal foam:a translational, adaptive, multicenter trial in recently deceased human subjects[J]. J Trauma Acute Care Surg, 2015, 79(1):39-46.
2 . Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield(2001-2011):implications for the future of combat casualty care[J]. J Trauma Acute Care Surg, 2012,73 (6 Suppl 5):431-437.
3 . Kelly JF, Ritenour AE, Mclaughlin DF, et al. Injury severity and causes of death from operation Iraqi freedom and operation enduring freedom:2003-2004 versus 2006[J]. Journal of Trauma-Injury Infection and Critical Care,2008, 64(2):21-26.
4 . Astbury A, Hussain M, Kemp MR, et al. Died of wounds on the battlefield:causation and implications for improving combat casualty care[J]. Journal of Trauma, 2011, 71(1Suppl):4-8.
5 . Kisat M, Morrison JJ, Hashmi ZG, et al. Epidemiology and outcomes of non-compressible torso hemorrhage[J]. J Surg Res, 2013, 184(1):414-421.
6 . Stannard A, Brown K, Benson C, et al. Outcome after vascular trauma in a deployed military trauma system[J].Br J Surg, 2011, 98(2):228-234.
7 . Clarke JR, Trooskin SZ, Doshi PJ, et al. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes[J]. J Trauma,2002, 52(3):420-425.
8 . Duggan MJ, Mejaddam AY, Beagle J, et al. Development of a lethal, closed-abdomen grade V hepato-portal injury model in non-coagulopathic swine[J]. J Surg Res, 2013,182(1):101-107.
9 . Bennett BL, Littlejohn LF, Kheirabadi BS, et al. Management of external hemorrhage in tactical combat casualty care:chitosan-based hemostatic gauze dressings--TCCC guidelines-change 13-05[J]. J Spec Oper Med, 2014, 14(3):40-57.
10 . Kragh JF, Parsons DL, Kotwal RS, et al. Testing of junctional tourniquets by military medics to control simulated groin hemorrhage[J]. J Spec Oper Med, 2014, 14(3):58-63.
11 . Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in operation Iraqi freedom:effect on hemorrhage control and outcomes[J]. J Trauma, 2008, 64(2 Suppl):28-37.
12 . Ribeiro Junior MAF, Feng CYD, Nguyen ATM, et al.The complications associated with resuscitative endovascular balloon occlusion of the aorta(REBOA)[J]. World J Emerg Surg, 2018, 13(1):20.
13 . Morrison JJ, Morrison JJ, Galgon RE, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock[J]. J Trauma Acute Care Surg, 2016, 80(2):324-334.
14 . Barnard EB, Morrison JJ, Lendrum R, et al. Resuscitative endovascular balloon occlusion of the aorta(REBOA):a population based gap analysis of trauma patients in England and Wales[J]. Emergency Medicine Journal, 2015, 32(12):926-932.
15 . Burg BD, Dongen TV, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination[J]. European Journal of Trauma b Emergency Surgery, 2018(6 Suppl 5):1-16.
16 . Duggan M, Rago A, Sharma U, et al. Self-expanding polyurethane polymer improves survival in a model of noncompressible massive abdominal hemorrhage[J]. Journal of Trauma and Acute Care Surgery, 2013, 74(6):1462-1 467.
17 . Peev MP, Rago A, Hwabejire JO, et al. Self-expanding foam for prehospital treatment of severe intra-abdominal hemorrhage:dose finding study[J]. J Trauma Acute Care Surg, 2014, 76(3):619-623.
18 . Rago A, Duggan MJ, Marini J, et al. Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury[J]. J Trauma Acute Care Surg, 2014, 77(1):73-77.
19 . Rago AP, Duggan MJ, Beagle J, et al. Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage:28-day survival and safety[J]. Journal of Trauma and Acute Care Surgery, 2014, 77(2):127-133.
20 . Rago AP, Duggan MJ, Hannett P, et al. Chronic safety assessment of hemostatic self-expanding foam:90-day survival study and intramuscular biocompatibility[J]. J Trauma Acute Care Surg, 2015, 79(4 Suppl 2):78-84.
21 . Rago AP, Marini J, Duggan MJ, et al. Diagnosis and deployment of a self-expanding foam for abdominal exsanguination:translational questions for human use[J]. J Trauma Acute Care Surg, 2015, 78(3):607-613.
22 . Mesar T, Martin D, Lawless R, et al. Human dose confirmation for self-expanding intra-abdominal foam:a translational, adaptive, multicenter trial in recently deceased human subjects[J]. J Trauma Acute Care Surg, 2015, 79(1):39-46.