胶原海绵医治体表出血创面的动物实验观察

目的 检测胶原海绵的类型及其对体表出血创面的影响；方法 利用酸碱法从牛腱提取精制可溶性胶原蛋白，冻干制成海绵状止血材料，用SDS－PAGE电泳分析胶原海绵的成分；观察用此胶原海绵治疗家兔耳部出血和体表感染创面止血情况；结果 由I型胶原蛋白组成的胶原海绵不仅止血时间短、减少出血量，而且能促进创面愈合；结论 胶原海绵可作为创面止血修复材料。     

明胶海绵在腭裂修复中的应用北大核心

背景:在腭裂修复手术中,以往多采用碘仿纱条来填塞腭裂术后两侧松驰切口及覆盖创面。临床中作者发现,采用这种方法处理的患者,术后常出现发热、食欲不振、异物感、继发性出血等并发症。为避免或减少腭裂患者术后出现以上并发症,使用明胶海绵填塞双侧松弛切口,取得了良好的临床效果。目的:对比腭裂患者修复术中创面不同处理方法对伤口愈合效果的影响。方法:根据患儿入院时间,将110例腭裂手术患儿分为2组:2013年1月至2015年12月入院腭裂患儿54例为实验组,2008年1月至2012年12月入院腭裂患儿56例为对照组。实验组采用明胶海绵填塞创面,对照组应用碘仿纱包及碘仿纱条填塞创面,评估患儿术后精神、饮食、体温、创口出血及愈合等情况。术后4周复查,测量患者松弛切口处瘢痕条索宽度。结果与结论:(1)实验组精神、饮食恢复时间和出院时间短于对照组(P<0.05);(2)实验组发热率明显低于对照组(P<0.05),且发热时间短于对照组(P<0.05);(3)实验组术后出血、恶心呕吐发生率明显低于对照组,差异有显著性意义(P<0.05);(4)术后4周,实验组患儿松弛切口处瘢痕条索宽度明显窄于对照组,差异有显著性意义(P<0.05);(5)结果表明,明胶海绵止血可靠,术后反应轻,伤口愈合快,不影响进食,具有较好的临床应用价值。     

胶原蛋白海绵对肝脏创伤止血的效果北大核心

背景:艾瑞金胶原蛋白海绵理化性能稳定,并已通过国家食品药品监督管理局的理化性能和生物相容性评价检测。目的:观察艾瑞金胶原蛋白海绵的止血效果。方法:取21只SD大鼠,建立肝脏出血创面,随机分3组干预:在实验组(n=7)肝脏创口内部植入艾瑞金胶原蛋白海绵,同时在肝脏切口表面外敷艾瑞金胶原蛋白海绵;在阳性对照组(n=7)肝脏创口内部植入医用胶原蛋白海绵,同时在肝脏切口表面外敷医用金胶原蛋白海绵;在空白对照组(n=7)肝脏切口表面外敷医用纱布,记录出血量及止血时间,干预后7,14,28 d进行肝脏创面组织学观察。结果与结论:①出血量及止血时间:3组出血量比较无差异;实验组、阳性对照组止血时间与空白对照组比较差异无显著性意义,实验组止血时间短于阳性对照组(P≤0.05);②肝脏创面组织学观察:实验组干预后7 d胶原材料被纤维结缔组织完全包裹,炎性细胞浸润以中性粒细胞为主,胶原材料开始降解,周边结缔组织内有新生毛细血管;干预后14 d,包裹胶原材料的纤维结缔组织明显增厚,中性粒细胞减少,巨噬细胞增多;干预后28 d,胶原材料完全降解,大部肝组织恢复正常,部分肝组织旁的炎性结缔组织中可看到巨噬细胞、单核细胞、成纤维细胞和毛细血管。阳性对照组情况类似于实验组。空白对照组干预后14 d创伤处结缔组织明显,肝窦含有红细胞,偶见肝组织内出血,空泡变性;干预后28 d,创口处具有较厚结缔组织,肝窦含有红细胞,被复肝星状细胞;③结果表明:艾瑞金胶原蛋白海绵对肝脏创伤止血效果明显,组织相容性好。     

新型止血材料SURGICELTM和明胶海绵在神经外科手术中的应用

背景：新型止血材料SURGICELTM在其他科室显微手术中已取得较好的临床效果,而在神经外科中尚无前瞻性随机对照的研究结果报道。 目的：比较明胶海绵和新型止血材料SURGICELTM控制神经外科术中出血及局部渗血的效果。　 方法：选择苏州市立医院神经外科2008-04/2010-12进行颅脑手术的患者60例,按随机数字表法分为SURGICELTM止血组30例和明胶海绵止血组30例。术中各自使用这两种止血材料进行止血。 结果与结论：明胶海绵止血组止血失败率为10%(3/30),显著高于SURGICELTM止血组[3%(1/30)],差异有显著性意义(P < 0.05)。SURGICELTM止血组止血时间为(2.43±  0.75) min,明胶海绵止血组止血时间为(4.23±0.89) min,两组比较差异有显著性意义(P < 0.05),术后均未发生过敏反应和排斥反应。新型止血材料SURGICELTM较传统明胶海绵可以更迅速地控制神经外科手术中的出血及局部渗血,止血成功率明显提高。     

两种止血材料在腰椎退变手术中止血疗效的临床研究

目的观察评价可吸收流体明胶与明胶海绵在腰椎退变后路手术中的止血效果。方法前瞻性随机对照研究自2016年8月至2017年5月在本科收治的腰椎管减压固定融合的后路手术患者,随机分为两组:流体明胶组28例中,男12例,女16例;明胶海绵组27例中,男12例,女15例;术中分别应用流体明胶和(或)明胶海绵止血,如果出血速度逐渐减慢至不再有明显的出血即认为止血成功,否则视为止血失败。记录止血3 min、5min的止血成功率,记录手术时间、术中出血量、自体血回输量、止血过程中的出血量、输血量,记录术前、术后2～3 d和术后5～7 d的BP、RBC、HCT、HB的变化,记录术后每天的引流量,记录全部的不良事件。结果全部病例至少随访1个月。明胶海绵组有18例3 min成功止血、3例5 min成功止血,流体明胶组有21例3min内快速止血,3例5 min成功止血。两组止血过程中的出血量差异明显(P=0.000);术前流体明胶组RBC和HCT小于明胶海绵组(P=0.038,P=0.030),术后两组之间差异无统计学意义(P0.05);术前两组收缩压差异无统计学意义(P0.05),术后2～3 d流体明胶组收缩压比明胶海绵组高(P=0.005);流体明胶组的术后1 d和术后2～4 d的引流量均少于明胶海绵组(P=0.014;P=0.011)。结论与明胶海绵相比,可吸收流体明胶可以减少止血过程中的出血量,可以减少术后引流量,是一种安全、有效的脊柱外科术中止血剂。     

可吸收材料生物蛋白胶及明胶海绵在肝部分切除的应用

背景：生物蛋白胶广泛应用于各种外科手术中对富含小血管创面渗血的处理。 目的：通过在肝部分切除中应用组织可吸收性医用生物蛋白胶,分析其对手术时间及肝部分切除后止血效果的影响。 方法：对42例肝部分切除患者随机等分为实验组和对照组。实验组在肝部分切除后,缺损处喷洒医用生物蛋白胶封闭,并以明胶海绵剪成多块小片段混合医用生物蛋白胶以覆盖断面来代替常规缝合断面。对照组仅缝合收拢肝组织缺损。 结果与结论：实验组使用的生物蛋白胶可迅速附着于创面,实验组患者肝部分切除的手术时间、出血量、引流量及渗血持续时间均明显小于对照组(P < 0.05),且2组患者的住院天数和住院费用的差异无显著性意义(P > 0.05)。提示在肝部分切除中应用医用生物蛋白胶可以在不增加患者费用及住院时间的同时,有效降低手术时间、减少肝部分切除后出血。 关键词：生物蛋白胶;可吸收性材料;明胶海绵;肝部分切除;生物材料 doi:10.3969/j.issn.1673-8225.2012.12.021     

胶原海绵及其止血性能的研究

利用酸碱溶解法，从牛腱中提取了可溶性胶原材料。冻干法制得了胶原海绵止血材料。对胶原材料的氨基酸分析和紫外吸收光谱分析，证实了可溶性胶原的结构和氨基酸组成。物理性能测试和止血效果实验结果表明，胶原海绵亲水性强，而且具有优良的止血和粘附创而的能力。     

胶原海绵的结构分析和毒理学评价

利用冻干工艺将可溶性胶原制成海绵状止血材料.通过胶原海绵的结构分析,清楚了所提取胶原的结构和组成.根据医用和实验要求,制成不同尺寸和形状的海绵试样,用于生物学评价.结果表明这种材料在细胞毒性、全身急性毒性、皮肤致敏、皮内注射、皮肤刺激和溶血等指标上均符合规定要求.     

局部应用明胶海绵浸润鼠神经生长因子治疗周围神经损伤

背景：有研究尝试将外源性鼠神经生长因子用于周围神经损伤局部,发现局部注射鼠神经生长因子能有效促进损伤神经修复,且局部应用效果优于全身应用。目的：评价明胶海绵浸润鼠神经生长因子用于治疗周围神经损伤的临床疗效。方法：纳入单一、完全断裂周围神经损伤患者36例,其中男16例,女20例,年龄18-48岁,采用随机数字表法均分为2 组,实验组急诊行清创、神经端端直接吻合,术中将浸润鼠神经生长因子的明胶海绵环绕包裹于神经吻合处;对照组急诊行清创、神经端端直接吻合,吻合神经处不予特殊处理。两组术后常规石膏固定,抗炎、营养神经、改善循环治疗。治疗后4周进行电生理检查,治疗后6个月进行神经损伤远端感觉、运动功能评价。结果与结论：实验组感觉电位恢复14例,恢复率为78%;运动电位恢复15例,恢复率为83%。对照组感觉电位恢复10例,恢复率为57%;运动电位恢复12例,恢复率为66%。两组间感觉、运动电位恢复率比较差异有显著性意义(P < 0.05)。实验组17例神经功能得到不同程度恢复,总有效率为94%;对照组15例神经功能得到不同程度恢复,总有效率为83%,两组间总有效率比较差异有显著性意义(P < 0.05)。表明局部应用明胶海绵浸润鼠神经生长因子可有效促进周围神经损伤的修复,且具有良好的生物相容性。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

不同生物止血材料研究进展及复合型止血材料的临床应用

背景：随着生物医用高分子材料如纤维素、甲壳素等天然高分子材料以及聚乙烯醇、胶原等合成高分子材料的研发,止血材料的运用和发展获得了飞跃。 目的：文章综述了近年来不同种类高分子止血敷料的研究进展,评价了不同种类复合止血敷料的临床应用价值。 方法：应用计算机检索万方和PubMed数据库中1996-01/2010-12关于医用高分子止血敷料研究应用的文章,在标题和摘要中以“止血材料;纤维蛋白;高分子材料;胶原蛋白;明胶海绵”或“biological;occlude the flow of blood;gelatin sponge; fibrae sanguis”为检索词进行检索。选择医用高分子止血敷料领域发表在近期文献或权威杂志上的文章。初检得到126篇文献,根据纳入标准选择28篇文章进行综述。 结果与结论：近年来国内外主要应用的可吸收止血材料包括壳聚糖、纤维蛋白胶、吸收性明胶海绵、微纤维胶原等以及常用的按材质和用途分类的藻酸盐类和水胶体类,不同的止血材料其止血机制和止血效果均不相同。文章通过对多种复合止血材料的效果进行比较观察,说明了各种止血材料止血途径和止血机制还有待进一步的研究,以便于开发出更卓越、更有效的止血材料。     

椎体成形术中明胶海绵填塞治疗椎体前壁破损的 OVCFs的临床疗效观察

目的 分析椎体成形术（PVP）中明胶海绵填塞治疗椎体前壁破损的胸腰椎骨质疏松性骨折（OVCFs）的临床疗效。方法 通过回顾性分析我科2016年1月~2018年10月采用PVP手术治疗老年性OVCFs椎体前壁破裂80例,根据手术方法不同分为明胶绵组和对照组,各40例。明胶体海绵组PVP手术中对椎体前壁破损者联合明胶海绵填塞,对照组行常规PVP手术治疗椎体前壁破损患者。比较两组患者手术时间、单个椎体骨水泥注入量、椎体数、手术前后VAS 评分、ODI指数、椎体前缘高度、Cobb角以及骨水泥前方渗漏率。结果 80例患者均顺利完成手术。两组患者手术时间、单个椎体骨水泥注入量以及椎体数比较,差异无统计学意义（P＞0.05）;两组患者VAS评分、ODI指数、椎体前缘高度和Cobb角手术后比较,差异无统计学意义（P＞0.05）;明胶海绵组术后3 d VAS评分和ODI指数均低于术前[（2.68±1.34）分 vs （7.08±0.61）分,（20.91±6.09）vs（74.59±6.46）],对照组术后3 d VAS评分和ODI指数均低于术前[（2.73±1.28）分 vs （6.81±0.87）分,（21.95±5.20）vs（75.96±5.12）],差异有统计学意义（P＜0.05）。明胶海绵组术后椎体前缘高度大于术前[（22.09±2.41）mm vs （18.05±2.74）mm],Cobb角小于术前[（11.01±2.42）° vs （20.80±5.23）°],对照组术后椎体前缘高度大于术前[（21.81±2.31）mm vs （18.36±2.67）mm],Cobb角小于术前[（12.74±3.06）° vs （22.41±4.48）°],差异有统计学意义（P＜0.05）。明胶海绵组骨水泥前方渗漏率低于对照组（5.00% vs 25.00%）,差异有统计学意义（P＜0.05）。结论 对于椎体前壁破裂者椎体成形术中是否使用明胶海绵填塞与其临床疗效无明显差异,但可有效降低椎体前方骨水泥的渗漏。     

几丁糖/海藻酸敷料止血性能的实验研究

目的研究一种新型敷料：几丁糖／海藻酸敷料（本项目组自行研制，已申请国家专利）的止血性能。方法取新西兰兔4只，在背部两侧对称性剪5个直径1cm的圆型创口，分别与创面大小相当的几丁糖／海藻酸敷料和明胶海绵止血，观察与创面的粘附情况，记录出血时间：止血停止后，将几丁糖／海藻酸敷料和明胶海绵放入预先配制好的氰化高铁血红蛋白检测试剂中仔细清洗，用分光光度计在540nm波长处光度比色，测出的Hb光度吸收值表示出血量。结果几丁糖／海藻酸敷料与创面粘附较好，几丁糖／海藻酸敷料、明胶海绵组的出血时间分别为87.7±19.1妙、170.7±22.6妙，Hb光度吸收值分别为1.131±0.44、1.733±0.733，经统计学分析，两组数据都有显著性差异（P〈0.01），几丁糖／海藻酸敷料组明显优于明胶海绵组。结论几丁糖／海藻酸敷料具有较好的止血性能。     

Preparation of collagen/gelatin sponge scaffold for sustained release of bFGF

Artificial dermis (AD) has been used to regenerate dermis-like tissues in the treatment of full-thickness skin defects, but it takes 2 or 3 weeks to complete dermal regeneration. Our previous study demonstrated that injection of basic fibroblast growth factor (bFGF)-impregnated gelatin microspheres (MS) into the AD accelerates the regeneration of dermis-like tissue. However, injection of gelatin MS before clinical use is complicated and time consuming. This study investigated a new scaffold, in which collagen and gelatin are integrated, and which is capable of sustained bFGF release. We produced collagen/gelatin sponges with a gelatin concentration of 0wt%, 10wt%, 30wt%, and 50wt%. The mean pore size in each sponge decreased with the gelatin concentration. In an in vitro study, proliferation of fibroblasts in each sponge was not significantly different over 7 days of culture. As for in vivo sustained release of bFGF, a radioisotope study demonstrated that retention of bFGF in gelatin 10wt% and 30wt% sponges was significantly larger than that in gelatin 0wt% sponge. The collagen/gelatin sponges were grafted on full-thickness skin defects created on a rabbit ear, and we evaluated regeneration of dermis-like tissue by measuring the amount of hemoglobin and size of dermis-like tissue on histological sections. Seven days after implantation, the amount of hemoglobin in dermis-like tissue in gelatin 10wt% sponge was significantly larger than those in control and gelatin 50wt% sponge. Twenty-eight days after implantation, the area of dermis-like tissue in gelatin 10wt% sponge was significantly larger than those in the other specimens. We conclude that the collagen sponge integrated with 10wt% gelatin has the most potential for sustained release of bFGF and that the combination of collagen/gelatin 10wt% sponge and bFGF is a promising therapeutic modality for the treatment of full-thickness skin defects.     

Preparation of Minocycline Collagen Sponge and its Clinical Observation in the Treatment of Chronic Peridentitis

Pathogen in theperiodontal pocketof peridentitisisthe majorfactorresulting inlocal inflammation.The adverse effects can be reduced by direct local application inthe periodontal pocket〔1〕.Atpresent,a lotof bio-medical material are used as carrierfor appl…     

Vascularization into a porous sponge by sustained release of basic fibroblast growth factor

Vascularization into a poly(vinyl alcohol) (PVA) sponge was investigated using basic fibroblast growth factor (bFGF). This growth factor was impregnated into biodegradable gelatin microspheres for its sustained release and then the bFGF-containing microspheres or free bFGF were incorporated into PVA sponges. Following subcutaneous implantation into the back of mice, the bFGF-containing gelatin microspheres induced vascularization in and around the sponge to a significantly greater extent than that of free bFGF from 3 days after implantation. Significant ingrowth of fibrous tissue into the sponge was also observed when bFGF-containing microspheres were added to the sponge in contrast to free bFGF. Tissue ingrowth occurred into the deeper portion of the sponge over time while it accompanied formation of new capillaries. Empty gelatin microspheres had no effect on vascularization and the level of fibrous tissue ingrowth into the sponge was similar to that of the control group. It was concluded that incorporation of gelatin microspheres containing bFGF into the PVA sponge was effective in prevascularization of the sponge pores.     

Granulomatous Arteritis with Massive Eosinophilic Leukocyte Infiltration and Transient Peripheral Eosinophilia Subsequent to Transarterial Embolization Therapy with a Gelatin Sponge

A 38-year old man presented with a cavernous hemangioma in the liver. Transarterial embolization (TAE) using a gelatin sponge was carried out 14 days prior to surgical resection of the tumor. Granulomatous arteritis with massive infiltration by eosinophilic leukocytes and histiocytes was present at the periphery of the hemangioma, and transient eosinophilia in the peripheral blood occurred six days after resection. Granulomatous arteritis was evident in medium-sized arteries and there was narrowing or occlusion of the vascular lumen. In the granulomatous cellular infiltrates in the arteries, giant cells of the foreign body type were numerous. An eosinophilic substance differing from fibrin was present in some of the vascular lumina. As this showed staining for collagen, it was considered likely to be fragments of the gelatin sponge. The patient had no symptoms of fever, chills or general fatigue. The clinical course and pathologic findings suggest a causative role of the gelatin sponge in this case of granulomatous arteritis. Vascular change, a rare complication of TAE therapy, may be induced by a hypersensitivity reaction against the intraarterial gelatin sponge. Acta Pathol Jpn 41: 618-622, 1991.     

合成α-氰基丙烯酸正丁酯医用胶用于肝脏止血

BACKGROUND: There are chemosynthetic and biological medical adhesives, and the former mainly composed by cyanoacrylate, holds poor hydrophilicity and is easy to break off, thereby achieving unsatisfactory hemostatic effect. OBJECTIVE: To evaluate the hemostatic and adhesion effect of the modified α-N butyl cyanoacrylate (NBCA) by the hemostatic test in white rabbit livers. METHODS: Material imprvement: cyanoacrylate monomer was prepared and its components and contents were analyzed by infrared spectrum and gas chromatograph. Sodium lauroyl sarcosinate was used as surfactant to improve the cohesive force between NBCA and tissues and increase the hydrophility. Hemostatic test in the liver incision: the liver incision of rabbits in three groups were sewn with absorbable suture and then covered with gelatin sponge (control group), cyanoacrylate and NBCA medical adhesives, respectively. Blood loss and bleeding time were recorded within 20 minutes. Hemostatic test in the liver section: the liver sections in two groups were smeared with surfactant plus NBCA and cyanoacrylate, respectively. The gross appearance of wound and its adherence to the omentum majus, as well as the histological changes by hematoxylin-eosin staining were observed at 1, 10 and 20 days postoperatively. RSULTS AND CONCLUSIPON: The adhesiveness of NBCA medical adhesive was excellent. Infrared spectrum and gas chromatograph found that the main component was NBCA up to 84.56%, with 8.2% reactants and 3.3% byproducts. The modified NBCA medical adhesive significantly decreased the blood loss and bleeding time compared with the control group (P < 0.01), and did not significantly differ from the cyanoacrylate (P > 0.05). In addition, the modified NBCA adhered more firmly to the wound, and was absorbed completely at 20 days postoperatively, showing no adverse reaction. These results suggest that NBCA is better and more stable than gelatin sponge, and exerts overt hemostatic effect causing no adverse reaction.     

医用胶原蛋白海绵及负压封闭引流联合自体刃厚皮复合移植在足部毁损伤难愈性创面中的应用

目的观察医用胶原蛋白海绵及负压封闭引流(VSD)联合自体刃厚皮复合移植修复足部毁损伤难愈性创面的效果。方法选取2017年1月至2019年10月海南省人民医院烧伤与皮肤修复外科收治的足部毁损伤难愈性创面患者18例,其中合并足背肌腱外露12例,跖骨骨外露6例。创面清创后,予医用胶原蛋白海绵覆盖肌腱外露、骨外露创面,并安装VSD装置,待创面覆盖肉芽组织后,再给予自体刃厚皮移植修复创面。记录治疗时间、外露肌腱或骨质坏死率、皮片成活率,术后随访6个月,以Maryland足部功能评分标准评估外观及功能。结果18例患者足部均得以保存,外露的肌腱和骨质均保持活性,皮片成活率85%~95%,平均(90±5)%。残余创面给予间断换药治疗后全部愈合,治疗时长14.0~45.0 d,平均(29.5±15.5)d。出院后6个月复诊以Maryland足部功能评分标准评估足部功能,优3例,良4例,中6例,差5例。结论医用胶原蛋白海绵及VSD在促进肌腱、骨质外露创面肉芽组织生长的同时可保留外露的肌腱及骨组织活性,联合自体刃厚皮移植,能较好地修复足部毁损伤难愈性创面。