生物止血材料在妇产科手术中的应用

背景：良好的生物敷料或纱布可直接促进凝血过程,不仅可用于广泛渗血创面,且在一些常用的妇产科手术中能有效降低渗血率。目的：评价不同生物止血敷料及纱布的材料学性能及应用于妇产科切口的生物相容性,寻找符合不同切口创面需要的止血材料。方法：采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索1999-01/2011-04有关妇产科生物止血材料应用的研究文章,关键词为“妇产科,生物材料,止血敷料,纱布,胶原/壳聚糖”,排除重复研究、普通综述或Meta分析类文章,筛选纳入30篇文献进行评价。结果与结论：近几年国内外生物医用可吸收止血材料主要包括纤维蛋白胶、壳聚糖、明胶海绵、氰基丙烯酸酯类组织胶、氧化纤维素和氧化再生纤维素等。各种止血性伤口急救材料都有各自的特点,但在妇产科应用的选择上,应考虑多方面因素,包括手术部位、出血部位、切口形态大小、不同渗/出血情况的填塞要求、不同止血材料的自身性能及与机体的相容性等。但因目前尚无完全符合理想标准的材料,因此开发新的快速止血和与宿主相容性良好的止血材料及复合材料势在必行。

Biological hemostatic materials in obstetrics and gynecology surgery

BACKGROUND:Good bio-dressing or gauze can directly promote blood clotting, not only for extensive bleeding wound, but also for some common obstetrics and gynecology surgeries to reduce bleeding rate.OBJECTIVE:To evaluate the material properties and biocompatibility of different bio-dressing or gauzes, and to find proper hemostatic materials for different wounds.METHODS:An electronic search of Wanfang database was performed to retrieve articles about hemostatic materials used in obstetrics and gynecology surgery using the keywords of “obstetrics and gynecology, biomaterial, hemostatic material, gauze, collagen/chitosan”. Repetitive studies, reviews or Meta analysis were excluded, and finally 30 articles were involved.RESULTS AND CONCLUSION:In recent years, biomedical absorbable hemostatic materials include fibrin glue, chitosan, gelatin sponge, cyano-acrylate tissue glue, oxidized cellulose and oxidized regenerated cellulose. A variety of hemostatic materials have their own characteristics, but the choice used in obstetrics and gynecology should consider various factors, including surgical site, bleeding, wound shape and size, different permeability/bleeding, different material performance and body compatibility and so on. There are no ideal materials, so the development of new rapid hemostatic materials and composite materials with good compatibility is imperative.