冻干人纤维蛋白胶在心血管外科手术中的应用

目的:评价冻干人纤维蛋白胶在心外科手术应用中的止血效果及安全性.方法:选取年龄为18～60岁,体外循环下行心脏直视手术,并有主动脉或右心室切口的病人共60例,随机分为试验组和对照组各30例,选择主动脉或右心室缝合后有渗血的切口为试验创面,局部使用试验药或对照药.以止血时间及出血量为主要疗效评价指标,比较试验药和对照药的临床疗效.试验组患者随机抽取7例进行3个月安全性随访.结果:用药前后生命体征变化及实验室检查结果的变化,两组之间无明显差异;试验组止血时间(14.67±6.18s)和渗血量(0.81±0.54g)等指标均明显优于对照组(分别为250.45±37.02s和15.39±2.69g);7例试验组病例术后3个月的安全性随访结果均为阴性.结论:冻干人纤维蛋白胶对心脏外科手术后的切口及创面渗血具有良好的止血和组织粘合作用,且具有可靠的病毒安全性.     

生物蛋白胶在PPH手术中的应用

目的评价生物蛋白胶在痔上粘膜环切手术(PPH)中减少术后出血的疗效。方法对2006年3月—2010年3月行PPH手术患者84例随机分成两组,对照组术后常规止血,局部用油纱布压迫;实验组在常规处理的基础上在吻合口处喷洒生物蛋白胶封闭。观察术后第一天渗血量及渗血持续时间。结果应用生物蛋白胶组术后第一天渗血量及渗血持续时间均明显低于对照组(P<0.01)。结论生物蛋白胶在PPH手术中应用可减少术后出血,未发现不良反应。     

两种国产医用胶在食管与胃机械吻合术中的应用

目的比较两种国产医用胶在食管与胃机械吻合术中应用的效果。方法食管、胃底贲门癌切除中行食管与胃机械吻合术 ,分别用国产医用OB吻合胶(简称OB胶)和医用生物蛋白胶(简称生物胶) ,喷涂在食管与胃吻合口的周围各20例进行对比观察。结果两组40例病人均无1例出现吻合口出血、瘘及狭窄。结论两种国产医用胶都有对吻合口的封闭、止血、粘合功能并可取代吻合口的全周浆肌层内翻缝合 ,既可防止吻合口瘘 ,又可防止吻合口狭窄 ,值得临床进一步推广应用     

罂粟碱纤维蛋白胶预防术后血管痉挛的实验和临床研究

目的 本课题研究以纤维蛋白胶作为罂粟碱缓释载体,通过体外测试缓释检测和临床观察,验证其解痉作用,为解决血管吻合术后血管痉挛提供新方法.方法 体外释放试验:将10、20、30 mg罂粟碱与5 ml纤维蛋白胶(FG) 混合成凝胶后分四组,分别于开始培养15 min,2、8、24、48、72、96、120、168 h后取样本测试其中的罂粟碱质量浓度,观察罂粟碱释放过程;临床试验:将40例病变位于手臂部的患者随机分组,每组20例.通过在临床中断指(肢)、游离皮瓣移植的患者吻合血管后在吻合口周围植入,观察患者疼痛评分以及创面情况比较如单位面积渗血量(g/cm2),平均止血时间(s),创面愈合时间(d).结果 处理组罂粟碱质量浓度随不同时间点的延长而逐渐增加,在同一时间点罂粟碱释放与每组中罂粟碱处理浓度成正比;罂粟碱与纤维蛋白联用组患者术后疼痛感觉轻微,止血时间短,创面封闭较快;罂粟碱单独处理组部分患者在术后感烧灼样疼痛持续约3 h,止血时间较长.结论 蛋白胶-罂粟碱复合体应用有快速止血、镇痛和促进创面快速愈合的特点,能满足患者无痛、微创要求.     

会阴侧切伤口缝合方式的技术探讨及临床观察

目的探讨不同的会阴侧切伤口缝合方法的临床疗效。方法取符合条件的阴道分娩行会阴侧切的产妇420例随机分为传统组和观察组,各210例,传统组采用羊肠线间断或连续缝合会阴各层,丝线缝合会阴皮肤,4～5d拆线;观察组采用可吸收线连续缝合会阴各层,皮肤采用可吸收线皮内缝合,不拆线。结果2组在伤口缝合耗时、伤口渗血量、会阴伤口感染率和住院时间方面比较差异均有统计学意义（P〈0．05和P〈0．01）。结论观察组优于传统组,皮内缝合法可缩短缝合时间,减少伤口渗血量,降低会阴伤口的感染率,缩短平均住院时间,值得推广。     

血管缝合器止血在冠状动脉介入治疗术后的临床应用

经皮冠状动脉介入治疗术(PCI)后动脉穿刺点的有效止血可减少外周血管的并发症,传统的方法为手压迫止血,但此方法要求病人术后长时间的下肢制动和卧床,且穿刺点局部渗血、血肿、假性动脉瘤形成及血管迷走反射时有发生。近年来,血管缝合器应用于临床,使得PCI后在完全抗凝的情况下     

医用生物蛋白胶在胸腔镜食管癌切除术中的应用

目的探讨医用生物蛋白胶（biomedical fibrin sealant,BFS）在电视胸腔镜食管癌切除术中的应用优势及前景。方法62例患者随机分为治疗组和观察组各31例,治疗组应用医用生物蛋白胶封闭胸部创面和吻合口,对照组仅用医用生物蛋白胶封闭吻合口。结果治疗组31例患者术后第1天胸腔引流量为（190±53）ml,术后总引流量（370±87）ml;对照组31例患者术后第1天胸腔引流量为（280±91）ml,术后总引流量（490±124）ml,两组间在术后第1天引流量和总引流量有统计学意义（P〈0.01）。同时,62例患者仅有1例发生吻合口瘘（1.61%）,吻合口漏发生率明显降低。结论医用生物蛋白胶在胸腔镜食管癌切除手术中可以有效的减少创面的渗血,预防食管胃吻合口的＂针孔漏＂;促进组织愈合,为胸腔镜手术提供有效的安全保障。     

血管缝合器止血对冠状动脉介入术后卧床时间及舒适度的影响

目的观察血管缝合器止血对冠状动脉介入术后卧床时间及舒适度的影响。方法178例患者行心导管术后,分为人工压迫止血组(A组,129例)和血管缝合器(B组,49例),术后即刻应用人工压迫止血或血管缝合器止血,观察止血时间、卧床制动时间、并发症、舒适度。结果人工压迫止血组平均止血时间(16±5·5)min,卧床制动时间为12~24h。血管缝合器组平均止血时间(4±2·5)min;单纯冠状动脉造影患者制动0·5~1h,经皮腔内冠状动脉成形术(PTCA)及支架术后患者止血后制动2h。血管缝合器组出血、血肿及血管迷走神经反射发生率明显少于人工压迫止血组。两种止血方法的舒适度评估有显著差异。结论应用血管缝合器止血可缩短止血与卧床制动时间,减轻患者痛苦及并发症的发生。     

医用生物蛋白胶在食管癌手术中应用体会

医用生物蛋白胶,国外称纤维蛋白胶,纤维蛋白封闭剂,纤维蛋白组织黏合剂。它是利用血液中的相关成分模拟凝血过程最后阶段,形成稳定的网状纤维蛋白多聚体膜,5～10s封闭创面,3～5min明显强化,7～18d左右被组织吸收,达到封闭黏合组织创面,充填缺损、诱发机体自身凝血机制,加快加强止血效果,减少微小静脉毛细血管渗出,减少淋巴管渗漏的目的。组织相容性好,预防瘘发生。     

老年冠状动脉介入诊疗术后Perclose血管缝合的临床作用

目的评价老年冠状动脉(简称冠脉)介入诊疗术后Perclose血管缝合止血的安全性和临床效果。方法204例老年冠脉介入诊疗术后患者,97例应用Perclose缝合器止血(称缝合组),107例应用手工压迫止血方法止血(称对照组)。分别记录止血时间、下肢制动时间和手术相关并发症。结果缝合组:缝合成功率92.8%;止血时间1.9±1.2min;下肢制动时间4.0±0.9h;并发症发生率为3.1%。对照组:一次止血成功率93.5%;止血时间27.5±10.5min;下肢制动时间22.0±4.3h;手术相关并发症发生率为18.7%。统计学处理显示:缝合组与对照组的止血成功率无显著性差异(χ2=1.16,P>0.05);缝合组的止血时间和下肢制动时间明显较对照组缩短(t止血=17.3熏t制动=29.3熏P<0.01);对照组手术相关并发症发生率明显高于缝合组(χ2=8.7熏P<0.01)。结论用Perclose血管缝合器处理老年冠脉介入诊疗术后穿刺血管安全有效,与手工压迫止血比有以下优点:①止血时间和下肢制动时间明显缩短,减少了因制动给患者带来的不适;②明显减少手术相关并发症的发生。缺点:Perclose血管缝合的直接费用较高。     

Hemostatic effect of a novel sheeted fibrin adhesive agent, TO-193, on experimental incision models]

TO-193 (TachoComb) is a new fibrin adhesive agent that consists of a collagen sheet coated with fibrin glue. We compared the hemostatic effect of TO-193 in several experimental models with Beriplast P as a fibrin adhesive agent, Avitene and Novacol as a microfibrillar collagen hemostat, and a sponge-like collagen sheet as the constitutional parts of TO-193. In the in vitro bleeding model in which blood leaks out through cotton cloth, the pressure of TO-193 when blood leakage was observed was higher than those of Beriplast P, Avitene, Novacol and the collagen sheet, indicating that TO-193 possessed a strong adhesive effect on the bleeding surface. On the kidney resection surface, TO-193 showed a more potent adhesive effect than those of Beriplast P and the collagen sheet, suggesting that TO-193 has a potent hemostatic effect. In the liver resection, TO-193 significantly reduced the bleeding volume compared with that of Novacol in normal rats. Furthermore, the bleeding volume of TO-193 was about half that of Beriplast P and equivalent to that of Novacol even in anticoagulant-treated rats. From these data, it is expected that TO-193 would be a valuable hemostatic agent for clinical use since TO-193 possesses a potent adhesive ability on the bleeding resection surface and would certainly stop bleeding in both patients with normal coagulation and those with a low blood coagulation condition.     

广山楂炭止血活性部位药效学筛选及作用机制初步研究

目的: 确定广山楂炭的止血活性部位,初步探讨其止血作用的机制。方法: 以昆明小鼠为研究对象,分为石油醚、氯仿、醋酸乙酯、正丁醇、水部位高、低剂量组,云南白药组和空白组。采用断尾法、毛细管法和玻片法测定各组小鼠出血、凝血时间。以 SD 大鼠为研究对象,分为石油醚高、低剂量组,醋酸乙酯高、低剂量组,模型组,云南白药组和空白组。除空白组外,其余组采用皮下注射盐酸肾上腺素加冰浴法复制血瘀出血大鼠模型,测定各组凝血四项、血液流变学、红细胞参数及血小板参数,探讨其止血作用机制。结果: 仅有广山楂炭的石油醚部位与醋酸乙酯部位能缩短小鼠出血、凝血时间;与模型组比较,石油醚组、醋酸乙酯组均缩短活化部分凝血酶原时间、凝血酶时间,延长凝血酶原时间,降低纤维蛋白原含量;升高血小板计数与平均血小板体积,降低血小板压积与血小板平均分布、红细胞计数、血红蛋白浓度、红细胞压积值和血浆黏度,以及高、中、低各切变率下的全血黏度值(P＜0.05)。结论: 石油醚部位、醋酸乙酯部位为广山楂炭的止血有效部位,其机制可能是通过内源性和外源性凝血系统两大途径发挥止血作用。     

BMSCs和软骨细胞共培养并与纤维蛋白黏胶复合后移植修复关节软骨缺损

目的 探讨BMSCs和软骨细胞共培养并与纤维蛋白黏胶复合后移植修复关节软骨缺损的效果.方法 关节软骨损伤动物模型分A、B、C、D四组,A组：骨髓基质干细胞、软骨细胞、纤维蛋白胶复合体移植;B组：骨髓基质干细胞、软骨细胞移植;C组：单纯凝胶复合体移植;D组：空白对照,软骨缺损不作处理.分别于4、12周处死取材.进行修复软骨的大体观察、用透射电镜检查观察软骨细胞内结构和O＇Driscoll软骨组织形态学评分.结果 大体观察和电镜检查：软骨的修复A组优于B、C组,D组修复不良.各组的O＇Driscoll软骨组织形态学评分分别为：A组：（20.43±1.81）分;B组：（16.29±2.63）分;C组：（10.57±3.60）分;D组：（5.77±3.30）分,各组之间差异均有极显著性（P＜0.01）.结论 BMSCs和软骨细胞共培养并与纤维蛋白黏胶复合后移植能更好的修复关节软骨缺损.     

巴曲亭在甲状腺术中的止血效果及对凝血功能影响的应用体会

目的观察巴曲亭在甲状腺术中、术后的止血效果及对凝血功能的影响。方法随机将甲状腺腺叶切除术80例患者分成巴曲亭组和对照组,观察创面止血时间、术中出血量、术后2d创面出血及渗血量及对患者凝血功能的影响。结果巴曲亭组切口止血时间、切口单位面积出血量、术中出血量、术后引流量均少于对照组(P<0.05),两组术前术后凝血功能无显著性差异。结论巴曲亭在甲状腺术中、术后具有较好的止血效果,对患者的凝血功能无影响,是安全有效的止血药物。     

The relationship between the onset of labor mechanisms and the hemostatic system

The relationship between onset of labor and the hemostatic system was evaluated in 38 pregnant women. The hemostatic system consists of blood coagulation, kinin-kallikrein system, the fibrinolytic system, and platelet function. The most prominent changes take place in the kinin-kallikrein system. After the onset of labor, prekallikrein decreases rapidly which may trigger changes in blood coagulation and the fibrinolytic system. Platelet hemostatic capacity (PHC) was also measured using the PFA-100 (platelet function analyzer) system. Closure times (CT) were shorter during pregnancy, compared to non-pregnant controls, suggesting an increase in PHC. Platelet aggregation by ADP at the end of pregnancy was decreased at the onset of labor. At the same time a slight increase in FDP (fibrin degeneration product) was also seen. While FDP increased, platelet aggregation decreased, which seems to suggest FDP inhibits platelet aggregation. In this manner, these three systems(kinin-kallikrein system, blood coagulation, and fibrinolytic system) and platelet aggregation are closely interrelated, possibly affecting uterine contractility during pregnancy and the onset of labor.     

纤维蛋白粘合剂作为抗肿瘤等药物缓释载体的研究进展

纤维蛋白粘合剂作为药物缓释载体因其具有良好的缓释性、生物相容性和定向作用,已被广泛应用于临床;其可通过模拟机体凝血过程的最后阶段,形成海绵状纤维蛋白凝胶,凝胶呈三维结构的纤维蛋白多聚体,和抗肿瘤等药物联合使用时可以将药物包合在凝胶内,形成储药库,当喷射或涂布于创面后,随着凝胶被逐渐吸收和降解,药物被缓慢释放,产生理想的定向缓释作用。此作用机制特别适合局部肿瘤治疗、抗菌治疗及局麻镇痛药物等方面的联合使用;在减少给药次数,降低药物毒副作用,提高药物治疗效果等方面具有非常好的应用前景。近年来,纤维蛋白粘合剂的缓释作用越来越受到学者们的重视,成为研究的热点。本文将对纤维蛋白粘合剂联合抗肿瘤等药物形成缓释体系的机理及临床应用进行综述。     

Fibrin sealant: a review of its use in surgery and endoscopy

Fibrin sealant (fibrin adhesive; fibrin glue; Beriplast P1) is a haemostatic and wound support product consisting of the blood coagulation factors fibrinogen, factor XIII and thrombin, the antifibrinolytic agent aprotinin and calcium chloride. Fibrin sealant has been used to good effect in a wide variety of surgical and endoscopic procedures. Suture support was provided in series of patients with oesophageal, gastric, colonic or rectal anastomoses, and fibrin sealant was as effective in haemostasis as microcrystalline collagen powder in hepatic surgery. It did not reduce postoperative peritoneal drainage after elective cholecystectomy, however. A 41% reduction (p<0.02) in incidence of air leakage was achieved when fibrin sealant was added to sutures in patients undergoing pulmonary resection in a randomised single-blind study. A high rate of complete remission of malignant pleural effusion has been reported after intrapleural instillation of fibrin sealant, and successful sealing of CSF leaks after trauma or surgery has also been achieved. Attenuation of prolonged or excessive haemorrhage after dental extraction has been achieved in patients on anticoagulant therapy or with haemorrhagic disorders who received fibrin sealant with packing and suturing. Repeated endoscopic injection of fibrin sealant was superior to single injection sclerotherapy with polidocanol 1% in a randomised study in 805 patients with bleeding peptic ulcers. Other data suggest that endoscopic injection of fibrin sealant is associated with lower recurrence of bleeding and need for emergency surgery than thrombin with adrenaline (epinephrine) or hypertonic saline with adrenaline. Similar haemostatic efficacy to laser photocoagulation or sclerotherapy was reported in a retrospective comparison. A statistically significant reduction relative to suturing in the incidence of wound dehiscence was reported after the use of fibrin sealant in cataract surgery, and benefit of the sealant has also been noted in patients receiving skin grafts and in those undergoing transurethral resection of the prostate gland. CONCLUSIONS: Although comparative studies would assist in the clarification of the place of the product discussed with respect to other haemostatic or wound support techniques and to other fibrin sealants, the formulation reviewed here has been shown overall to be effective and well tolerated in a variety of haemostatic and wound healing support roles in numerous types of surgery. Fibrin sealant has also been shown to be useful when administered endoscopically, with superiority over sclerotherapy being shown after repeated application in patients with peptic ulceration. Fibrin sealant can therefore be considered useful in a number of surgical and endoscopic settings.     

In vivo and in vitro hemostatic activity of Chromolaena odorata leaf extract

Context: Chromolaena odorata (L.) R.M.King & H.Rob. (Asteraceae) or Siam weed has long been used to stop bleeding in Thailand and many countries. Only the aqueous leaf extract was investigated in in vivo and there have been conflicting results of in vitro hemostatic mechanisms of this plant. Objective: The most appropriate C. odorata leaf extract that promoted the highest hemostatic activity and the hemostatic mechanisms of these plant extracts will be investigated. Materials and methods: The lyophilized aqueous leaf extract and alcoholic (50, 70, and 95% ethanol) extracts from the fresh and dried leaves were investigated both in vivo and in vitro. The bleeding time in male Wistar rats was measured to investigate the hemostatic effect. The hemostatic mechanisms were tested using in vitro platelet aggregation and blood coagulation tests in sheep plasma. Results: All extracts displayed significantly reducing bleeding time (<2.5?min) in rats but did not induce platelet aggregation or blood clotting in the in vitro study. The in vitro blood clotting times of all extracts were > 0.6?min. Ethanol extract (70%) from the dried leaves proved to be the extract producing the highest hemostatic activity in vivo with the bleeding time of 1.85?min. Discussion and conclusion: The in vivo study with rats confirmed the significant ability of this plant extract to stop bleeding. However, the sufficient amount of calcium and active compounds which are aggregating and clotting agents to enhance blood coagulation and platelet aggregation in in vitro tests should be further studied.     

尖吻蝮蛇凝血酶对腹部手术切口止血的有效性及安全性临床研究

目的 评价尖吻蝮蛇凝血酶在腹部手术切口的止血作用,以及对机体凝血功能的影响和凝血酶安全性.方法 本研究采用随机、双卣单模拟、安慰剂平行对照和多中心的研究方法,对腹部手术患者共120例进行研究,分为研究组及对照组各60例.2组分别应用尖吻蝮蛇凝血酶2 U和模拟尖吻蝮蛇凝血酶2 U,术前15 min静脉注射,对腹部手术切口出血的止血时间、出血量、单位面积出血鼍,以及机体凝血功能和安全性指标等方面进行观察.结果 2组患者应用药物后,注射凝血酶2U的研究组平均止血时间为97s,切口平均出血量为1.89 g,平均单位面积出血量0.048 g/cm^2,对照组结果分别为185 s、2.67 g、0.057 g/cm^2,2组比较,差异有统计学意义（P＜0.05）.在凝血功能及安全性指标等方面,2组结果相似（P＞0.05）.整个试验过程无不良事件.结论 尖吻蝮蛇凝血酶对腹部切口毛细血管有较好的止血作用和安全性.