改良绷带加压法在桡动脉介入中压迫止血的应用

目的 探讨改良绷带加压法在桡动脉介入中压迫止血的应用价值.方法 选择2012年1月-2013年5月在某三级医院经桡动脉行冠脉介入诊疗的患者191例.随机分为两组,改良绷带组108例,专用止血器组83例.比较两组患者桡动脉介入术后加压包扎的并发症及舒适度情况.结果 改良绷带加压组与专用止血器组患者的性别、年龄、高血压、糖尿病、桡动脉穿刺史及经皮冠脉介入治疗（PCI）例数比较,差异无统计学意义（P＞0.05）.与专用止血器组患者比较,改良绷带组患者穿刺处出血、周围青紫及皮肤破损移位发生率无统计学差异（P＞0.05）;但在手肿胀、麻木、压迫处疼痛改良绷带组患者发生率低于专用止血器组患者（P ＜0.05）,同时改良绷带组患者舒适度良好的百分比高于专用止血器组患者（P ＜0.05）.结论 改良绷带加压法相对于专用止血器法具有并发症更少、舒适度好且价格便宜等优点,值得临床推广.     

Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery- a systematic review

Background: Proper haemostasis is an important prerequisite for a successful outcome in all operative fields. TachoSil^® is used in many surgical specialties, especially for diffuse bleeding. However, TachoSil is not only used for haemostasis but also for closure of other anatomical structures. Objective: To review the literature concerning the efficacy of TachoSil, a topical fibrin-based haemostat. Methods: PubMed was searched for data on TachoSil and TachoComb from clinical trials and basic research. Results/conclusion: TachoSil is used in many surgical specialties and has proven to be a valuable tool for several indications. It also seems to be cost effective. Solid data from randomized controlled trials are available for liver surgery, thoracic surgery and urology where a positive value is clearly documented.     

一种可吸收多聚糖止血材料的生物降解研究

目的:研究机体及组织对来源于淀粉的可吸收多聚糖止血粉(starch-derived absorbable polysac-charide hemostat,SAPH)的降解,以对其术中应用的安全性做出评价。方法:手术操作将2μg SAPH产品Per-clotTM注射入大鼠颅内或腹腔,分别于术后30,60和120 min,提取脑组织匀浆或腹腔灌洗液上清,加入碘溶液,通过碘-淀粉显色反应的标准曲线检测PerclotTM浓度;体外实验采用大鼠脑、肝、肾、肺组织各1 g,匀浆取上清加入2μg PerclotTM,或在脑组织匀浆上清中加入0.01~1μg不同剂量PerclotTM,孵育30 min后检测剩余量。结果:注射后30,60和120 min PerclotTM平均残留率脑内分别为38.62%,6.48%和0.85%,腹腔内分别为64.08%,33.36%和1.78%;体外条件下各器官组织匀浆在30 min内对PerclotTM的降解效率均超过50%,其中肝脏组织的降解效果最好;脑组织匀浆对浓度高于0.1μg.mL-1PerclotTM30 min的分解效率均约为50%。结论:体内条件下大鼠颅内和腹腔降解95%S...     

内镜药物与内镜金属钛夹治疗上消化道出血效果对比

目的分析比较内镜下药物喷洒与内镜下金属钛夹联合止血钳治疗上消化道出血的效果。方法本次研究对象为2018年5月-2019年5月本院收治的84例上消化道出血患者,随机分为对照组42例(内镜下药物喷洒治疗)和研究组42例(内镜下金属钛夹联合止血钳治疗),对比两组的疗效。结果研究组治疗总体有效率(97.62%)高于对照组(80.95%),(P<0.05)。研究组隐血转阴时间、住院时间为(3.02±0.50)d、(6.37±0.50)d与对照组隐血转阴时间、住院时间(6.02±1.00)d、(9.67±2.00)d相比明显更优,两组数据差异有统计学意义(P<0.05)。结论内镜下金属钛夹联合止血钳治疗上消化道出血临床效果好,值得患者信赖。     

Radiculopathy due to microfibrillar collagen hemostat mimicking recurrence of disc herniation

Microfibrillar collagen hemostat (Avitene) is an absorbable topical hemostatic agent prepared from purified bovine corium collagen. A 65-year-old woman presented with left buttock and lower extremity radicular pain. The patient underwent a disc excision in which Avitene was used to control venous bleeding from the epidural space. Leg pain decreased postoperatively, but she developed radicular pain when she started walking 3 days after the operation. Magnetic resonance imaging (MRI) performed post-operatively showed there was a mass lesion located between the dural sac and L5 nerve root. The lesion exhibited high signal intensity on T1-weighted images and higher signal intensity at the rim of the mass on T2-weighted images. A second operation performed 10 days later revealed that the nerve root was adherent to an extradural granulomatous mass associated with Avitene. Macroscopically, the resected mass was found to be composed mainly of microfibrillar collagen hemostat materials. Hemostat agents may produce a clinically symptomatic, radiologically apparent mass lesion. When considering a mass lesion arising after spine surgery, the differential diagnosis should include foreign body granuloma along with recurrent disc herniation and peridural scar formation.     

Potent Hemostatic Efficacy of a Novel Recombinant Fibrin Sealant Patch (KTF-374) in Rabbit Bleeding Models

Purpose: Fibrin sealants are used for hemostasis during surgery. Commercially available fibrin sealants are made of materials of human or animal origin. We developed a novel recombinant fibrin sealant patch (KTF-374) that has thin and flexible properties. This study evaluated the hemostatic efficacy of KTF-374 for various patterns of bleeding in rabbits, as compared with that of the existing fibrin-coated collagen fleece (FCCF). Materials and Methods: Test hemostats used were KTF-374 and FCCF. Laparotomy was performed under general anesthesia in rabbits. We created wounds in the liver, caudal vena cava, and ventral aorta under anticoagulating conditions with heparin. Test hemostats were then applied to the wound site and compressed manually for 3 min. Hemostatic efficacy was evaluated with the success rate of hemostasis at 3 min. Results: In all bleeding models, the success rate of hemostasis was significantly higher with KTF-374 than FCCF. The hemostatic success rate of KTF-374 and FCCF was 100% vs. 25% (p = .007) in the partial hepatectomy model (n = 8); 100% vs. 12.5% (p = .001) in the caudal vena cava resection model (n = 8); and 100% vs. 25% (p = .004) in the ventral aortic puncture model (n = 8). The wound site could clearly be recognized through the patch after the application of KTF-374 but not FCCF. Conclusions: These results suggest that KTF-374 possesses more potent hemostatic properties than FCCF for various patterns of bleeding. KTF-374 is a promising hemostat due to its potent efficacy and good visibility of the wound site through the patch.     

动脉压迫止血器应用于冠状动脉介入术后的临床观察

目的探讨动脉压迫止血器在冠状动脉介入术后的临床应用。方法选择住院经股动脉穿刺行心脏介入手术患者100例,按术后是否应用止血器分为2组,观察组50例应用动脉压迫止血器止血,对照组50例则采用传统人工按压沙袋加压的方法止血。比较2组止血操作及制动时间的差异,并观察2组患者舒适度等相关副作用的情况。结果观察组止血操作及制动时间明显少于对照组,有显著性差异（P〈0.01）;患者舒适度等相关副作用的发生率明显低于对照组（P〈0.05）。结论应用动脉压迫止血器,止血操作及制动时间明显缩短,既减轻了操作者的劳动强度,又缓解了患者的身心不适,是一种医师愿意采用,患者乐于接受的止血方法。     

Evaluation of resorption and biocompatibility of collagen hemostats in the spinal epidural space

Background contextCollagen hemostats have different characteristics depending on their properties and configuration. In vivo serial evaluation of local reactions because of placement of hemostats in the epidural space has not been reported.PurposeThis study compared the resorption and biocompatibility of two types of collagen hemostats placed in the epidural space.Study designThis in vivo study used experimental animals to evaluate collagen hemostats that were placed in the epidural space.MethodsA ligamentum flavum resection model was created in Japanese white rabbits (n=65). A microfibrillar collagen hemostat (MCH group, n=5), cotton-type collagen hemostat (CCH group, n=5) that was chemically cross-linked, or no hemostat (control group, n=4) was placed in the spinal epidural space. For histologic evaluation, each group was euthanized 1, 2, 4, and 8 weeks postoperatively (PO), and hematoxylin-eosin and immunohistochemical (IHC) staining for inflammatory cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-6), cyclooxygenase (COX)-2, and macrophages (CD68) was performed. To evaluate exudate accumulation and the degree of inflammation in the epidural space, magnetic resonance imaging at 7.04 T was serially performed in each group (n=3) under anesthesia and sedation.ResultsThe collagen hemostats in both groups were reabsorbed at 4 weeks PO. In the MCH group, there was inflammatory cell infiltration and granuloma formation around the hemostat, TNF-α–positive cells were seen up to 1 week, and IL-6–, COX-2–, and CD68-positive cells were seen at all evaluation times. In the CCH group, no inflammatory cell infiltration around the hemostat was observed, and IHC staining showed no positive cells at 4 weeks PO and later. T2*-weighted MR images showed significantly higher mean signal intensity of the epidural space in the MCH group than in the CCH group but only at 1 week PO (p<.05).ConclusionsResorption of both hemostats was similar. In the MCH group, there was intense tissue inflammation around the hemostatic material, and MR images showed high signal intensity because of exudate accumulation in the epidural space. This indicated a strong foreign-body reaction to the MCH, thus demonstrating a difference in biocompatibility with the CCH.     

经皮冠状动脉介入治疗患者使用股动脉压迫止血器的不良反应及护理

回顾性总结分析了63例经皮冠状动脉介入治疗患者使用股动脉压迫止血器的不良反应：2例出现迷走神经反射，6例出现穿刺点出血、血肿或假性动脉瘤，11例出现穿刺点疼痛，19例出现腰背酸痛，15例出现皮肤损害。对出现迷走神经反射者拔鞘前向患者讲明拔管的目的、步骤及拔管后的注意事项，拔管整个过程与患者交谈，分散注意力；对疼痛敏感的患者可使用利多卡因麻醉穿刺口周围皮肤，两侧股动脉同时有伤口时不同时拔管。对穿刺点出血及血肿者，使用股动脉压迫止血器前需擦干皮肤上的血迹、汗迹、消毒液，防止因胶布不粘帖未有效止血而引起出血；护士分析了解每位患者潜在的出血因素，有针对性、有目的地进行观察和护理。对穿刺点疼痛者，在使用止血器时注意加压力度，避免穿刺部位压迫过紧，影响下肢血运。对腰背疼痛者术前加强健康教育、心理护理，训练床上翻身、大小便等，术后严密观察，由护士协助患者变动体位。对皮肤损害者使用股动脉压迫止血器前仔细询问患者有无胶布过敏史，备皮要干净、彻底，去除胶布时先用温盐水浸湿后再以180°角平着皮肤轻柔缓慢揭去胶布，防止牵扯体毛引起皮肤疼痛。