| 膨胀止血材料在战创伤一线急救中的应用探索 |
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| 引用本文： | 曹智,鲁欣,杨印辉,赵琳,李劲锋,侯建国,陈基快,王林辉.膨胀止血材料在战创伤一线急救中的应用探索[J].第二军医大学学报,2023,44(10). |
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| 作者姓名： | 曹智 鲁欣 杨印辉 赵琳 李劲锋 侯建国 陈基快 王林辉 |
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| 作者单位： | 海军军医大学第一附属医院,第二军医大学附属长海医院,第二军医大学附属长海医院,第二军医大学附属长海医院,海军军医大学海军医学系,第二军医大学附属长海医院,海军军医大学海军医学系,海军军医大学第一附属医院 |
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| 基金项目： | 国家自然科学基金青年科学基金项目，上海市卫生健康委员会临床研究专项青年项目，海军军医大学第一附属医院“深蓝123”军事医学研究专项。 |
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| 摘 要： | 目的 探讨膨胀止血材料在一线战伤救治中的应用价值。
方法 体外物理性能评价中，将聚乙烯醇（PVA）和聚醚酯-氨基甲酸乙酯(PEU)分别置于生理盐水、兔血和生理盐水兔血1:1混合物中，记录两种膨胀止血材料的体积、重量变化及体积压缩一半时所需压强。体内止血性能评价中，构建大鼠股动静脉损伤出血模型和兔肝损伤出血模型，将纱布、PVA和PEU分别置于股动静脉损伤和肝损伤处；观察记录1小时和24小时总出血量、取出止血材料后1分钟出血量、黏连程度和取出难易程度。
结果 PVA在模拟体液中的体积变化系数和体积变化速率大于PEU（p<0.05），PEU在模拟体液中的重量变化系数和体积压缩一半所需压强大于PVA（p<0.05）。动物模型实验中膨胀止血材料置入1小时后，PVA组取出时黏连程度和取出难易程度优于无菌纱布和PEU。PVA在股动静脉出血模型中的1小时总出血量显著低于PEU（p<0.001），PVA在肝损伤出血模型中的1小时总出血量显著高于PEU（p<0.001）；取出止血材料后，无菌纱布组1分钟内可观察到少量出血，PVA和PEU组1分钟内均未观察到活动性出血。膨胀止血材料置入24小时后，PVA组取出时黏连程度和取出难易程度优于无菌纱布，PEU大部分被降解，无法取出。无菌纱布组和PVA组24小时总出血量显差异无统计学意义（p>0.05），PEU组仅观察到少量出血，无法计算出血量；取出止血材料后，所有观察组1分钟内均未观察到活动性出血。PVA附近肌肉组织周边炎细胞浸润量显著低于无菌纱布组和PEU组。
结论 PVA和PEU均可以通过吸收包括血液在内的体液使自身体积膨大控制股动静脉损伤出血和肝损伤出血，为一线战伤救治新装备的研发提供了新的选择。
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| 关 键 词： | 战创伤、肝损伤、股动静脉、膨胀止血材料、聚乙烯醇、 聚醚酯-氨基甲酸乙酯 |
| 收稿时间： | 2023/4/1 0:00:00 |
| 修稿时间： | 2023/6/11 0:00:00 |
Exploration on the application of swelling hemostatic materials in first aid of war trauma |
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| caozhi,luxin,yangyinhui,zhaolin,lijinfeng,houjianguo,chenjikuai and wanglinhui.Exploration on the application of swelling hemostatic materials in first aid of war trauma[J].Academic Journal of Second Military Medical University,2023,44(10). |
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| Authors: | caozhi luxin yangyinhui zhaolin lijinfeng houjianguo chenjikuai and wanglinhui |
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| Affiliation: | he First Affiliated Hospital, Navy Medical University |
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| Abstract: | Objective To explore the feasibility of swelling hemostatic materials in the first-line treatment of war trauma.
Methods In the evaluation of physical properties in vitro, polyvinyl alcohol and polyurethane were placed in the mixture of normal saline, rabbit blood and normal saline rabbit blood at 1:1, and the volume and weight changes of the two swelling hemostatic materials and the pressure required when the volume was compressed in half were recorded. In the evaluation of hemostatic performance in vivo, the rat femoral arteriovenous injury model and rabbit hepatic injury model were established. Gauze, polyvinyl alcohol and polyether-ethyl carboamate were placed in the femoral arteriovenous injury and liver injury respectively. The total amount of blood loss at 1 hour and 24 hours, the amount of blood loss at 1 minute after removing the hemostatic material, the degree of adhesion and the degree of removal difficulty were observed and recorded.
Results The volume change coefficient and volume change rate of polyvinyl alcohol in simulated body fluid were higher than that of polyether ester-ethyl carbamate (p<0.05), the weight change coefficient and the pressure required for half volume compression of polyether ester-ethyl carbamate in simulated body fluids were greater than that of polyvinyl alcohol (p<0.05). In the animal model experiment, the adhesion degree and the difficulty of removing the swelling hemostatic material in the polyvinyl alcohol group was better than that of sterile gauze and polyether ester-ethyl carbamate 1 hour after implantation. The 1-hour total blood loss of polyvinyl alcohol in femoral arteriovenous hemorrhage was significantly lower than that of polyether ester-ethyl carbamate (p<0.001), the 1-hour total blood loss of polyvinyl alcohol in liver injury was significantly higher than that of polyether ester-ethyl carbamate (p<0.001). After the hemostatic material was removed, a small amount of bleeding was observed in the sterile gauze group within 1 minute, while no active bleeding was observed in the polyvinyl alcohol and polyether-ethyl carbamate groups within 1 minute. 24 hours after implantation of the swelling hemostatic material, the degree of adhesion and removal difficulty in the polyvinyl alcohol group was better than that of sterile gauze, and most of the polyether ester-ethyl carbamate was degraded and could not be removed. There was no significant difference in 24-hour total blood loss between the sterile gauze group and the polyvinyl alcohol group (p>0.05), only a small amount of bleeding was observed in the polyether ester-ethyl carbamate group, and the amount of bleeding could not be calculated. After the hemostatic material was removed, no active bleeding was observed in all observation groups within 1 minute. The infiltration amount of proinflammatory cells around muscle tissue near polyvinyl alcohol was significantly lower than that in sterile gauze group and polyether ester-ethyl carbamate group.
Conclusion Both polyvinyl alcohol and polyether ester-ethyl polyurethane can control femoral arteriovenous injury and liver injury by absorbing body fluids including blood to enlarge their own volume, which provides a new choice for the research and development of new equipment for the first-line treatment of war trauma. |
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| Keywords: | war trauma liver injury femoral arteriovenous swelling hemostatic material polyvinyl alcohol polyether ester-ethyl carbamate |
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