目的观察S100吸收性止血绫（absorbable stanching satin S100，ASS）在肝脏外科的止血效果。方法将40例择期行肝部分切除术的患者随机分成两组，应用ASS贴敷肝断面为ASS组（n=20），肝断面不用任何局部止血材料为对照组（n=20），分别于术后2 h、12 h、24 h及72 h观察腹腔引流情况，其中重点观察引流量。结果ASS组术后腹腔引流量较对照组明显减少，差异有显著性意义（P＜0.01）;ASS组术后无漏胆发生，对照组术后有2例发生漏胆; ASS组的腹腔引流管拔管时间及平均住院日均小于对照组，但差异无显著性意义（Pgt;0.05）。结论ASS在肝脏部分切除术中具有安全、有效的止血作用，特别是对于伴有凝血机能障碍的患者。
Objective To prepare a self-made compound, hemostatic jelly with polylactic acid(PLA), which has the hemostatic and absorbable effect on injured cancellous bone. Methods Two bone defects of 5 mm in diameter and 4 mm in depth were subjected on 20 health rabbits by drilling through their either outside plate of the iliac, and were filled with hemostatic jelly(group A), bone wax(group B) and blank(group C) respectively. Hemostasis were observed and recorded after 1 and 10 minutes. Five specimens were harvested at 2, 4, 8 and 12 weeks postoperatively for histological observation. Results ① Hemostatic effect: Bleeding of injured spongy bone stopped within 10 minutes after the treatment of hemostatic jelly and bone wax, but bleeding of balnk did not stop. Hemostatic jelly and bone wax adhered to bone defects firmly within 10 minutes was after the treatment. ② Absorbable effect: Hemostatic jelly and bone defects have not changed visibly in the first 2 weeks. With histological observation 4 to 8 weeks after the operation, hemastatic jelly was absorbed gradually and replaced by osteogenous tissue. It was absorbed completely after 8 to 12 weeks. Bone wax was not absorbed after 12 weeks, no new bone tissue was observed at bone wax area. The blank was replaced by connective tissue and osteogenous tissue partially after 12 weeks. Conclusion The compound hemostatic jelly manifests both hemostatic and absorbable effects on injured cancellous bone and may substitute for bone wax in clinical application.
Objective To improve the flexibil ity and hemostatic properties of chitosan (CS)/carboxymethyl chitosan (CMCS) hemostatic membrane by using glycerol and etamsylate to modify CS/CMCS hemostatic membrane. To investigate themechanical properties and hemostatic capabil ity of modified CS/CMCS hemostatic membrane. Methods The 2% CS solution, 2% CMCS solution, 10%, 15%, 20%, 25%, 30% glycerol with or without 0.5% etamsylate were used to prepare CS/CMCS hemostatic membrane with or without etamsylate by solution casting according to ratio of 16 ∶ 4 ∶ 5. The tensile properties were evaluated by tensile test according to GB 13022-1991. Twenty venous incisions and five arterial incisions hemorrhage of 1 cm × 1 cm in rabbit ears were treated by CS/CMCS hemostatic membrane modified by 15% (group A) and 25% (group B) of glycerol, and a combination of them and 0.5% etamsylate (groups C and D). The bleeding time and blood loss were recorded. Results The pH of yellow CS/ CMCS hemostatic membrane with thickness of 30-50 μm was 3-4. The incorporation glycerol into CS/CMCS hemostatic membrane resulted in decreasing in tensile strength (7.6%-60.2%) and modulus (97%-99%). However, elongation at break and water content increased 5.7-11.6 times and 13%-125% markedly. CS/CMCS hemostatic membrane adhered to wound rapidly, absorbed water from blood and became curly. The bleeding time and blood loss of venous incisions were (70 ± 3) seconds and (117.2 ± 10.8) mg, (120 ± 10) seconds and (121.2 ± 8.3) mg, (52 ± 4) seconds and (98.8 ± 5.5) mg, and (63 ± 3) seconds and (90.3 ± 7.1) mg in groups A, B, C, and D, respectively; showing significant differences (P lt; 0.05) between groups A, B and groups C, D. The bleeding time and blood loss of arterial incision were (123 ± 10) seconds and (453.3 ± 30.0) mg in group C. Conclusion CS/CMCS hemostatic membrane modified by glycerol and etamsylate can improve the flexibil ity, and shorten the bleeding time.
In order to explore the effect of Sipunculus nudus extract (SNE) on skin wound healing in mice and its mechanism, hemostasis effect of SNE was measured, the mouse skin wound model was established by full-thickness excision. The morphological changes of the wound were observed after the treatment with SNE and the healing rate was measured. The changes of wound histology were observed by hematoxylin eosin (HE) staining, Masson staining and transmission electron microscope (TEM). The expression of cell factors and related proteins was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Results showed that the SNE possessed hemostatic function. SNE could obviously improve the healing rate of wound in mouse and shorten time of scab removal compared with the none-treatment (NT) group (P < 0.05).The pathological histology analysis results showed complete epidermal regeneration, with remarkable capillary and collagen fiber observed in the SNE group. The expression level of tumor necrosis factor-α (TNF -α), interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) in SNE group was significantly lower than that of the NT group on 7 d (P < 0.05). Moreover, compared with the NT group, the gene expressions level of Smad7 was significantly increased and the level of type II TGF-β receptors (TGF-βRII), collagen I (COL1A1) and α-smooth muscle actin (α-SMA) were significantly reduced in the SNE group on 28 d (P < 0.05), but the difference was not statistically significant compared to Yunnanbaiyao group (PC group) (P > 0.05). These results indicated that SNE possessed obvious activity of accelerating wound healing and inhibiting scar formation, and its mechanism was closely related to hemostatic function, regulation of inflammatory factors, collagen deposition, collagen fiber remodeling and intervening TGF-β/Smads signal pathway. Therefore, SNE may have promising clinical applications in skin wound repair and scar inhibition.
Objective To investigate the effect of applying a tourniquet on perioperative blood loss and short-term effectiveness in primary total knee arthroplasty (TKA). Methods A total of 94 patients (94 knees) with osteoarthritis underwent primary TKA between September 2010 and December 2011, whose data met the inclusion criteria and were retrospectively analyzed. A tourniquet was used in 51 cases (group A), no tourniquet in 43 cases (group B). There was no significant difference in gender, age, affected side, body mass index, preoperative hemoglobin (Hb) level, range of motion (ROM), visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups (P gt; 0.05). The data were compared between 2 groups, including hematocrit (Hct), Hb, hidden blood loss, dominant blood loss, theoretical total blood loss, the operation time, hospitalization days, increasing rate of circumference length above 10 cm of the knee, VAS score, ROM, HSS score, and WOMAC score. Results Four cases (7.84%) of group A and 1 case (2.33%) of group B received blood transfusions, showing no significant difference (χ2=1.410, P=0.235). There was no significant difference in the Hb and Hct between 2 groups at 2 days after operation (P gt; 0.05). The dominant blood loss of group A was significantly less than that of group B (P lt; 0.05), while the hidden blood loss of group A was significantly more than that of group B (P lt; 0.05), but there was no significant difference in theoretical total blood loss between 2 groups (t=0.662, P=0.510). The operation time, hospitalization days, and VAS score at 3 days showed no significant difference between 2 groups (P gt; 0.05). The wound healed by first intention after operation without related complication. At 3 days after operation, the increasing rate of circumference length above 10 cm of the knee in group A was significantly higher than that of group B (t=9.435, P=0.000), but no significant difference at 7 days (t=0.462, P=0.645). At 3 and 5 days after operation, the ROM values in group B were significantly larger than those of group A (P lt; 0.05), but no significant difference at 7 days (t= — 1.279, P=0.204). The patients were all followed up 12-18 months (mean, 14.3 months). There was no significant difference in the HSS score between 2 groups at 1 year after operation (t=0.952, P=0.344), but significant difference was found in the WOMAC score between 2 groups (t= — 2.488, P=0.015). The X-ray films showed that the prosthesis was in good position, without loosening, subsidence, or osteolysis. Conclusion Application of a tourniquet in TKA increases hidden blood loss, and there is no obvious advantage in reducing transfusion rate compared with the non-tourniquet group, so it is recommended to reduce the time and pressure of the tourniquet for patients with high-risk of thrombosis.
Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.