摘要
目的探讨以高岭土和壳聚糖作为主要止血成分的两种国产新型止血敷料在紧急止血中的应用效果和止血机制。方法构建兔股动脉离断出血模型,分别以高岭土止血敷料(高岭土组)、壳聚糖止血敷料(壳聚糖组)和医用纱布(医用纱布组)进行压迫止血。比较3组兔的止血时间和出血量;对3组兔行患肢屈伸和抬高实验,评估止血稳定性;观察记录3组兔24 h存活率。剪取高岭土止血敷料、壳聚糖止血敷料和医用纱布小样,从兔耳缘静脉采血,记录不同止血敷料使3、6 ml新鲜血液在体外凝固的时间;另制备肝素抗凝血,测试不同止血敷料小样能否使3、6 ml抗凝血在体外凝固,记录凝血时间;用磷酸盐缓冲液(phosphate buffer saline,PBS)浸泡处理不同止血敷料小样,将浸提液以1:10比例加入新鲜采集的静脉血,利用流式细胞术测试3组止血敷料的血小板活化情况。结果高岭土组和壳聚糖组兔的止血时间及出血量均显著低于医用纱布组(P均<0.05),其中高岭土组和壳聚糖组兔在出血量和止血时间上各有优势,但差异无统计学意义(P>0.05)。高岭土组和壳聚糖组兔的总再出血发生率分别为0.00%和12.50%,均低于医用纱布组(37.50%)。止血并缝合创口后,3组兔24 h存活率均为100%。在体外凝血实验中,使3 ml新鲜血液体外凝固的时间从快到慢依次为壳聚糖止血敷料、高岭土止血敷料和医用纱布,各组间差异有统计学意义(P均<0.05);使6 ml新鲜血液体外凝固的时间从快到慢依次为高岭土止血敷料、壳聚糖止血敷料和医用纱布,各组间差异有统计学意义(P均<0.05)。壳聚糖止血敷料能使抗凝血凝固,高岭土止血敷料和医用纱布无法使抗凝血凝固。流式细胞术分析显示,血小板活化标志物活化血小板糖蛋白Ⅱb/Ⅲa复合体(activated platelet glycoprotein Ⅱb/Ⅲa complex,PAC1)和CD62p阳性率从高到低依次为高岭土组、壳聚糖组和医用纱布组;其中,高岭土组PAC1和CD62p双阳性率高达89.00%。结论两种国产新型止血敷料在兔股动脉离断出血模型中均展现出了良好的止血性能,且安全性良好;其中高岭土止血敷料能够有效激活血小板实现快速止血,壳聚糖止血敷料则能够高效吸液形成凝胶状血凝块通过物理封堵发挥止血效果,二者均具备临床应用潜力。
Objective To explore the efficacy and hemostatic mechanism of two domestically produced novel hemostatic dressings based on kaolin and chitosan in emergency hemorrhage control.Methods Rabbit femoral artery transection hemorrhage models were constructed,and hemostasis was performed by compression using kaolin-based hemostatic dressing(kaolin group),chitosan-based hemostatic dressing(chitosan group)and medical gauze(gauze group)respectively.The hemostatic time and blood loss of rabbits were compared among 3 groups;limb flexion-extension and elevation tests were performed to assess hemostatic stability;the 24 h survival rate of rabbits was observed and recorded among 3 groups.Small samples of the kaolin-based hemostatic dressing,chitosan-based hemostatic dressing and medical gauze were sheared and collected;fresh blood(3 ml and 6 ml)was collected from the auricular veins of rabbits,and the in vitro coagulation times induced by different dressings were recorded;heparinized blood was also prepared to test whether the different dressings samples could clot 3 ml and 6 ml of anticoagulated blood,with the coagulation times recorded;samples of the dressings were soaked in phosphate buffer saline(PBS),and the extracts were mixed with freshly collected venous blood at 1:10 ratio respectively,after which flow cytometry was employed to test platelet activation of hemostatic dressings among 3 groups.Results Rabbits in kaolin and chitosan groups showed significantly shorter hemostasis times and lower blood loss compared to the gauze group(all P<0.05),and the kaolin group and chitosan group eath had advantages in bleeding volume and hemostasis time respetively,however,the difference was not statistically significant(P>0.05).The rebleeding rates of rabbits in kaolin and chitosan groups were 0.00%and 12.50%respectively,both lower than the gauze group(37.50%).After hemostasis and wound suture,the survival rate of rabbits in the 3 groups at 24 h was 100%.In in vitro coagulation tests,chitosan-based hemostatic dressing achieved the fastest clotting time for 3 ml fresh blood,followed by kaolin-based hemostatic dressing and medical gauze,with significant differences among the groups(all P<0.05);for 6 ml blood,the clotting time from fast to slow was:kaolin-based hemostatic dressing,chitosan-based hemostatic dressing and medical gauze,and there were significant differences among the groups(all P<0.05).Chitosan-based hemostatic dressing induced coagulation in heparinized blood,while kaolin-based hemostatic dressing and medical gauze failed.Flow cytometry analysis showed that the positive rates of platelet activation biomarkers,activated platelet glycoprotein Ⅱb/Ⅲa complex(PAC1)and CD62p,descended in the order of kaolin group,chitosan group and gauze group;among which,the double-positive rate of PAC1 and CD62p in the kaolin group reached as high as 89.00%.Conclusion Both domestically produced novel hemostatic dressings exhibit excellent hemostatic performance and favorable safety in the rabbit femoral artery transection hemorrhage model.Specifically,the kaolin-based hemostatic dressing effectively activates platelets to achieve rapid hemostasis,while the chitosan-based dressing efficiently absorbs fluid to form gel-like blood clots that exerts hemostatic effects through physical occlusion,both dressings exhibit significant potential for clinical application.
作者
王刚
叶城辰
何安妮
刁波
WANG Gang;YE Chengchen;HE Anmi;DIAO Bo(Basic Medical Laboralory,General Hospital of the Central Theater Command,Wuhan Hubei 430070,China)
出处
《联勤军事医学》
2025年第4期280-285,共6页
Military Medicine of Joint Logistics
基金
中部战区总医院“三英一队”人才工程(第一批)(1674)。
关键词
高岭土
壳聚糖
止血敷料
医用纱布
抗凝效果
紧急止血
Kaolin
Chitosan
Hemostatic dressing
Medical gauze
Effect of anticoagulation
Emergency hemostasis
作者简介
通信作者:刁波,E-mail:dpitao@163.com。
