Dickneite G, Metzner H, Nicolay U
Preclinical Pharmacology and Toxicology, Aventis Behring, Postfach 1230, Marburg, D-35002, Germany.
J Surg Res. 2000 Oct;93(2):201-5. doi: 10.1006/jsre.2000.5985.
Suture hole bleeding is a frequent complication in vascular surgery. The use of fibrin sealants (FSs) during surgery is reported to reduce blood loss by enhancing hemostasis.
Using a pig vascular graft model we investigated: (1) the use of FSs in vascular surgery and measured blood loss with and without the use of FSs; (2) the effect of factor XIII in FSs on hemostasis and blood loss; and (3) the effect of increasing FS incubation time on hemostasis and blood loss.
During surgery, a 3-cm incision was made in the carotid artery wall. Incisions were covered with a Gore-Tex (PTFE) patch sutured with Ethicon monofil 5/0 or 3/0. The resulting suture holes were treated according to study protocol. Study 1: Nine pigs received either FS treatment (n = 5) or no treatment (n = 4). Study 2: Twenty pigs underwent bilateral surgery; right (n = 20) and left (n = 20) patches received either FS with factor XIII (FS + FXIII) or FS depleted of factor XIII (FS - FXIII). Study 3: Bilateral surgery was carried out on 24 pigs; PFTE patches secured with Ethicon 3/0 were treated with FS and allowed to polymerize for 120 s (n = 12), 180 s (n = 12), or 240 s (n = 12) or with solid support/thrombin (n = 12).
Study 1: Mean blood loss was significantly lower in the FS-treated group compared with untreated controls (9.2 +/- 10.6 mL vs 178.8 +/- 125.5 mL, mean +/- SD, P = 0.016). Study 2: Significantly less blood was lost in the FS + FXIII group than in the FS - FXIII group (Delta = 9.6 mL, P = 0. 02). Study 3: Blood loss was significantly higher from patches treated with solid support/thrombin compared with those treated with FS (P < 0.01).
FSs containing factor XIII, such as Beriplast P, are effective in reducing suture hole bleeding and improving hemostasis during vascular graft procedures. The presence of factor XIII contributes to the efficacy of FSs and reduces the time to hemostasis. During vascular surgery, blood loss can be reduced significantly by the use of fibrin sealant compared with absorbable gelatin sponges coated with thrombin.
缝线孔出血是血管外科手术中常见的并发症。据报道，手术中使用纤维蛋白封闭剂（FSs）可通过增强止血作用来减少失血。
我们使用猪血管移植模型进行了以下研究：（1）在血管外科手术中使用FSs，并测量使用和不使用FSs时的失血量；（2）FSs中因子XIII对止血和失血量的影响；（3）增加FS孵育时间对止血和失血量的影响。
手术过程中，在颈动脉壁上做一个3厘米的切口。切口用Gore-Tex（聚四氟乙烯）补片覆盖，并用Ethicon单丝5/0或3/0缝线缝合。根据研究方案处理由此产生的缝线孔。研究1：9头猪接受FS治疗（n = 5）或不治疗（n = 4）。研究2：20头猪接受双侧手术；右侧（n = 20）和左侧（n = 20）补片分别接受含因子XIII的FS（FS + FXIII）或不含因子XIII的FS（FS - FXIII）。研究3：对24头猪进行双侧手术；用Ethicon 3/0固定的聚四氟乙烯补片分别用FS处理，并使其聚合120秒（n = 12）、180秒（n = 12）或240秒（n = 12），或用固体支持物/凝血酶处理（n = 12）。
研究1：与未治疗的对照组相比，FS治疗组的平均失血量显著更低（9.2±10.6毫升对178.8±125.5毫升，平均值±标准差，P = 0.016）。研究2：FS + FXIII组的失血量明显少于FS - FXIII组（差值 = 9.6毫升，P = 0.02）。研究3：与用FS处理的补片相比，用固体支持物/凝血酶处理的补片失血量显著更高（P < 0.01）。
含因子XIII的FSs，如百普素，在减少血管移植手术中缝线孔出血和改善止血方面是有效的。因子XIII的存在有助于FSs的疗效并减少止血时间。在血管外科手术中，与涂有凝血酶的可吸收明胶海绵相比，使用纤维蛋白封闭剂可显著减少失血量。
