Chang H, Wu G J, Perng W L, Hwang F Y, Hung C R
Department of Surgery, National Taiwan University Hospital, Taipei, R.O.C.
J Formos Med Assoc. 1992 Jun;91(6):601-7.
In order to decrease complications following incomplete hemostasis, we tried to make a safe, efficient and highly concentrated fibrin glue by thawing single-donor fresh frozen plasma. Using a unique animal model, in which arterial bleeding was created, fibrin glue and some related hemostatic agents were tested to evaluate their hemostatic effectiveness. The results demonstrated that: 1) the concomitant use of cryoprecipitate-thrombin tissue glue with adjuvant (aprotinin or calcium chloride) had a better hemostatic effect than the use of cryoprecipitate-thrombin tissue glue alone (p < 0.05); 2) impregnation of fibrin glue with a suitable vehicle was advisable to accelerate the coagulation plug formation and to enhance the mechanical strength of the adhesive plug; 3) Gelform, used as a vehicle to hold the fibrin glue, had a more efficient hemostatic effect than gauze, collagen fleece and Surgicel (p < 0.05); 4) systemic heparinization attenuated the effectiveness of the hemostatic agents and aggravated the bleeding problem, but a low hematocrit level did not; 5) fibrin glue had its own limitations, especially under systemic heparinization, on hemostatic effectiveness in a high-pressure system. Understanding the characteristics of fibrin glue, as mentioned above, definitely improved the hemostatic effectiveness of the glue, especially after failure of the usual methods of controlling bleeding.
为了减少不完全止血后的并发症,我们尝试通过解冻单供体新鲜冰冻血浆来制备一种安全、高效且高浓度的纤维蛋白胶。使用一种独特的动物模型(在该模型中制造动脉出血),对纤维蛋白胶和一些相关止血剂进行测试以评估它们的止血效果。结果表明:1)冷沉淀-凝血酶组织胶与佐剂(抑肽酶或氯化钙)联合使用比单独使用冷沉淀-凝血酶组织胶具有更好的止血效果(p < 0.05);2)用合适的载体浸渍纤维蛋白胶有利于加速凝血块形成并增强粘附性凝块的机械强度;3)用作容纳纤维蛋白胶载体的Gelform比纱布、胶原绒和外科用纤维素具有更有效的止血效果(p < 0.05);4)全身肝素化会减弱止血剂的效果并加重出血问题,但低血细胞比容水平则不会;5)纤维蛋白胶有其自身局限性,尤其是在全身肝素化情况下,在高压系统中的止血效果受限。了解上述纤维蛋白胶的特性,无疑提高了该胶的止血效果,尤其是在常规止血方法失败后。