Pusateri Anthony E, Modrow Harold E, Harris Richard A, Holcomb John B, Hess John R, Mosebar Robert H, Reid Thomas J, Nelson James H, Goodwin Cleon W, Fitzpatrick Glenn M, McManus Albert T, Zolock David T, Sondeen Jill L, Cornum Rhonda L, Martinez Raul S
US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA.
J Trauma. 2003 Sep;55(3):518-26. doi: 10.1097/01.TA.0000075336.92129.27.
An advanced hemostatic dressing is needed to augment current methods for the control of life-threatening hemorrhage. A systematic approach to the study of dressings is described. We studied the effects of nine hemostatic dressings on blood loss using a model of severe venous hemorrhage and hepatic injury in swine.
Swine were treated using one of nine hemostatic dressings. Dressings used the following primary active ingredients: microfibrillar collagen, oxidized cellulose, thrombin, fibrinogen, propyl gallate, aluminum sulfate, and fully acetylated poly-N-acetyl glucosamine. Standardized liver injuries were induced, dressings were applied, and resuscitation was initiated. Blood loss, hemostasis, and 60-minute survival were quantified.
The American Red Cross hemostatic dressing (fibrinogen and thrombin) reduced (p < 0.01) posttreatment blood loss (366 mL; 95% confidence interval, 175-762 mL) and increased (p < 0.05) the percentage of animals in which hemostasis was attained (73%), compared with gauze controls (2,973 mL; 95% confidence interval, 1,414-6,102 mL and 0%, respectively). No other dressing was effective. The number of vessels lacerated was positively related to pretreatment blood loss and negatively related to hemostasis.
The hemorrhage model allowed differentiation among topical hemostatic agents for severe hemorrhage. The American Red Cross hemostatic dressing was effective and warrants further development.
需要一种先进的止血敷料来增强当前控制危及生命出血的方法。本文描述了一种研究敷料的系统方法。我们使用猪的严重静脉出血和肝损伤模型，研究了九种止血敷料对失血的影响。
使用九种止血敷料之一对猪进行治疗。敷料使用以下主要活性成分：微纤维胶原蛋白、氧化纤维素、凝血酶、纤维蛋白原、没食子酸丙酯、硫酸铝和完全乙酰化的聚-N-乙酰葡糖胺。诱导标准化的肝损伤，应用敷料，并开始复苏。对失血量、止血情况和60分钟生存率进行量化。
与纱布对照组（分别为2973 mL；95%置信区间，1414-6102 mL和0%）相比，美国红十字会止血敷料（纤维蛋白原和凝血酶）减少了（p<0.01）治疗后失血量（366 mL；95%置信区间，175-762 mL），并提高了（p<0.05）实现止血的动物百分比（73%）。没有其他敷料有效。撕裂血管的数量与治疗前失血量呈正相关，与止血呈负相关。
出血模型能够区分用于严重出血的局部止血剂。美国红十字会止血敷料有效，值得进一步研发。
