Pursifull Nathan F, Morris Michael S, Harris Richard A, Morey Allen F
Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78324, USA.
J Trauma. 2006 Feb;60(2):346-50. doi: 10.1097/01.ta.0000202514.96964.85.
We developed a porcine grade 5 renal laceration damage control model to evaluate the hemostatic efficacy of FloSeal gelatin matrix (Baxter Healthcare, Corp., Deerfield, Ill).
Ten commercial swine underwent celiotomy, contralateral nephrectomy, and cooling to 32 degrees C after a well-established hypothermia protocol to simulate a damage control scenario. Following prospective randomization, a complex grade 5 renal injury was uniformly produced on the remaining kidney. Control animals (group 1, n = 5) were treated with direct manual compression with a gelatin sponge. Experimental animals (group 2, n = 5) were treated by application of FloSeal gelatin matrix followed by direct compression with a gelatin sponge. Operative blood loss and efficacy of hemostasis were compared. Creatinine levels were obtained daily until postoperative day 7. Abdominal computed tomography was performed at 10 days.
Use of FloSeal gelatin matrix hemostatic sealant resulted in significantly less mean blood loss than gelatin sponge bolster compression alone (202.4 mL vs. 540.4 mL, respectively, p = 0.016). Hemostasis was complete in 60% (three out of five) of experimental animals after 2 minutes, but was incomplete in all control animals. After an initial increase, serum creatinine approached baseline by postoperative day 7 in all animals. Axial imaging 10 days postoperatively revealed no evidence of significant delayed perirenal hemorrhage.
FloSeal gelatin matrix performed well as a rapidly deployable, effective hemostatic agent in a hypothermic grade 5 renal injury damage control model. The absence of delayed bleeding and nephrotoxicity suggests a possible increased role for FloSeal in the treatment of devastating renal injuries in damage control surgery.
我们建立了猪5级肾裂伤损伤控制模型，以评估弗洛塞尔明胶基质（百特医疗保健公司，伊利诺伊州迪尔菲尔德）的止血效果。
10头商用猪接受剖腹术、对侧肾切除术，并按照既定的低温方案冷却至32摄氏度，以模拟损伤控制场景。经过前瞻性随机分组后，在剩余的肾脏上均匀造成复杂的5级肾损伤。对照动物（第1组，n = 5）用明胶海绵直接手动压迫治疗。实验动物（第2组，n = 5）先应用弗洛塞尔明胶基质，然后用明胶海绵直接压迫治疗。比较手术失血量和止血效果。每天测定肌酐水平，直至术后第7天。术后10天进行腹部计算机断层扫描。
使用弗洛塞尔明胶基质止血密封剂导致的平均失血量明显少于单独使用明胶海绵支撑压迫（分别为202.4 mL和540.4 mL，p = 0.016）。2分钟后，60%（5头中的3头）的实验动物止血完成，但所有对照动物的止血均不完全。在最初升高后，所有动物的血清肌酐在术后第7天接近基线水平。术后10天的轴向成像显示没有明显延迟性肾周出血的迹象。
在低温5级肾损伤损伤控制模型中，弗洛塞尔明胶基质作为一种可快速部署的有效止血剂表现良好。无延迟出血和肾毒性表明弗洛塞尔在损伤控制手术中治疗严重肾损伤方面可能发挥更大作用。
