Fiss Ingo, Danne Marco, Stendel Ruediger
Department of Neurosurgery, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Neurol Med Chir (Tokyo). 2007 Oct;47(10):462-7. doi: 10.2176/nmc.47.462.
The present study evaluated the hemostatic efficacy and handling of gelatin-thrombin matrix hemostatic sealant during intracranial procedures. A retrospective analysis of 478 consecutive patients undergoing intracranial procedures identified seven patients with acute intense or persistent intraoperative bleeding which could not be arrested in time by standard hemostatic methods. The efficacy of gelatin-thrombin matrix was assessed by determining bleeding severity before and after application, time to hemostasis, amount of gelatin-thrombin matrix necessary, need for additional hemostatic measures, and need for reoperation to control hemorrhage. Immediate hemostasis was achieved in five of seven patients. Two of these five patients had abnormal clotting parameters. Cessation of bleeding was achieved by additionally applying either fibrinogen or gelatin sponge to the bleeding site in the other two patients. No complications attributable to gelatin-thrombin matrix use were recorded. The gelatin-thrombin matrix was ready to use within 1 minute in every case. Gelatin-thrombin matrix appears to be an effective, easy-to-use, and readily available hemostatic agent for cranial neurosurgery. Combination with fibrinogen is recommended in special situations.
本研究评估了明胶-凝血酶基质止血密封剂在颅内手术中的止血效果及操作情况。对478例连续接受颅内手术的患者进行回顾性分析，发现7例患者术中出现急性剧烈或持续性出血，采用标准止血方法无法及时止血。通过确定应用明胶-凝血酶基质前后的出血严重程度、止血时间、所需明胶-凝血酶基质的量、是否需要额外的止血措施以及是否需要再次手术控制出血，来评估明胶-凝血酶基质的疗效。7例患者中有5例立即实现止血。这5例患者中有2例凝血参数异常。另外2例患者通过在出血部位额外应用纤维蛋白原或明胶海绵实现止血。未记录到与使用明胶-凝血酶基质相关的并发症。明胶-凝血酶基质在每种情况下均能在1分钟内准备好使用。明胶-凝血酶基质似乎是一种用于颅脑神经外科手术的有效、易用且随时可用的止血剂。特殊情况下建议与纤维蛋白原联合使用。
