Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2011 May;124(9):1352-6.
The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound (CEUS) is one of the hottest research topic. Gelatin/thrombin/calcium (GTC) was developed as a novel haemostatic agent for non-operable intra-abdominal trauma. We hypothesized that GTC can achieve haemostasis (without the use of pressure) within a short time in a large wound model by percutaneous injection under CEUS guidance.
Forty Wister rats received large liver injuries by haemostatic clamp and were randomly divided into four groups, according to the haemostatic agent used. These included normal saline (NS) group A, lyophilising thrombin powder (LTP) group B, GTC group C, and absorbable α-cyanoacrylate (ACNA) group D. Each injury site was treated with one of the above materials and total bleeding time was recorded. All liver wounds were evaluated using CEUS at three periods: pre-injury, injury and post-treatment. The liver wounds were also evaluated by histology 3, 6, and 9 days after injury and the extents of abdominal adhesions were recorded.
The sensitivity of CEUS (100%) in detecting blunt traumatic liver lesions was significantly higher than conventional ultrasound (42.5%). Bleeding times at the injury site in the GTC group C ((129.3 ± 14.0) seconds) and ACNA group D ((5.2 ± 1.0) seconds) were significantly shorter than those in the NS group A ((369.5 ± 48.8) seconds, P < 0.01) and LTP group B ((324.7 ± 52.22) seconds, P < 0.01). The LTP group B showed no significant difference compared with the NS group A. Gross examination of liver tissue revealed that there were fewer intra-abdominal adhesions in the GTC group C (10%) than in the ACNA group D (100%). Histopathologic examination showed that GTC was completely absorbed after nine days.
GTC, delivered by percutaneous injection under CEUS, may achieve haemostasis (without the use of pressure) within a short time in a large wound model. GTC is absorbable and may prevent intra-abdominal adhesions. Therefore, it may be the optimal choice for first aid treatment of large abdominal wounds in the setting of blunt trauma.
在腹部创伤中，非手术治疗对比增强超声（CEUS）是研究热点之一。明胶/凝血酶/钙（GTC）是一种新型的非手术治疗腹腔内出血的止血剂。我们假设 GTC 可以在 CEUS 引导下经皮注射，在短时间内实现大伤口模型中的止血（无需加压）。
40 只 Wistar 大鼠采用止血夹造成肝脏大创伤，随机分为四组，根据使用的止血剂不同分为生理盐水（NS）组 A、冻干凝血酶粉（LTP）组 B、GTC 组 C 和可吸收α-氰基丙烯酸酯（ACNA）组 D。每组用上述材料之一处理一个损伤部位，并记录总出血时间。在损伤前、损伤时和治疗后三个时期分别使用 CEUS 对所有肝损伤进行评估。肝损伤还在损伤后 3、6 和 9 天进行组织学评估，并记录腹部粘连程度。
CEUS（100%）检测钝性肝损伤的敏感性明显高于常规超声（42.5%）。GTC 组 C（129.3 ± 14.0）秒和 ACNA 组 D（5.2 ± 1.0）秒的损伤部位出血时间明显短于 NS 组 A（369.5 ± 48.8）秒和 LTP 组 B（324.7 ± 52.22）秒，P<0.01）。LTP 组 B 与 NS 组 A 相比无显著差异。肝组织大体检查发现，GTC 组 C（10%）的腹腔内粘连明显少于 ACNA 组 D（100%）。组织病理学检查发现，GTC 在 9 天后完全吸收。
GTC 在 CEUS 引导下经皮注射可在短时间内在大伤口模型中实现止血（无需加压）。GTC 可吸收，可预防腹腔内粘连。因此，它可能是钝性腹部创伤大伤口急救治疗的最佳选择。
