Lewis Kevin M, Atlee Holly, Mannone Angela, Lin Lawrence, Goppelt Andreas
Baxter Healthcare Corporation, Deerfield, Illinois.
H Atlee Consulting, Baltimore, Maryland.
J Surg Res. 2015 Feb;193(2):825-30. doi: 10.1016/j.jss.2014.08.026. Epub 2014 Aug 22.
Microporous Polysaccharide Hemospheres (MPH) are a new plant-derived polysaccharide powder hemostat. Previous studies investigated MPH as a replacement to nonflowable hemostatic agents of different application techniques (e.g., oxidized cellulose, collagen); therefore, the purpose of this study was to determine if MPH is a surrogate for flowable hemostatic agents of similar handling and application techniques, specifically a flowable thrombin-gelatin hemostatic matrix.
Hemostatic efficacy was compared using a heparinized porcine abrasion model mimicking a capsular tear of a parenchymal organ. MPH (ARISTA, 1 g) and hemostatic matrix (Floseal, 1 mL) were applied, according to a randomized scheme, to paired hepatic abrasions (40 lesions per group). Hemostatic success, control of bleeding, and blood loss were assessed 2, 5, and 10 min after treatment. Hemostatic success and control of bleeding were analyzed using odds ratios and blood loss using mean differences.
Hemostatic matrix provided superior hemostatic success relative to MPH at 5 (odds ratio: 0.035, 95% confidence interval: 0.004-0.278) and 10 min (0.032, 0.007-0.150), provided superior control of bleeding at 5 (0.006, <0.001-0.037) and 10 min (0.009, 0.001-0.051), and had significantly less blood loss at 5 (mean difference: 0.3118 mL/min, 95% confidence interval: 0.0939-0.5296) and 10 min (0.5025, 0.2489-0.7561).
These findings corroborate other MPH investigations regarding its low-level efficacy and suggest that MPH is not an appropriate surrogate for hemostatic matrix despite similar application techniques. The lack of a procoagulant within MPH may likely be the reason for its lower efficacy and need for multiple applications.
微孔多糖微球（MPH）是一种新型的植物源性多糖粉末止血剂。以往的研究将MPH作为不同应用技术（如氧化纤维素、胶原蛋白）的不可流动止血剂的替代品进行了研究；因此，本研究的目的是确定MPH是否可替代具有相似操作和应用技术的可流动止血剂，特别是可流动的凝血酶-明胶止血基质。
使用模拟实质器官包膜撕裂的肝素化猪擦伤模型比较止血效果。按照随机方案，将MPH（ARISTA，1 g）和止血基质（Floseal，1 mL）应用于成对的肝脏擦伤（每组40个损伤）。在治疗后2、5和10分钟评估止血成功率、出血控制情况和失血量。使用优势比分析止血成功率和出血控制情况，使用平均差异分析失血量。
在5分钟（优势比：0.035，95%置信区间：0.004-0.278）和10分钟（0.032，0.007-0.150）时，止血基质的止血成功率优于MPH；在5分钟（0.006，<0.001-0.037）和10分钟（0.009，0.001-0.05）时，止血基质对出血的控制效果更好；在5分钟（平均差异：0.3118 mL/分钟，95%置信区间：0.0939-0.5296）和10分钟（0.5025，0.2489-0.7561）时，止血基质的失血量显著更少。
这些发现证实了其他关于MPH低水平疗效的研究，并表明尽管应用技术相似，但MPH不是止血基质的合适替代品。MPH中缺乏促凝血剂可能是其疗效较低且需要多次应用的原因。
