Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.
Adv Mater. 2018 Jan;30(4). doi: 10.1002/adma.201700859. Epub 2017 Nov 22.
Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed.
创伤、手术以及先天性、疾病相关或药物诱导的血液疾病引起的出血并发症可导致平民和军人的重大发病率和死亡率。因此，止血（止血）在预防、手术和紧急情况下具有至关重要的临床意义。对于外部可触及的损伤，各种天然和合成生物材料已经进行了大量研究，导致了包括胶水、绷带、填塞物、止血带、敷料和促凝血粉在内的止血技术。相比之下，对内非可压缩性出血的治疗仍然严重依赖于全血或血液止血成分（血小板、纤维蛋白原和凝血因子）的输注。血小板输注存在着可用性有限、成本高、污染风险、货架寿命短、便携性低、性能可变性和免疫副作用等重大挑战，而纤维蛋白原或凝血因子的使用仅为止血提供了部分机制。考虑到这些因素，人们进行了大量跨学科的研究，致力于开发方便制造、消毒以最小化污染和延长货架寿命、并可通过静脉内给药以模拟、利用和放大生理止血机制的材料和技术。在此，全面综述了各种局部、腔室内和静脉内止血技术的材料、机制和最新进展，并讨论了有助于该领域发展的挑战和机遇。
