Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
J Surg Res. 2021 Jul;263:176-185. doi: 10.1016/j.jss.2020.12.040. Epub 2021 Mar 3.
This work sought to (1) establish a reliable gunshot model of junctional femoral artery rupture in swine that accurately simulates field rescue conditions and (2) use the gunshot model to compare the efficacy and ease of application of zeolite nanometer hemostatic gauze with other hemostatic materials.
Thirty-six healthy landrace swine (body weight 50 ± 5 kg) were randomly divided into three groups which were treated with Combat Gauze (CG), FeiChuang hemostatic gauze (FG), or standard medical gauze (SG). A gunshot model of femoral artery hemorrhage in landrace swine was used with portable ultrasound to accurately position the wound. After the shooting, when mean arterial pressure of swine decreased by at least 30% for 10 s, wounds were pressed with standard packing (39 g) of gauze materials for 3 min to stop bleeding, then bandaged with pressure. Blood samples were taken 15 min before injury, then 10 min, 30 min, and 60 min after injury to determine hemodynamic, coagulation, and arterial blood gas indexes. Wound temperatures were taken at 5 min, 10 min, 30 min, and 60 min after injury, and survival times were recorded. The volume of blood loss and survival time were used to evaluate hemostatic effect, whereas the fill time, wound temperature, and physiological indexes were used to evaluate the safety and operation of the product.
The CG (11.15 ± 3.09 mL/kg) and FG (12.19 ± 3.5 mL/kg) groups had significantly less blood loss than the SG group (16.8 ± 5.14 mL/kg) (P = 0.04; P = 0.039, respectively). After gauze packing, bleeding in CG (5.85 ± 1.17 mL/kg) and FG (5.37 ± 0.93 mL/kg) groups remained significantly lower than that of the SG group (6.93 ± 1.03 mL/kg) (P = 0.011; P = 0.003, respectively). Wound temperature rose with time for all groups (P < 0.001). The wound temperatures in the FG group and the CG group were significantly higher than that of the SG group (P = 004 and 0.009, respectively). Survival rates and times were not significantly different among the three groups, although the FG group had the longest average survival time (standard deviation [SD] 204.8 s), compared with the SG group (SD 177.8 s) and CG (SD 187.5 s) groups. No significant differences in hemodynamics, blood gas, and coagulation were observed among the three groups.
The gunshot model of junctional femoral arterial hemorrhage guided by ultrasound had high accuracy for femoral arterial rupture by bullet wound and provided consistent and reproducible field-simulation conditions for comparison of hemostatic materials. FeiChuang zeolite hemostatic gauze effectively controlled bleeding as well as combat gauze, without excessive heat as found in other zeolite-based products. However, improvements to application technique, such as a packing device, are needed to improve operating time.
本研究旨在（1）建立一种可靠的股动脉交界处破裂的枪伤模型，该模型能够准确模拟野外救援条件；（2）利用枪伤模型比较沸石纳米止血纱布与其他止血材料的疗效和应用便利性。
36 头健康长白猪（体重 50±5kg）随机分为三组，分别用战斗纱布（CG）、菲创止血纱布（FG）和标准医用纱布（SG）治疗。使用便携式超声定位股动脉出血的长白猪枪伤模型。枪击后，当猪的平均动脉压下降至少 30%持续 10s 时，用标准包扎（39g）的纱布材料按压伤口 3min 止血，然后加压包扎。在损伤前 15min、损伤后 10min、30min 和 60min 取血样，测定血流动力学、凝血和动脉血气指标。在损伤后 5min、10min、30min 和 60min 测量伤口温度，记录存活时间。通过出血量和存活时间评估止血效果，通过填充时间、伤口温度和生理指标评估产品的安全性和操作性。
CG（11.15±3.09mL/kg）和 FG（12.19±3.5mL/kg）组的出血量明显少于 SG 组（16.8±5.14mL/kg）（P=0.04；P=0.039）。在纱布包扎后，CG（5.85±1.17mL/kg）和 FG（5.37±0.93mL/kg）组的出血仍然明显低于 SG 组（6.93±1.03mL/kg）（P=0.011；P=0.003）。所有组的伤口温度随时间升高（P<0.001）。FG 组和 CG 组的伤口温度明显高于 SG 组（P=0.004 和 0.009）。三组的存活率和存活时间无显著差异，尽管 FG 组的平均存活时间最长（标准差[SD]204.8s），与 SG 组（SD177.8s）和 CG 组（SD187.5s）相比。三组的血流动力学、血气和凝血无显著差异。
超声引导的股动脉交界处枪击伤模型对股动脉破裂的动脉有较高的准确性，为比较止血材料提供了一致且可重复的现场模拟条件。菲创沸石止血纱布与战斗纱布一样能有效控制出血，且没有其他沸石基产品那样的过热现象。然而，需要改进包装技术等应用技术，以缩短操作时间。
