目的观察S100吸收性止血绫（absorbable stanching satin S100，ASS）在肝脏外科的止血效果。方法将40例择期行肝部分切除术的患者随机分成两组，应用ASS贴敷肝断面为ASS组（n=20），肝断面不用任何局部止血材料为对照组（n=20），分别于术后2 h、12 h、24 h及72 h观察腹腔引流情况，其中重点观察引流量。结果ASS组术后腹腔引流量较对照组明显减少，差异有显著性意义（P＜0.01）;ASS组术后无漏胆发生，对照组术后有2例发生漏胆; ASS组的腹腔引流管拔管时间及平均住院日均小于对照组，但差异无显著性意义（Pgt;0.05）。结论ASS在肝脏部分切除术中具有安全、有效的止血作用，特别是对于伴有凝血机能障碍的患者。
Three different methods of electrocautery were used to study the effects of electrocoagu-lation on limbs and intraabdominal blood vessel of 6 rabbits. These methods are non-touching, touching and segmental electrocoagulation. The results show that all three methods can satisfactorily stop bleeding of the blood vessel which is smaller than 1. 5mm in diameter. For arteries with the diameter 1.5～2.0mm. the effect of segment electrocoagulation is better than the other methods because it has a long burn end after cautery.
Objective To investigate the effect of applying a tourniquet on perioperative blood loss and short-term effectiveness in primary total knee arthroplasty (TKA). Methods A total of 94 patients (94 knees) with osteoarthritis underwent primary TKA between September 2010 and December 2011, whose data met the inclusion criteria and were retrospectively analyzed. A tourniquet was used in 51 cases (group A), no tourniquet in 43 cases (group B). There was no significant difference in gender, age, affected side, body mass index, preoperative hemoglobin (Hb) level, range of motion (ROM), visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups (P gt; 0.05). The data were compared between 2 groups, including hematocrit (Hct), Hb, hidden blood loss, dominant blood loss, theoretical total blood loss, the operation time, hospitalization days, increasing rate of circumference length above 10 cm of the knee, VAS score, ROM, HSS score, and WOMAC score. Results Four cases (7.84%) of group A and 1 case (2.33%) of group B received blood transfusions, showing no significant difference (χ2=1.410, P=0.235). There was no significant difference in the Hb and Hct between 2 groups at 2 days after operation (P gt; 0.05). The dominant blood loss of group A was significantly less than that of group B (P lt; 0.05), while the hidden blood loss of group A was significantly more than that of group B (P lt; 0.05), but there was no significant difference in theoretical total blood loss between 2 groups (t=0.662, P=0.510). The operation time, hospitalization days, and VAS score at 3 days showed no significant difference between 2 groups (P gt; 0.05). The wound healed by first intention after operation without related complication. At 3 days after operation, the increasing rate of circumference length above 10 cm of the knee in group A was significantly higher than that of group B (t=9.435, P=0.000), but no significant difference at 7 days (t=0.462, P=0.645). At 3 and 5 days after operation, the ROM values in group B were significantly larger than those of group A (P lt; 0.05), but no significant difference at 7 days (t= — 1.279, P=0.204). The patients were all followed up 12-18 months (mean, 14.3 months). There was no significant difference in the HSS score between 2 groups at 1 year after operation (t=0.952, P=0.344), but significant difference was found in the WOMAC score between 2 groups (t= — 2.488, P=0.015). The X-ray films showed that the prosthesis was in good position, without loosening, subsidence, or osteolysis. Conclusion Application of a tourniquet in TKA increases hidden blood loss, and there is no obvious advantage in reducing transfusion rate compared with the non-tourniquet group, so it is recommended to reduce the time and pressure of the tourniquet for patients with high-risk of thrombosis.
Objective To investigate the hemostasis of thermosensitive chitosan hemostatic film. Methods Fifty adult Sprague Dawley rats, male or female and weighing 190-210 g, were made the models of liver injury. The models were randomly divided into 5 groups (n=10) depending on different hemostatic materials. The incision of the liver was covered with the hemostatic materials of 2.0 cm × 1.0 cm × 0.5 cm in size: thermosensitive chitosan hemostatic film (group A), chitosan hemostatic film (group B), cellulose hemostatic cotton (group C), gelatin sponge (group D), and no treatment (group E), respectively. The bleeding time and bleeding amount were recorded. After 4 weeks, the incisions of the liver were observed with HE staining. Results Gross observation showed better hemostatic effect and faster hemostatic time in groups A, B, and C; group D had weaker hemostatic effect and slower hemostatic time; group E had no hemostatic effect. The bleeding time and bleeding amount of groups A, B, C, and D were significantly lower than those of group E (P lt; 0.05). The bleeding time and bleeding amount of groups A, B, and C were significantly lower than those of group D (P lt; 0.05), but no significant difference was found among groups A, B, and C (P gt; 0.05). The liver cells of group A had milder edema and ballooning degeneration than other 4 groups through histological observation. Conclusion The thermosensitive chitosan hemostatic film has good hemostasis effect on the liver incision of rats.
Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.
Objective To improve the flexibil ity and hemostatic properties of chitosan (CS)/carboxymethyl chitosan (CMCS) hemostatic membrane by using glycerol and etamsylate to modify CS/CMCS hemostatic membrane. To investigate themechanical properties and hemostatic capabil ity of modified CS/CMCS hemostatic membrane. Methods The 2% CS solution, 2% CMCS solution, 10%, 15%, 20%, 25%, 30% glycerol with or without 0.5% etamsylate were used to prepare CS/CMCS hemostatic membrane with or without etamsylate by solution casting according to ratio of 16 ∶ 4 ∶ 5. The tensile properties were evaluated by tensile test according to GB 13022-1991. Twenty venous incisions and five arterial incisions hemorrhage of 1 cm × 1 cm in rabbit ears were treated by CS/CMCS hemostatic membrane modified by 15% (group A) and 25% (group B) of glycerol, and a combination of them and 0.5% etamsylate (groups C and D). The bleeding time and blood loss were recorded. Results The pH of yellow CS/ CMCS hemostatic membrane with thickness of 30-50 μm was 3-4. The incorporation glycerol into CS/CMCS hemostatic membrane resulted in decreasing in tensile strength (7.6%-60.2%) and modulus (97%-99%). However, elongation at break and water content increased 5.7-11.6 times and 13%-125% markedly. CS/CMCS hemostatic membrane adhered to wound rapidly, absorbed water from blood and became curly. The bleeding time and blood loss of venous incisions were (70 ± 3) seconds and (117.2 ± 10.8) mg, (120 ± 10) seconds and (121.2 ± 8.3) mg, (52 ± 4) seconds and (98.8 ± 5.5) mg, and (63 ± 3) seconds and (90.3 ± 7.1) mg in groups A, B, C, and D, respectively; showing significant differences (P lt; 0.05) between groups A, B and groups C, D. The bleeding time and blood loss of arterial incision were (123 ± 10) seconds and (453.3 ± 30.0) mg in group C. Conclusion CS/CMCS hemostatic membrane modified by glycerol and etamsylate can improve the flexibil ity, and shorten the bleeding time.
Objective To compare the hemostatic effects and tourniquet induced side reactions of 2 different tourniquets in internal fixation of bilateral tibia and fibula fracture. Methods Between May 2008 and May 2010, 21 patients with bilateral tibia and fibula fracture were treated and randomly divided into 2 groups according to left and right l imbs. When steel plate fixation was performed, equil ibrium pressure pneumatic tourniquet (EPPT group) and common tourniquet (common group) were used to staunch the flow of blood respectively. The time of using tourniquet was 60 minutes, and the hemostatic pressure was 50 kPa. There were 12 males and 9 females with an age range of 17 to 58 years (mean, 32.5 years). Injurywas caused by traffic accident in 9 patients, by heavy pound in 6 patients, and fall ing from height in 6 patients. According to X-ray calssification, there were 15 cases of simple type, 3 cases of butterfly type, and 3 cases of comminuted type in EPPT group; there were 13 cases of simple type, 5 cases of butterfly type, and 3 cases of comminuted type in common group. The time from injury to operation was 3 to 72 hours (mean, 37.5 hours). Results The time of using tourniquet was (95.30 ± 4.19) minutes in EPPT group and (94.11 ± 5.16) minutes in common group, showing no significant difference (P gt; 0.05). All the incision of 2 groups healed by first intension. After 2 weeks of operation in common group, peroneal nerve injury occurred in 3 cases, and was cured by supporting nerve for 3 months; bl ister occurred in 1 case and was cured after dressing change for 3 weeks; and the injury rate was 19%. No compl ication occurred in EPPT group with an injury rate of 0. There was significant difference in the injury rate between 2 groups (P lt; 0.05). The hemostatic effects were excellent in 19 cases and good in 2 cases of EPPT group, were excellent in 10 cases, good in 3 cases, and poor in 8 cases of common group; the excellent and good rate were 100% and 61.9% respectively, showing significant difference (P lt; 0.05). All patients were followed up 3-24 months. Fracture healed without nonunion and deformity union in 2 groups. Conclusion Comparing to common tourniquet, the EPPT can provide good bloodless field, lower hemostatic pressure, and less tourniquet compl ication.
Objective To study hemostasis of a new chitosan hemostatic powder. Methods Twenty-four adult SD rats were made the models of l iver injury, male or female, and weighing 210-240 g. They were divided into three groups randomly (n=8) depending on different hemostatic powders. The incision of the l iver was treated with 300 mg Yunnan baiyao (group A1), chitosan hemostatic powder of pH6.5 (group B1) and pH7.5 (group C1), respectively. The bleeding time and bleeding amount were recorded. In vitro, with the modified Ree-White method, 2 mL artery blood from New Zealand whiterabbit was added into the 0.2 mL solution of Yunnan baiyao, chitosan hemostatic powder of pH6.5 and pH7.5 (concentration of 0.2 mg/mL), respectively. The blood coagulation time was recorded. The chitosan blood clots of group B2 and group C2 were observed with scanning electron microscopy (SEM). Results The bleeding time of group A1, group B1 and group C1 was (292 ± 31), (261 ± 23), and (224 ± 28) s, respectively, the bleeding amount was (1.63 ± 0.21), (1.47 ± 0.18), and (1.18 ± 0.17) g, respectively, showing statistically significant differences between groups B1, C1, and group A1 (P lt; 0.05), between group C1 and group B1 (P lt; 0.05). The blood clotting time of group A2, group B2, and group C2 was (653 ± 41), (255 ± 20), and (202 ± 11) s, respectively, showing statistically significant differences between groups B2, C2, and group A2 (P lt; 0.05), between group C2 and group B2 (P lt; 0.05). The SEM showed that the blood cells of group B2 and group C2 gathered around the chitosan. Conclusion Chitosan hemostatic powder of pH7.5 has good hemostasis.