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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2018, Vol. 13 ›› Issue (02) : 88 -93. doi: 10.3877/cma.j.issn.1673-9450.2018.02.003

所属专题： 文献；

论著

复合大孔聚多糖止血材料对肝脏钝挫伤止血的有效性研究
曾莉君1, 程刚毅2, 王赟3, 许零4,†(), 邓利5, 林链凤2   
  1. 1. 518057　北京大学深圳研究院；100029　北京化工大学
    2. 361026　厦门大学附属第一医院
    3. 361026　厦门大学公共卫生学院
    4. 518057　北京大学深圳研究院；361026　厦门大学公共卫生学院
    5. 100029　北京化工大学
  • 收稿日期:2018-02-02 出版日期:2018-04-01
  • 通信作者: 许零
  • 基金资助:
    深圳市科技计划项目(JCYJ20150616163111759); 厦门市科技计划项目(3502Z20151087)

Hemostatic efficacy of macroporous polysaccharide complex hemostatic materials on acute hepatic blunt trauma

Lijun Zeng1, Gangyi Cheng2, Yun Wang3, Ling Xu4,†(), Li Deng5, Lianfeng Lin2   

  1. 1. Peking University Shenzhen Institute, Shenzhen 518057, China; Beijing University of Chemical Technology, Beijing 100029, China
    2. First Affiliated Hospital of Xiamen University, Xiamen 361026, China
    3. School of Public Health, Xiamen University, Xiamen 361026, China
    4. Peking University Shenzhen Institute, Shenzhen 518057, China; School of Public Health, Xiamen University, Xiamen 361026, China
    5. Beijing University of Chemical Technology, Beijing 100029, China
  • Received:2018-02-02 Published:2018-04-01
  • Corresponding author: Ling Xu
  • About author:
    Corresponding author: Xu Ling, Email:
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引用本文：

曾莉君, 程刚毅, 王赟, 许零, 邓利, 林链凤. 复合大孔聚多糖止血材料对肝脏钝挫伤止血的有效性研究[J]. 中华损伤与修复杂志(电子版), 2018, 13(02): 88-93.

Lijun Zeng, Gangyi Cheng, Yun Wang, Ling Xu, Li Deng, Lianfeng Lin. Hemostatic efficacy of macroporous polysaccharide complex hemostatic materials on acute hepatic blunt trauma[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2018, 13(02): 88-93.

目的

研究具有交联微孔结构的复合大孔聚多糖止血材料(MPCHM)应用于模拟临床肝脏钝挫伤的止血效果，评价其对肝功能修复作用的有效性和安全性。

方法

建立动物肝脏钝挫伤模型，将24只新西兰兔按照随机数字表法分为实验组(使用MPCHM)和空白组(不使用任何止血材料)，分别记录止血时间和出血量。在术后第1、4、8周采集兔的外周血进行血常规、生化分析及凝血两项检测，所得数据指标进行独立样本t检验。

结果

实验组止血时间为(105.00±29.15) s，空白组止血时间为(381.00±54.86) s，差异有统计学意义(t＝－4.442，P<0.05)。实验组出血量为(0.45±0.26) g，空白组出血量为(1.26±0.51) g，差异有统计学意义(t＝－14.048，P<0.05)。实验组淋巴细胞含量于术后第1、8周显著低于空白组，差异均有统计学意义(t＝－12.595、－7.909，P值均小于0.05)，丙氨酸氨基转移酶和天门冬氨酸氨基转移酶于术后第8周显著低于空白组，差异均有统计学意义(t＝－5.613、－3.656，P值均小于0.05)，白细胞计数术后显著高于空白组，差异均有统计学意义(t＝5.521、6.433、2.399，P值均小于0.05)，白蛋白于术后第1、8周显著高于空白组，差异均有统计学意义(t＝3.120、5.168，P值均小于0.05)。实验组术后活化部分凝血活酶时间和凝血酶原时间处于正常值范围内。

结论

MPCHM具有良好的生物安全性，能促进肝功能恢复，降低机体对于肝损伤的应激反应，不会引起机体炎症反应、排斥反应及生物毒性。本课题研究为临床肝损伤止血无法完全保存肝组织这一难题的解决提供新思路。

关键词: 创伤，非贯通性, 肝, 止血, 复合大孔聚多糖止血材料, 辐照交联
Objective

To study the hemostatic efficacy of macroporous polysaccharide complex hemostatic materials(MPCHM)with microporous structure applied to simulate clinic hepatic trauma model, the efficacy and safety of liver repair function of the materials was evaluted.

Methods

Hepatic trauma model in clinic was mimicked. The 24 New Zealand rabbits were divided into the experimental group (using MPCHM) and the blank group (not using any hemostatic materials) according to the random number table, and the hemostatic time and amount of bleeding were recorded. The blood routine, biochemical analysis and coagulation indexes were detected after 1, 4, 8 weeks by collecting rabbit′s peripheral blood, and independent sample t test was completed by analyzing all the obtained data.

Results

The hemostatic time of the experimental and blank group were (105.00±29.15)s and (381.00±54.86)s, the difference was statistically significant (t=-4.442, P<0.05). The amount of bleeding blood of the experimental and blank group were (0.45±0.26)g and (1.26±0.51)g, the difference was statistically significant (t=-14.048, P<0.05). The lymphocyte content in the experimental group in 1 and 8 weeks after operation were significantly lower than the blank group(t=-12.595, -7.909; with P values below 0.05). Alanine transaminase and aspartate aminotransferase in the experimental group in 8 weeks after operation were significantly lower than the blank group(t=-5.613, -3.656; with P values below 0.05). White blood cell count after operation were significantly higher than the blank group(t=5.521, 6.433, 2.399; with P values below 0.05). Albumin in the experimental group in 1 and 8 weeks after operation were significantly higher than the blank group(t=3.120, 5.168; with P values below 0.05). Activited partial thomboplastin time and prothrombin time in the experimental group were in normal range after operation.

Conclusions

The MPCHM have good biological safety and can promote the function recovery of liver and reduce the body′s stress response to liver injury. The materials will not cause adverse body inflammatory reaction, rejection and biological toxicity during the period. The materials provide a new way for solving the problem of completely preserving liver tissue in clinical liver injury hemostasis.

Key words: Wounds, nonpenetrating, Liver, Hemostasis, Macroporous polysaccharide complex hemostatic materials, Radiation crosslink
图1 新西兰兔肝脏钝挫伤模型。A示动物取肝示意图；B　示肝右叶受钝器损伤示意图；C　示损伤止血示意图
图2 两组新西兰兔肝脏钝挫伤止血实验的止血时间及出血量
表1 实验组与空白组肝脏钝挫伤新西兰兔不同观察时间血常规检测(±s)
组别 只数 红细胞计数(×1012/L) 血红蛋白浓度(g/L)
术后1周 术后4周 术后8周 术后1周 术后4周 术后8周
实验组 12 5.81±0.46 6.07±0.43 6.56±0.78 20.67±1.46 21.14±0.18 21.62±1.55
空白组 12 5.56±0.42 6.08±0.47 5.89±0.27 20.38±0.74 20.58±0.22 21.50±0.85
t值 ? 0.202 1.006 1.730 －0.694 1.546 0.158
P值 ? 0.371 0.791 0.224 0.901 0.585 0.425
组别 只数 白细胞计数(×109/L) 血小板计数(×109/L)
术后1周 术后4周 术后8周 术后1周 术后4周 术后8周
实验组 12 12.03±3.37 11.24±1.64 12.52±3.99 366.33±40.24 367.00±37.26 370.00±35.41
空白组 12 6.80±1.26 8.05±0.51 7.40±1.27 411.75±71.36 434.00±84.33 380.00±79.11
t值 ? 5.521 6.433 2.399 －1.576 －2.940 0.360
P值 ? 0.001 <0.05 0.013 0.921 0.006 0.759
组别 只数 淋巴细胞含量(%)
术后1周 术后4周 术后8周
实验组 12 33.81±1.35 53.54±6.95 56.08±3.32
空白组 12 57.10±7.29 60.62±8.43 63.45±0.16
t值 ? －12.595 －3.502 －7.909
P值 ? <0.05 0.224 0.002
表2 实验组与空白组肝脏钝挫伤新西兰兔不同观察时间的生化检测(±s)
组别 只数 ALP(U/L) ALT(U/L)
术后1周 术后4周 术后8周 术后1周 术后4周 术后8周
实验组 12 82.96±6.65 76.46±9.08 71.68±9.09 53.50±7.53 69.60±11.84 72.60±13.56
空白组 12 97.59±20.62 71.07±13.36 72.90±8.45 60.13±12.2 77.80±11.13 117.50±21.92
t值 ? －6.550 0.532 0.452 －0.471 0.247 －5.613
P值 ? 0.021 0.147 0.104 0.064 0.375 <0.05
组别 只数 AST(U/L) 白蛋白(g/L)
术后1周 术后4周 术后8周 术后1周 术后4周 术后8周
实验组 12 51.83±6.34 54.50±9.15 58.80±5.83 46.30±3.68 47.32±5.75 49.11±3.24
空白组 12 50.00±7.58 63.33±5.48 84.33±13.65 41.85±3.88 43.05±6.72 44.50±2.79
t值 ? 1.208 －1.794 －3.656 3.120 1.122 5.168
P值 ? 0.287 0.027 <0.05 0.045 0.739 <0.05
表3 实验组与空白组肝脏钝挫伤新西兰兔不同观察时间的凝血检测(±s)
组别 只数 APTT(s) PT(s)
术后1周 术后4周 术后8周 术后1周 术后4周 术后8周
实验组 12 19.98±2.18 20.12±1.9 18.86±1.52 8.74±1.54 8.90±1.83 7.32±0.73
空白组 12 20.34±2.34 15.64±2.37 18.22±1.22 7.92±0.35 7.30±0.55 8.57±0.44
t值 ? －0.252 3.268 0.733 1.156 1.878 －3.295
P值 ? 0.808 0.011 0.485 0.281 0.097 0.011
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