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A Qualitative Morphological Comparison of Two Haemostatic Agents in a Porcine Liver Trauma Model

Surgical Science 2013年第8期4卷 359-364页

作者： Kenneth E. Coenye claire bourgain Claudia Keibl Sylvia Nürnberger Martijn van Griensven Department for Pathological Anatomy Free University Brussels (VUB) Brussels Belgium Departments for Surgery and Emergency Medicine AZ Jan Portaels Vilvoorde Belgium Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the Research Centre of the AUVA Vienna Austria

Background: Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topical gelatine-based haemostatic agents in a porcine liver trauma model. Methods: We compared the activity of Floseal? (with human or bovine thrombin), Surgiflo? and Surgiflo? plus 5000 IU bovine thrombin per 10 mL of product (n = 6 test sites/group). Different clinical scenarios were evaluated in two anaesthetised piglets;normal physiological conditions (normotension and normothermia), and a status of hypotension, hypothermia and haemodilution, requiring inotropic support. Laparotomy was performed, and five identical stab wounds were made on each liver lobe. Four of these wounds were randomly treated with one of the agents under investigation, while one wound was kept as an untreated control. Haemostasis was observed during and immediately following surgery. After euthanisation, wounds were examined (blinded for treatment) macroscopically, microscopically and using scanning electron microscopic evaluation. Results: Surgiflo? produced some degree of clotting in 1/3 applications in both piglets. Co-treatment with thrombin resulted in a minor improvement in performance in the animal with normal physiological conditions (some degree of clotting in all wounds);no improvement was seen in the animal in a status of hypotension, hypothermia and haemodilution. Floseal? induced clotting in all wounds for both piglets. Microscopic and scanning electron microscope examination of the stab wounds demonstrated that Floseal? created a stable, dense agglomerate of gelatine and fibrin, which firmly adhered to the adjacent liver tissue. In wounds treated with Surgiflo? or Surgiflo? plus thrombin, the gelatine contained more air bubbles, resulting in less fibrin inclusion in the clot and weaker adhesion of the clot to the liver tissue. Conclusion: Floseal? created a dense and

关键词： Haemostasis Coagulation Thrombin Fibrin Gelatine Sealant Clot Surgery Trauma Wound Healing

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