Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model.
Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model.
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DOI：
10.1006/jsre.2002.6426
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发表时间：
2002-07
期刊：
影响因子：
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通讯作者：
B. Kheirabadi;Aida Field-Ridley;R. Pearson;M. Macphee;W. Drohan;D. Tuthill
中科院分区：
文献类型：
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作者：
B. Kheirabadi;Aida Field-Ridley;R. Pearson;M. Macphee;W. Drohan;D. Tuthill
目的：比较常用的外科止血药物与纤维蛋白密封剂（FS）的止血效果，并评估其功能强度，以确保止血，而不是进行额外的缝合。方法对中度抗凝兔进行横断腹主动脉端到端吻合，采用4、6次间断缝合。缝合线用纱布单独覆盖（“未经处理”）或纱布加Gelfoam、Avitene、Surgicel、FloSeal或FS，随后血流恢复。用纱布吸收出血量，测量出血量。术后4周，取存活兔，对修复血管进行组织学检查。研究者对治疗组是不知情的。主动脉吻合术使用8或12缝合线（未经治疗）。结果未经处理的主动脉4缝线吻合导致大量出血，平均失血量108.0 +/- 19.2 ml（平均+/- SD），死亡率100% （n = 4）。应用FS封闭吻合口，防止家兔失血（P < 0.01）和出血（n = 4）。与未治疗组相比，其他止血药物不同程度地减少了出血量（Gelfoam 66.4 +/- 17.6, Avitene 80.6 +/- 34, Surgicel 66.7 +/- 16.7, FloSeal 44.2 +/- 8.5 ml出血量，n = 4/组），但变化无统计学意义。每组1 ~ 3只兔子术后存活。六缝线主动脉吻合术，未经治疗，导致67.7 +/- 21.8 ml出血量和100%生存率（n = 6）。应用FS可使所有动物立即和持续止血（P < 0.01）。其他止血药物也能减少出血（Gelfoam 42.5 +/- 10, Avitene 50.9 +/- 12.4, Surgicel 32.1 +/- 14, FloSeal 33.9 +/- 5.4 ml出血量，n = 6/组），但变化无统计学意义。8缝线和12缝线主动脉修复术导致中度失血（分别为43.9 +/- 19和21.3 +/- 14.9 ml），随后稳定止血，无需使用任何止血剂。8-缝合和12-缝合的主动脉交叉夹持时间和止血时间均明显长于4-缝合加FS的主动脉交叉夹持时间（P < 0.01, P < 0.01, P < 0.05）。结论在中度凝血病中，FS是最有效的止血药物，可在动脉吻合口产生即时和持续的止血作用。这种高功效部分归因于该剂的强组织粘接性能。FS的应用可能会缓解吻合，缩短及时进行关键血管手术的时间。
OBJECTIVE The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. METHODS End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ("untreated") or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. RESULTS Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 +/- 19.2 (mean +/- SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 +/- 17.6, Avitene 80.6 +/- 34, Surgicel 66.7 +/- 16.7, FloSeal 44.2 +/- 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 +/- 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 +/- 10, Avitene 50.9 +/- 12.4, Surgicel 32.1 +/- 14, FloSeal 33.9 +/- 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 +/- 19 and 21.3 +/- 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). CONCLUSION In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.