Adhesive Hemostatic Hydrogel with Ultrafast Gelation Arrests Acute Upper Gastrointestinal Hemorrhage in Pigs
Adhesive Hemostatic Hydrogel with Ultrafast Gelation Arrests Acute Upper Gastrointestinal Hemorrhage in Pigs
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DOI：
10.1002/adfm.202109332
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发表时间：
2021-12
影响因子：
19
通讯作者：
X. Xia;Xiayi Xu;Bin Wang;Di Zhou;Weili Zhang;Xianchun Xie;Huasheng Lai;Ju Xue;Aliza Rai;Zhuo Li;Xin Peng;Pengchao Zhao;L. Bian;P. Chiu
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文献类型：
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作者：
X. Xia;Xiayi Xu;Bin Wang;Di Zhou;Weili Zhang;Xianchun Xie;Huasheng Lai;Ju Xue;Aliza Rai;Zhuo Li;Xin Peng;Pengchao Zhao;L. Bian;P. Chiu
上消化道出血是世界范围内常见的临床急症。内镜下止血是目前的一线治疗方法。然而，对于严重活动性出血和解剖困难的患者，内窥镜治疗仍然很困难，通常需要更高水平的外科专业知识。因此，一种简单有效的内镜止血方法是临床迫切需要的。本文报道了一种由硫脲-儿茶酚偶联和二硫键稳定的透明质酸和聚乙二醇组成的止血杂化水凝胶。与纤维蛋白凝胶相比，混合水凝胶具有力学性能增强、凝胶时间短、凝血能力强等特点。在大鼠动脉出血模型中证实了体内止血效果，局部应用混合水凝胶后迅速凝胶化，有效地阻止了失血，在复苏过程中，当血压大致恢复正常时，没有再出血发生。一项大型动物研究进一步证明了混合水凝胶对猪上消化道出血的内镜止血效果。随访观察表明，混合水凝胶可以在出血伤口上保持粘附48小时，表明其在体内具有持续的止血功能。总的来说，这项工作证明了一种有前途的止血水凝胶用于上消化道出血的内镜止血。
Upper gastrointestinal (GI) hemorrhage is a common clinical emergency worldwide. Endoscopic hemostasis is the current first line treatment. Nevertheless, for patients with severe active bleeding and challenging anatomy, endoscopic management can be still difficult and usually requires a higher level of surgical expertise. A simple and effective method of endoscopic hemostasis is therefore in acute clinical demand. Herein a hemostatic hybrid hydrogel comprised of hyaluronic acid and polyethylene glycol stabilized by thiourea–catechol coupling and disulfide bonds is reported. The hybrid hydrogels exhibit enhanced mechanical properties, short gelation time, and good blood clotting ability compared with fibrin gels. The in vivo hemostatic efficacy is confirmed in a rat model of arterial bleeding, in which the rapid gelation of hybrid hydrogels after topical application effectively arrests blood loss with no rebleeding occurring during resuscitation when blood pressure approximately recovers to normal. A large animal study further demonstrates the efficacy of hybrid hydrogels to achieve endoscopic hemostasis against upper GI hemorrhage in pigs. Follow‐up observations show that the hybrid hydrogels can remain adherent at the bleeding wound for 48 h, indicating the sustained hemostatic function in vivo. Collectively, this work demonstrates a promising hemostatic hydrogel for endoscopic hemostasis in upper GI hemorrhage.