自制可注射性明胶基止血剂在超声造影引导治疗肝创伤的实验研究  

Effect of injectable gelatin matrix as a hemostat for management of hepatic trauma in dogs under contrast-enhanced ultrasound guidance

作　　者：谢霞[1] 田江克[2] 吕发勤[1] 武荣[1] 唐文博[1] 罗渝昆[1] 黄雅钦[3] 唐杰[1] 

机构地区：[1]解放军总医院超声科,北京100853 [2]解放军第三零二医院,北京100039 [3]北京化工大学生物材料系,北京100029

出　　处：《南方医科大学学报》2012年第9期1260-1264,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81071279)~~

摘　　要：目的探讨自制可注射性明胶基止血剂在超声造影引导下治疗实验犬Ⅲ～Ⅳ级肝创伤的止血效果。方法21只健康成年杂种犬戊巴比妥钠全麻后开腹暴露肝脏，制作Ⅲ～Ⅳ级肝创伤模型。实验动物被随机分为治疗组，阳性对照组和阴性对照组。治疗组（n=7）病灶处在超声造影引导经皮注射自制止血剂，阳性对照组（n=7）病灶处注射凝血酶溶液，而阴性对照组（n=7）病灶处注射0．9％生理盐水。比较术后30min腹腔内总出血量，及术后7d谷丙转氨酶和谷草转氨酶。并于术后7d对每个动物进行超声造影随访。结果治疗组平均出血量（47．69m1）显著少于阳性对照组（81．77ml，P〈0．01）和阴性对照组（110．35ml，P〈0．01）。治疗组谷丙转氨酶和谷草转氨酶的平均值均明显低于阳性对照组和阴性对照组（谷丙转氨酶分别为：49．37、62．81、82．83U／L，P〈O．01；谷草转氨酶分别为：48．32、67．16、82．54U／L，P〈0．01）。超声造影检查显示治疗组所有动物未见创伤灶及腹腔积液，肝脏灌注均匀一致；而阳性对照组和阴性对照组仍可见创伤灶及腹腔积液。结论超声造影引导自制可注射性明胶基止血剂可有效控制犬Ⅲ～Ⅳ级肝创伤出血，其止血及促进伤口愈合作用较明显。Objective To explore the efficacy of injectable gelatin matrix as a hemostatic agent for treatment of grade III-IV hepatic trauma to a canine model with contrast-enhanced ultrasound （CEUS） guidance. Methods Twenty-seven healthy adult dogs underwent celiotomy in induce grade Ⅲ～Ⅳ hepatic trauma in the left lateral lobe of the liver. The dogs were then randomized into 3 groups, namely the treatment group in which the injectable hemostat was percutaneouly injected into the injury site under CEUS guidance, and the positive and negative control groups with thrombin solution and normal saline treatment, respectively. Intra-abdominal blood loss within 30 min postoperatively, and alanine aminotransferase （ALT） and aspartate aminotransferase （AST） 7 days postoperatively were compared among the groups. Follow-up CEUS was performed in each animal 7 days after the operation. Results The mean blood loss was 47.69 ml in the treatment group, significantly less than that in the positive control group （81.77 ml, P〈0.01） and negative control group （110.35 ml, P〈0.01）. The treatment group had also significantly lower ALT and AST levels than the two control groups （ALT： 49.37, 62.81, and 82.83 U/L, respectively, P〈 0.05; AST： 48.32, 67.16, and 82.54 U/L, respectively, P〈0.05）. In the treatment group, CEUS did not detect hepatic lesions or ascites as found in the two control groups, and the perfusion of the liver was homogeneous. Conclusion The injectable hemostat injected under the guidance of CEUS can effectively control grade Ⅲ～Ⅳ hepatic hemorrhage in the canine model and show strong effects of stopping bleeding and promoting wound healing.

关 键 词：止血 创伤 超声造影 明胶 谷氨酰胺转氨酶 

分 类 号：R657.3[医药卫生—外科学]