可溶性止血纱布与蛇毒血凝酶联合应用对止血效果的影响

目的 评价非离子化可溶性止血纱布与蛇毒血凝酶联合应用对手术出血及创面渗血的止血效果.方法 将涂布蛇毒血凝酶冻干品的可溶性止血纱布,与可溶性止血纱布、普通医用纱布、涂布蛇毒血凝酶的普通医用纱布以小鼠剪尾试验法和兔肝、脾创面止血法比较各组止血效果.结果 涂布血凝酶的可溶性止血纱布、可溶性止血纱布、普通纱布、涂布血凝酶的普通纱布分别缩短出血时间约56%、43%、10.2%、33%.结论 可溶性止血纱布和蛇毒血凝酶联合应用能获得良好的止血效果.     

医用生物蛋白胶在体外循环心脏直视手术中止血的应用体会

目的:探讨医用生物蛋白胶在在体外循环心脏直视手术创面应用止血的临床效果.方法:随机将体外循环心脏直视手术分为试验组70例和对照组70例,观察两组术后24h引流量、总引流量及拔管时间.结果:试验组术后24h引流量、总引流量和拔管时间均明显少于对照组(P<0.05).结论:正确使用医用生物蛋白胶可明显减少体外循环手术后的引流量,止血效果明确、安全,有利于患者术后康复.     

多聚糖止血颗粒对兔股动脉出血的止血效果观察

目的:观察PerClotTM多聚糖止血颗粒在兔股动脉局部止血效果。方法:分离并剪断兔股动脉,应用多聚糖止血颗粒止血,通过测定出血量与止血时间同阴性对照组对比了解活动患肢对止血稳定性的影响。结果:受试2组平均出血量如下:PerClotTM组:(1.46±0.06)g;阴性对照组(2.48±0.10)g。统计分析后可知PerClotTM组较阴性对照组出血量减少(P<0.01)。平均止血时间如下:PerClotTM组:(100±30.1)s;阴性对照组(200±36.33)g。统计分析后可知PerClotTM组较阴性对照组止血时间减少(P<0.01).活动患肢对止血稳定性无影响。结论:多聚糖颗粒止血效果可靠,有临床应用前景,值得进行临床实验。     

多聚糖止血颗粒对兔股动脉出血的止血效果观察

目的：观察PerClot^TM多聚糖止血颗粒在兔股动脉局部止血效果。方法：分离并剪断兔股动脉,应用多聚糖止血颗粒止血,通过测定出血量与止血时间同阴性对照组对比了解活动患肢对止血稳定性的影响。结果：受试2组平均出血量如下：PerClot^TM组：（1．46±0．06）g;阴性对照组（2．48＞±0．10）g。统计分析后可知PerClot^TM组较阴性对照组出血量减少（P〈0．叭。平均止血时间如下：PerClot^TM组：（100±30．1）s;阴性对照组（200±36．33）g。统计分析后可知PerClot^TM组较阴性对照组止血时间减少（P〈0．01）．活动患肢对止血稳定性无影响。结论：多聚糖颗粒止血效果可靠,有临床应用前景,值得进行临床实验。     

生物衍生止血材料研究进展

生物来源的胶原蛋白、明胶、纤维蛋白原、纤维素、淀粉以及壳聚糖等材料,因为其无毒性、良好的生物相容性、生物可降解性以及促凝血活性越来越受到研究者的青睐,成为更加优异的止血选择。本文综述目前止血材料的几种类型及相应的止血机理,重点讨论上述生物来源止血材料的基本结构、止血机理、市售产品及最新科研进展,并对其发展前景进行展望。     

可吸收性止血颗粒在鼻内镜下经口腺样体吸切术中的应用

目的:探讨可吸收性止血颗粒(Arista AH)在鼻内镜下经口腺样体吸切术创面止血上的应用效果。方法:54例腺样体肥大患者行鼻内镜下经口腺样体吸切术,随机分为四组,A组20例(压迫止血后喷洒Arista AH),B组15例(压迫止血后双极电凝止血),C组7例(压迫止血后Merocel高膨胀海绵填塞),D组12例(仅压迫止血)。比较四组患者的止血时间、术后出血、咽痛持续时间、恢复正常通气时间等指标,同时采用视觉模拟评分法记录止血难度的主观评估。结果:A组手术时间、止血难度均低于B组、D组,差异具有统计学意义(P0.05),与C组无统计学差异(P0.05)。而A组术后出血发生率低于D组(P0.05),与B组、C组无统计学差异。A组咽痛持续时间低于B组、C组,差异具有统计学意义(P0.05),与D组无统计学差异(P0.05)。而A组恢复正常通气时间与B组、D组无统计学差异(P0.05)。结论:可吸收性止血颗粒可用于鼻内镜下经口腺样体吸切术创面止血,具有快速简便、安全有效的特点。     

新型医用止血多聚糖改性材料的实用性研究

止血淀粉是一种具有生物相容性的可降解材料，在止血和促进伤口愈合方面具有巨大的潜力。其具有高度亲水性，这使它们能够大量吸收血液中的水分，并诱导形成血块，以达到止血的目的。文章对自制新型止血淀粉的吸水性、降解性、止血效果进行了相应的研究，并与市面上现有的产品和普通淀粉进行了相应的比较。     

微纤维止血胶原在内镜下腺样体吸切术中的应用

目的:探讨微纤维止血胶原(Avitene)在内镜下腺样体吸切术创面止血的临床效果。方法:将58例行内镜下腺样体吸切术的患者随机分为三组,A组23例(盐酸赛洛唑啉纱条压迫+Avitene涂抹),B组19例(盐酸赛洛唑啉纱条压迫+电凝止血),C组16例(仅以盐酸赛洛唑啉纱条压迫止血)。比较三组患者的手术时间、止血时间、出血程度、止血难度、术后疼痛、进食恢复时间及术后并发症等指标。结果:三组出血程度比较无统计学差异(P0.05)。A组手术时间、止血时间、止血难度均低于B组、C组,差异具有统计学意义(P0.05)。A组术后疼痛、进食恢复时间低于B组,差异具有统计学意义(P0.05),与C组比较无统计学差异。三组均未出现术后出血、感染、误吸等并发症。结论:微纤维止血胶原用于内镜下腺样体吸切术创面止血,具有快速方便、安全有效的特点。     

胶原/纤维蛋白止血效果观察

目的研究胶原/纤维蛋白对新西兰兔的止血作用,并与胶原蛋白海绵止血效果作比较。方法选用胶原/纤维蛋白止血贴,对新西兰兔耳部动、静脉出血、耳表创面、股动脉割伤、肝损伤、体表创面进行止血试验,同时与胶原蛋白海绵止血效果作比较,观察其止血时间、失血量、敷料与创面的粘合等情况,并定期观察创面愈合、体内吸收和抗炎情况。结果胶原/纤维蛋白复合止血贴组、胶原蛋白海绵组新西兰兔耳动、静脉、耳表创面、股动脉割伤、标准肝创伤的止血时间与对照组比较,差异显著（P〈0.05）。胶原/纤维蛋白复合止血贴组新西兰兔耳动、静脉、耳表创面的止血时间与胶原蛋白海绵组,差异显著（P〈0.05）。胶原/纤维蛋白复合止血贴组、胶原蛋白海绵组动物的耳表创面、标准肝创伤失血量与对照组比较,差异显著（P〈0.05）。体内标准肝创伤、体表创伤后期观察,胶原/纤维蛋白复合止血贴与胶原蛋白海绵均能在21d内完全吸收,未见炎症反应。结论胶原/纤维蛋白复合止血贴对新西兰兔耳动脉割伤、耳静脉割伤、耳标创伤、股动脉割伤和标准肝损伤模型都具有明显的止血作用,体表创面伤口恢复良好,体内吸收速度快,具有一定的抗炎作用,而且在新西兰兔耳动脉、耳静脉割伤和耳表创伤的止血效果明显优于胶原蛋白海绵。胶原/纤维蛋白复合止血贴是一种较安全有效的局部止血生物材料。     

腹腔镜下卵巢囊肿剥除术后缝合与电凝止血对卵巢功能的影响

目的:探究腹腔镜下卵巢囊肿剥除术后缝合与电凝止血对卵巢功能的影响。方法:选择2014年5月~2015年12月期间我院收治卵巢囊肿患者78例为研究对象,两组患者均行腹腔镜下卵巢囊肿剥除术,根据患者术中止血方式的不同将其分为观察组(41例)和对照组(37例);观察组术中采用双极电凝止血,对照组患者性术中采用缝合止血;观察并比较术后4周、12周两组患者促卵泡生长激素(FSH)、促黄体激素(LH)、雌二醇(E2)及窦状卵泡计数(Shape of sinus follicle count,AFC),对比两组术后12周卵巢功能恢复情况。结果:术后4周两组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,差异均有统计学意义(P0.05);术后12周对照组FSH、LH、E2及AFC水平与术前比较,差异无统计学意义(P0.05),观察组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,且观察组患者FSH、LH水平高于对照组,E2及AFC水平低于对照组,差异均有统计学意义(P0.05);术后12周,观察组患者出现排卵异常、经量过少及经期延长的发生率均高于对照组(P0.05)。结论:缝合止血在腹腔镜下卵巢囊肿剥除术止血对患者卵巢功能的损伤作用小于电凝止血,术后卵巢功能恢复快,临床上应当优选缝合止血,降低对卵巢功能的影响。     

Effect of polypeptides from sea anemone <Emphasis Type="Italic">Heteractis crispa</Emphasis> on the rodent blood pressure,heart rate,and hemostasis

АРНС1–3 peptides, modulators of TRPV1 receptors, have been administered to SD rats to study their influence on the animal hemostatic system, heart rate, and blood pressure. None of АЗРС1–3 polypeptides have any effect on the hemostatic system. Both АРНС1 and АРНС2 polypeptides increased significantly the heart rate, but they did not affect blood pressure, which was probably caused by an ability of these polypeptides to modify animal thermoregulation.     

Newly Identified HNP‐F from Human Neutrophil Peptide‐1 Promotes Hemostasis

Active hemostatic agents can play a crucial role in saving patients’ lives during surgery. Active hemostats have several advantages including utilization of natural blood coagulation and biocompatibility. Among them, although human neutrophil peptide‐1 (HNP‐1) has been previously reported with the hemostatic mechanism, which part of HNP‐1 facilitates the hemostatic activity is not known. Here, a partial peptide (HNP‐F) promoting hemostasis, originating from HNP‐1, has been newly identified by the blood coagulation ability test. HNP‐F shows the best hemostatic effect between the anterior half and posterior half of peptides. Moreover, microscopic images show platelet aggregation and an increase in the concentration of platelet factor 4, and the scanning electron microscope image of platelets support platelet activation by HNP‐F. Thromboelastography indicates decreased clotting time and increased physical properties of blood clotting. Mouse liver experiments demonstrate improved hemostatic effect by treatment of peptide solution. Cell viability and hemolysis assays confirm the HNP‐F's biosafety. It is hypothesized that the surface charge and structure of HNP‐F could be favorable to interact with fibrinogen or thrombospondin‐1. Collectively, because HNP‐F as an active peptide hemostat has many advantages, it could be expected to become a potent hemostatic biomaterial, additive or pharmaceutical candidate for various hemostatic applications.     

Evolution of hematophagy in ticks: common origins for blood coagulation and platelet aggregation inhibitors from soft ticks of the genus Ornithodoros

Identification and characterization of antihemostatic components from hematophagous organisms are useful for the elucidation of the evolutionary mechanisms involved in adaptation to a highly complex host hemostatic system. Although many bioactive components involved in the regulation of the host's hemostatic system have been described, the evolutionary mechanisms of how arthropods adapted to a blood-feeding environment have not been elucidated. This study describes common origins of both blood coagulation inhibitors and platelet aggregation inhibitors (PAIs) from soft ticks of the genus Ornithodoros. Neighbor-joining analysis indicates that fXa, thrombin, and PAIs share a common ancestor. Maximum parsimony analysis and a phylogeny based on root mean square deviation values of alpha-carbon backbone structures suggest a novel evolutionary pathway by which different antihemostatic functions have evolved through a series of paralogous gene duplication events. In this scenario, the thrombin inhibitors preceded the fXa and PAIs. This evolutionary model explains why the tick serine protease inhibitors have inhibition mechanisms that differ from that of the canonical bovine pancreatic trypsin inhibitor (BPTI)-like inhibitors. Higher nonsynonymous-to-synonymous substitution rates indicate positive Darwinian selection for the fXa and PAIs. Comparison with hemostatic inhibitors of hard ticks suggests that the two main tick families have independently evolved novel antihemostatic mechanisms. Independent evolution of these mechanisms in ticks points to a rapid divergence between tick families that could be dated between 120 and 92 MYA. This coincides with current molecular phylogeny views on the early divergence of modern birds and placental mammals in the Late Cretaceous, which suggests that this event might have been a driving force in the evolution of hematophagy in ticks.     

鳖源胶原蛋白提取纯化及在生物材料中的应用

近年来,胶原蛋白因其良好的生物学性能在生物材料应用中得到越来越多的关注,为了建立一种快速高效的鳖源胶原蛋白纯化方法和探究其在生物材料中的应用价值,首先用Van Gieson染色法和苦味酸-天狼星红染色法观察裙边胶原纤维组织结构,发现裙边胶原纤维含量非常高且类型主要是Ⅰ型。采用不同截留分子量的透析袋对裙边胶原蛋白粗提液进行直接透析纯化,发现截留分子量为100 k Da的透析袋在透析48 h后对裙边胶原蛋白的纯化效果最好,SDS-PAGE检验显示几乎没有杂带。对裙边胶原蛋白生物学性能包括吸水性、体外降解性进行考察,其吸水力和持水力分别高达12.06 g/g和98.21%,且在72 h后被完全降解;对裙边胶原蛋白海绵的溶血性、皮肤致敏性、肝部创伤止血性、促创伤皮肤愈合性进行了研究,并和交联胶原进行比较,发现裙边胶原蛋白和交联胶原均不会造成SD大鼠溶血和皮肤过敏,二者均具有良好的止血效果,且裙边胶原蛋白能显著缩短创伤皮肤愈合时间,具有良好的促创伤皮肤愈合性,而交联胶原效果欠佳。本研究表明裙边胶原蛋白表现出了优良的生物学性能,在生物材料领域具有很大应用价值。     

Postprandial activation of hemostatic factors: role of dietary fatty acids

Intake of dietary fat is an important determinant of the plasma concentration of triacylglycerol-rich lipoproteins, and the degree of alimentary lipemia is reported to have effects on hemostatic status including platelet function. Although association between the amount of dietary fat intake, lipemic response and certain cardiovascular disease (CVD) risk factors (VIIa and PAI-1) has been reported, the significance of the fatty acid composition of ingested fat for the postprandial lipid concentrations and the hemostatic factors is still unclear. Accumulating evidence suggests a relationship between dietary fatty acids and emerging hemostatic CVD risk factors, although much of this evidence is incomplete or conflicting. In order to improve our knowledge in this area, sufficient sample size in future studies are required to take into account of the genetic variation (gene polymorphisms for VII, PAI-1), sex, physical activity, stage of life factors, and sufficient duration to account for adaptation for definitive conclusions.     

Contribution of perfusion techniques to the evaluation of the hemostatic effectiveness of platelet concentrates.

Perfusion systems allowing the morphometric analysis of platelet interactions with vessel subendothelium under flow conditions have been applied to evaluate the quality and function of stored platelets. Studies performed in vitro indicate that despite the existence of storage lesions, platelets in concentrates stored for up to 5 days retain their ability to interact with the subendothelium. Perfusion studies ex vivo with nonanticoagulated blood from anemic-thrombocytopenic patients have shown the critical hemorrheological role of red blood cells facilitating platelet interactions with subendothelium. Similar studies performed on severely thrombocytopenic patients who received transfusions of platelets stored at 4 degrees C indicate that incompletely viable platelets can contribute to primary hemostasis through procoagulant mechanisms. The latter results suggest that storage lesions which contribute to impairment of platelet function may result in enhancement of platelet procoagulant activities. Perfusion techniques have contributed to the evaluation of the hemostatic effectiveness of platelet concentrates. These techniques will provide a useful model to test the impact of new storage technologies on platelet hemostatic function.     

Laminin Peptide-Immobilized Hydrogels Modulate Valve Endothelial Cell Hemostatic Regulation

Valve endothelial cells (VEC) have unique phenotypic responses relative to other types of vascular endothelial cells and have highly sensitive hemostatic functions affected by changes in valve tissues. Furthermore, effects of environmental factors on VEC hemostatic function has not been characterized. This work used a poly(ethylene glycol) diacrylate (PEGDA) hydrogel platform to evaluate the effects of substrate stiffness and cell adhesive ligands on VEC phenotype and expression of hemostatic genes. Hydrogels of molecular weights (MWs) 3.4, 8, and 20 kDa were polymerized into platforms of different rigidities and thiol-modified cell adhesive peptides were covalently bound to acrylate groups on the hydrogel surfaces. The peptide RKRLQVQLSIRT (RKR) is a syndecan-1 binding ligand derived from laminin, a trimeric protein and a basement membrane matrix component. Conversely, RGDS is an integrin binding peptide found in many extracellular matrix (ECM) proteins including fibronectin, fibrinogen, and von Willebrand factor (VWF). VECs adhered to and formed a stable monolayer on all RKR-coated hydrogel-MW combinations. RGDS-coated platforms supported VEC adhesion and growth on RGDS-3.4 kDa and RGDS-8 kDa hydrogels. VECs cultured on the softer RKR-8 kDa and RKR-20 kDa hydrogel platforms had significantly higher gene expression for all anti-thrombotic (ADAMTS-13, tissue factor pathway inhibitor, and tissue plasminogen activator) and thrombotic (VWF, tissue factor, and P-selectin) proteins than VECs cultured on RGDS-coated hydrogels and tissue culture polystyrene controls. Stimulated VECs promoted greater platelet adhesion than non-stimulated VECs on their respective culture condition; yet stimulated VECs on RGDS-3.4 kDa gels were not as responsive to stimulation relative to the RKR-gel groups. Thus, the syndecan binding, laminin-derived peptide promoted stable VEC adhesion on the softer hydrogels and maintained VEC phenotype and natural hemostatic function. In conclusion, utilization of non-integrin adhesive peptide sequences derived from basement membrane ECM may recapitulate balanced VEC function and may benefit endothelialization of valve implants.     

Genetics of thrombophilia: impact on atherogenesis

PURPOSE OF REVIEW: The goal of this review is to present an update on basic and epidemiological findings associating variants in prothrombotic genes with atherogenesis and atherothrombotic disease. RECENT FINDINGS: The relation between atherosclerosis and thrombosis has long been recognized but only recently has it been understood that certain hemostatic factors affect not only thrombus formation, but also have a direct atherogenic role. Atherosclerosis is a complex disorder that results from the interaction of multiple genetic and environmental factors. Numerous polymorphisms and mutations in genes related to the hemostatic system and to vascular redox determinants that modulate nitric oxide bioavailability have been identified in the past decade; their role in atherogenesis and the risk of cardiovascular disease, however, remain uncertain. We will discuss the functional implications and association with disease risk of polymorphisms in coagulation factors (fibrinogen, prothrombin, and factor V); fibrinolytic factors (plasminogen activator inhibitor 1 and lipoprotein(a)); platelet surface receptors; and vascular redox determinants (methylenetetrahydrofolate reductase, endothelial nitric oxide synthase, and the antioxidant enzymes cellular glutathione peroxidase and paraoxonase). SUMMARY: Overall, these genetic variants have a modest effect on risk when considered individually but gain potency when acting synergistically with other genetic or environmental risk factors. We conclude that a better characterization of these interactions, in addition to the identification of potential novel genetic determinants, constitute key issues in the future understanding of the pathogenesis of atherothrombosis.     

青龙蛇药的药理作用实验研究

本文报道青龙蛇药的药理实验结果,发现青龙蛇药有镇静、催眠、止痛、止血、广谱抗菌、解痉、抗过敏、强心、利尿、降血压等多种药理作用;经毒性试验证明该药无明显毒性,临床使用安全。     

Changes in the hemostatic function of muscle tissue in phylogenesis

Studies have been made on coagulating and fibrinolytic activity of muscle tissue from various animals (earthworm, clam, car, frog, pigeon, rat). It was shown that extracts from muscles of these animals contain activators and inhibitors of hemocoagulation and fibrinolysis, exhibiting also antiheparin activity. It is concluded that progressive development of hemostatic function of muscle tissue involves the decrease in anticoagulating activity and the increase of thromboplastic activity.