A local hemostatic agent in the form of a chitosan-based gel is a promising technique for stopping ongoing intra-abdominal bleeding: an experimental study

Konstantin P. Golovko; Головко Константин Петрович; Konstantin P. Golovko; Artem M. Nosov; Носов Артем Михайлович; Artem M. Nosov; Andrey B. Yudin; Юдин Андрей Борисович; Andrey B. Yudin; Igor M. Samokhvalov; Самохвалов Игорь Маркеллович; Igor M. Samokhvalov; Konstantin N. Demchenko; Демченко Константин Николаевич; Konstantin N. Demchenko; Artem A. Pichugin; Пичугин Артём Андреевич; Artem A. Pichugin; Arkady Ya. Kovalevskiy; Ковалевский Аркадий Янович; Arkady Ya. Kovalevskiy

doi:10.17816/brmma562796

壳聚糖凝胶形式的局部止血剂——止住腹腔内持续出血的有效技术（实验研究）

作者: Golovko K.P.¹, Nosov A.M.¹, Yudin A.B.², Samokhvalov I.M.¹, Demchenko K.N.¹, Pichugin A.A.¹, Kovalevskiy A.Y.¹
隶属关系:
1. Kirov Military Medical Academy
2. State Research Testing Institute Military Medicine
期: 卷 26, 编号 1 (2024)
页面: 61-70
栏目: Research paper
URL: https://journals.rcsi.science/1682-7392/article/view/255216
DOI: https://doi.org/10.17816/brmma562796
ID: 255216

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在医疗后送阶段，出血是 "有可能获救"的伤员群体中最常见的死亡原因。为止住持续的外部出血，已开发出大量医疗器械：局部止血剂（敷料、绷带、粉剂）、止血带、压缩器等。止住持续的内出血仍是军事医学急需解决的问题。到目前为止，在到达合格的护理阶段之前，不可能停止腔内出血。为此，正在开发在入院前阶段止住（控制）腔内出血的新方法和新技术。作为研究工作的一部分，开发了一种凝胶形式的壳聚糖制剂，用于止住内出血。在大型实验动物腹腔持续出血模型实验中，对所开发产品的功效进行了评估，结果表明其止血效率很高。根据术中肝脏伤口出血的严重程度，研制的局部止血剂，经腹腔穿刺注入，可实现肝创面术中出血3级止血，而且不会引起周围器官和组织的炎症变化。与对照组相比，使用局部止血剂可避免实验组出现致命结果（3 只动物中 1 只出现致命结果）。血红蛋白和红细胞计数的动态变化表明，实验组动物在使用局部止血剂后几乎立即止血，而对照组动物的止血在整个观察期间一直不稳定。肝脏制剂的组织学研究结果证实，使用局部生物相容性止血剂可持续止血，不会出现局部炎症反应或坏死。所创造的技术可以从急救阶段开始使用，因为它解决了在医院前阶段阻止腔内出血的问题，改善腹部受伤伤员的治疗效果。

关键词

腹腔内持续出血, 持续止血, 止血剂, 肝损伤, 壳聚糖, 急救, 院前阶段, 腹腔穿刺术

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clinical resident

俄罗斯联邦, Saint Petersburg

参考

Samokhvalov IM, Goncharov AV, Chirskij VS, et al. “Potentially survivable” casualties - reserve to reduce pre-hospital lethaility in injuries and traumas. Emergency medical care. 2019;20(3):10–17. EDN: CUUXRN doi: 10.24884/2072-6716-2019-0-3-10-17
Yareshko VG, Mikheev YA, Otarashvili KN. The concept of damage control in trauma (surgeon’s view). Medicine of urgent conditions. 2014;(7):176–180. EDN: TZCEVX (In Russ.).
Hoencamp R, Vermetten E, Tan ECTH, et al. Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan. Injury. 2014;45(7): 1028–1034. doi: 10.1016/j.injury.2014.02.012
Bonanno FG. Management of hemorrhagic shock: Physiology approach, timing and strategies. J Clin Med. 2022;7(2):110–113. doi: 10.3390/jcm12010260
Rall JM, Redman TT, Ross EM, et al. Comparison of zone 3 resuscitative endovascular balloon occlusion of the aorta and the abdominal aortic and junctional tourniquet in a model of junctional hemorrhage in swine. J Surg Res. 2018;226:31–39. doi: 10.1016/j.jss.2017.12.039
Kheirabadi BS, Terrazas IB, Miranda N, et al. Physiological consequences of abdominal aortic and junctional tourniquet (AAJT) application to control hemorrhage in a swine model. Shock. 2018;46(3S):160–166. doi: 10.1097/SHK.0000000000000651
Duggan M, Rago A, Sharma U, et al. Self-expanding polyurethane polymer improves survival in a model of noncompressible massive abdominal hemorrhage. J Trauma Acute Care Surg. 2013;74(6): 1462–1467. doi: 10.1097/TA.0b013e31828da937
Rago AP, Duggan MJ, Beagle J, et al. Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage: 28-day survival and safety. J Trauma Acute Care Surg. 2014;77(3):127–133. doi: 10.1097/TA.0000000000000380
Golovko KP, Samokhvalov IM, Grishin MS, et al. Use of a local hemostatic agent based on chitosan and external compression of the abdominal area to control intra-abdominal bleeding. Bulletin of the Russian Military Medical Academy. 2022;24(1):43–54. EDN: BUFMLE doi: 10.17816/brmma91155
Cantle PM, Hurlet MJ, Swartz MD. Methods for early control of abdominal hemorrhage: an assessment of potential benefit. J Spec Oper Med: Peer Rev J SOF Med Prof. 2018;18(2):98–104. doi: 10.55460/I0EU-SQE7

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2. Fig. 1. Stages of inducing a pig liver wound with grade 3 bleeding based on the VIBe scale: а — removal of the left lobe of the liver from a laparotomy wound; b — application of a plastic limiter with a square hole in the center (3 × 3 cm in size); с — creation of a liver wound using a scalpel; d — appearance of liver wounds with grade 3 bleeding based on the VIBe scale

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3. Fig. 2. Position of the animal on the operating table. The abdomen was bandaged with a CBP-U bandage after the introduction of MBGS into the abdominal cavity to reduce its volume

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4. Fig. 3. Dynamics of hemoglobin levels in both groups

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5. Fig. 4. Liver wound in an experiment with MBGS. Staining with hematoxylin and eosin: а — after 3 h, the edge of the liver wound is covered with abundant fibrin coagulation, magnified × 100; b — fragment. The formed fibrin bundle is tightly glued to the underlying wound surface, uv. × 200

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6. Fig. 5. Liver wound in the control group. Staining with hematoxylin and eosin: а — after 3 h, the edge of the liver wound is covered with a relatively thin layer of fibrin, uv. × 100; b — fragment. The fibrin bundle loosely covers the underlying wound surface, magnified × 200

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