止血材料分类及介绍.ppt

* * 1.对于大血管出血或大面积伤口的出血几乎无效。 2.导致组织缺血而引起代谢异常产生并发症，甚至易造成由于有毒代谢物的聚集造成休克或肾功能衰竭 * * (a) Initial platelet plug is formed in the primary hemostasis when the vascular wall is injured. Inactive platelets circulating in blood become activated, subsequently. Platelets trigger an aggregation of other locally activated platelets. (b) Formation of fibrin in the secondary hemostasis, when the coagulation cascade is initiated. The clotting factor involved in this stage is activated gradually. Activated X cleaves prothrombin into thrombin, then fibrinogen is cleaved into fibrin monomers by the enzymolysis of thrombin. Finally, fibrin monomers are crosslinked with the participation of Ca2+ and activated factor XIII. (c) Process of the coagulation cascade, which includes intrinsic and extrinsic coagulation pathways (including the common pathway). * * * * * * LIVE AND LEARN 止血材料概述 Summary of hemostatic materials XXX 目 录 CONTENTS 1 背景介绍 background 2 性能要求 Requirements 3 止血机理 mechanism 4 分类介绍 Classification 1 背景介绍 background 战争 手术 工厂 交通 事故 50% of military deaths are caused by hemorrhages More than 85% of the deaths are due to excessive loss of blood Bleeding is a very common and intractable problem during surgery. Factory accident Uncontrollable bleeding Ref: J. Biomed.Mater. Res., Part A, 2014, 102, 4182–4194 The history of hemostat Ref: 蓝广芊. 壳聚糖/明胶复合止血材料的研制及其性能研究[D].西南大学,2016. 2 性能要求 Requirements 止血迅速，要求能在２分钟内止住主血管及体内脏器的出血渗血 在体内能自行降解吸收，无长期不良影响 性能稳定，方便保存 性能要求 无毒副作用、无潜在病源性，不增加感染概率 成本低廉，价格经济 不影响组织愈合（最好能促进组织愈合）等 3 止血机理 mechanism 人体止血 Ref: Biomater. Sci., 2017, 5, 2357 Schematic of the coagulation process 比如沸石类（Quick-Clot），高岭土类（WoundStat），铝酸盐类 （Combat Gauze）等，他们都是通过快速吸收血液中的水分。部分高分子，比如明胶、海藻酸盐类止血材料也能快速吸收血液中的水分 通过（物理或者化学的作用）短时间内提高伤口附近的血液凝血因子浓度 壳聚糖类止血材料， 壳聚糖表面带正电荷，导致带负电的红细胞 容易聚集于其表面，也可以激活血液中的补体系统，对血小板也有聚集作用等。而氧化纤维素是由于其自身的羧基能与血红细胞中铁离子络合成血块，封堵血管，纤维蛋白胶、短肽类、凝血酶等类型的止血材料则依靠快速启动血液的内源性止血系统。 通过直接激活或参与凝血系统 比如：α -氰基丙烯酸酯类、PEG 类等合成高分子，它们遇到血 液后能迅速形成粘性很强的胶体，迅速封堵血管 通过强黏着进行物理封闭血管 材料止血机理 止血机理 4 分类介绍 C