Hemostatic effect of macroporous polysaccharides composite hemostatic materials on small-artery severed injury

doi:10.12307/2022.453

Abstract

Abstract: BACKGROUND: The hemostatic performance of absorbable hemostatic materials for arterial bleeding cannot meets for the clinical demands.
OBJECTIVE: To study the hemostatic effect of macroporous polysaccharides composite hemostatic materials on small artery hemorrhage.
METHODS: The rabbit model of arteriolar hemorrhage was established by severing the femoral artery and randomly divided into two groups. The experimental group (n=10) was treated with macroporous polysaccharides composite hemostatic materials, and the control group (n=7) was treated with commercial microporous polysaccharide hemostatic powder. After operation, hemostatic success rate, blood loss, blood routine test, liver and kidney function index were recorded and hematoxylin-eosin staining was used to observe wound tissue.
RESULTS AND CONCLUSION: (1) The success ratio of hemostasis in experimental group was higher than that in the control group (90%, 43%, P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). (2) The blood routine and liver and kidney function index test results within 180 days after operation showed that the change trend of each index of the two groups was basically the same, and the two hemostatic materials did not cause obvious liver and kidney dysfunction, nor did it cause purulent or inflammation in the degradation and absorption process. (3) The hematoxylin-red staining of the wound tissue 90 days after the operation showed that the tissues in the experimental group were evenly stained; the muscle fiber morphology and structure were normal; the boundaries were clear; and the arrangement was regular. There was no obvious abnormality in the interstitium, and no scars in the wound. In the control group, the tissues were uniformly stained; the morphology and structure of muscle fibers were normal; the boundaries were clear; and the arrangement was regular. There was no obvious abnormality in the interstitium, but there were more scars locally. (4) These results suggest that effectiveness of the macroporous polysaccharides composite hemostatic materials is higher than that of the commercial hemostatic powder. The safety is not inferior to that of the commercial hemostatic powder. Therefore, the macroporous polysaccharides composite hemostatic materials can be used for hemostasis in vivo.

Key words: composite macroporous polysaccharide hemostatic material, composite microporous polysaccharide hemostatic powder, carboxymethyl chitosan, absorbable hemostatic material, small arterial hemostasis, arterial disconnection

CLC Number:

Xu Lin, Cheng Gangyi, Li Hongwei, Wang Hongjian, Lin Minghui, Guo Hongwei, Lin Lianfeng, Xu Ling. Hemostatic effect of macroporous polysaccharides composite hemostatic materials on small-artery severed injury[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(34): 5442-5447.

Figures/Tables 5

References

[1] LESTARI W, YUSRY WNSW, HARIS MS, et al. A glimpse on the function of chitosan as a dental hemostatic agent. Jpn Dent Sci Rev. 2020;56(1): 147-154.
[2] SAPAHN DR, BOUILLON B, CERNY V, DURANTEAU J, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23(1): 98-99.
[3] 刘锐,李辉,杨俊峰,等.可吸收止血胶原海绵在心脏外科术中胸骨止血的应用体会[J].心肺血管病杂志,2014,33(5):719-721.
[4] YU W, XU J, SHENG H, et al. Clinical Evaluation of Absorbable Regenerated Oxidized Cellulose in Lung Cancer Surgery. Zhongguo Fei Ai Za Zhi. 2020;23(6):492-495.
[5] CHEN XY, CUI CY, LIU Y, et al. A robust poly (N-acryloyl-2-glycine)- based sponge for rapid hemostasis. Biomater Sci. 2020;8(13):3760-3771.
[6] NADERI Z, AZIZIAN J. Synthesis and characterization of carboxymethyl chitosan/Fe3O4 and MnFe2O4 nanocomposites hydrogels for loading and release of curcumin. Photochem Photobiol B. 2018;18(5):206-214.
[7] YIN ML, WANG YF, ZHANG Y, et al. Novel quaternarized N-halamine chitosan and polyvinyl alcohol nanofibrous membranes as hemostatic materials with excellent antibacterial properties. Carbohydr Polym. 2020;232. doi: 10.1016/j.carbpol.2019.115823.
[8] BUKZEM ANDREA L, SIGNINI ROBERTA, DOS SANTOS DANILO M, et al. Optimization of carboxymethyl chitosan synthesis using response surface methodology and desirability function. Int J Biol Macromol. 2016;85(1):615-624.
[9] FERNANDA GL, MEDEIROS BORSAGLI, ALEXANDRA AP, et al. O -carboxymethyl functionalization of chitosan: Complexation and adsorption of Cd (II) and Cr (VI) as heavy metal pollutant ions. React Funct Polym. 2015;97(1):37-47.
[10] GHOLAMALI I, ASNAASHARIISFAHANI M, ALIPOUR E. Silver Nanoparticles Incorporated in pH-Sensitive Nanocomposite Hydrogels Based on Carboxymethyl Chitosan-Poly (Vinyl Alcohol) for Use in a Drug Delivery System. Regen Eng Transl Med. 2020;6(2):138-153.
[11] DEMARCHI CA, SILVA L MD, NIEDZWIECKA A, et al. Nanoecotoxicology study of the response of magnetic O-Carboxymethylchitosan loaded silver nanoparticles on Artemia salina. Environ Toxicol Pharmacol. 2020; 74(2):151-156.
[12] HATTORI H, ISHIHARA M. Changes in blood aggregation with differences in molecular weight and degree of deacetylation of chitosan. Biomed Mater. 2015;10(1):015014.
[13] WANG YM, XIAO DD, ZHONG Y, et al. Facile fabrication of carboxymethyl chitosan/paraffin coated carboxymethylated cotton fabric with asymmetric wettability for hemostatic wound dressing. Cellulose. 2020; 27(6):3443-3453.
[14] WANG LY, ZHONG YY, QIAN CT, et al. A natural polymer-based porous sponge with capillary-mimicking microchannels for rapid hemostasis. Acta Biomater. 2020;114:193-205.
[15] CHAO Y, LING X, YING Z, et al. A green fabrication approach of gelatin/CM-chitosan hybrid hydrogel for wound healing. Carbohydr Polym. 2010;82(4):1297-1305.
[16] 曾莉君,程刚毅,王赟,等.复合大孔聚多糖止血材料对肝脏钝挫伤止血的有效性研究[J].中华损伤与修复杂志(电子版),2018,13(2): 88-93.
[17] HAO C, SHANG XQ, YU L, et al. Safety evaluation of a low-heat producing zeolite granular hemostatic dressing in a rabbit femoral artery hemorrhage model. J Biomater Appl. 2020;34(7):988-997.
[18] CHUNYU L, CHENYU L, SIMIAO Y, et al. Efficient antibacterial dextran-montmorillonite composite sponge for rapid hemostasis with wound healing. Int J Biol Macromol. 2020;160:1130-1143.
[19] YANG WJ, SONG JC, ZHU YW, et al. Application of chain-based sponge dressing for gunshot wounds in the groin. Am J Emerg Med. 2021;39: 24-27.
[20] TANAKA SM, IMAMURA T, FUJIMOTO M, et al. Potent Hemostatic Efficacy of a Novel Recombinant Fibrin Sealant Patch (KTF-374) in Rabbit Bleeding Models. J Invest Surg. 2019;32(3):257-261.
[21] QIAO ZW, LV XL, HE SH, et al. A mussel-inspired supramolecular hydrogel with robust tissue anchor for rapid hemostasis of arterial and visceral bleedings. Bioact Mater. 2021;6(9):2829-2840.
[22] QIANQIAN OY, TINGTING H, CHENGPENG L, et al. Construction of a composite sponge containing tilapia peptides and chitosan with improved hemostatic performance. Int J Biol Macromol. 2019;139(1): 719-729.
[23] 张爽,徐庆华,童琳,等.可吸收止血材料的研究现状与应用[J].中国组织工程研究,2021,25(10):1628-1634.
[24] ZHENG YX, PAN NY, LIU Y, et al. Novel porous chitosan/N-halamine structure with efficient antibacterial and hemostatic properties. Carbohydr Polym. 2021;253(1):117-205.
[25] HU Z, ZHANG DY, LU ST, et al. Chitosan-Based Composite Materials for Prospective Hemostatic Applications. Mar Drugs. 2018;16(8):273.
[26] ZHANG DY, HU Z, ZHANG LY, et al. Chitosan-Based Thermo-Sensitive Hydrogel Loading Oyster Peptides for Hemostasis Application. Materials (Basel, Switzerland). 2020;13(21):1-16.
[27] ZHENG W, CHEN CT, ZHANG XJ, et al. Layer-by-layer coating of carboxymethyl chitosan-gelatin-alginate on cotton gauze for hemostasis and wound healing. Surf Coat Technol. 2020. doi: 10.1016/j.surfcoat.2020.126644.
[28] YONG Z, JZ L, FAN L, et al. Degradable porous carboxymethyl chitin hemostatic microspheres. J Biomater Sci Polym Ed. 2020;31(11):1369-1384.
[29] WEI Z, YU X, BIN Y, et al. Synthesis and properties of crosslinked carboxymethyl chitosan and its hemostatic and wound healing effects on liver injury of rats. J Biomater Appl. 2019;34(3):442-450.
[30] ZHOU LB, DING RY, XU BX, et al. Application of microfibrillar collagen hemostat sponge for cartilage engineering. Int J Clin Exp Med. 2016; 9(3):6127-6132.
[31] 肖丹宇,卫骆云,俞俊峰,等.可吸收止血微球在腹腔镜胆囊切除术中的临床应用[J].中国内镜杂志,2014,20(4):398-400.
[32] GRUNKHORN R, BURNHAM R, WALTON G. Successful use of a military-grade haemostatic agent for a major head and neck bleed. J Laryngol Otol. 2013;127(10):1031-1033.
[33] POURSHAHRESTANI S, ZEIMARAN E, KADRI NA, et al. Polymeric Hydrogel Systems as Emerging Biomaterial Platforms to Enable Hemostasis and Wound Healing. Adv Healthc Mater. 2020;9(20):e2000905.
[34] BIRANJE SS, MADIWALE PV, PATANKAR KC, et al. Cytotoxicity and hemostatic activity of chitosan/carrageenan composite wound healing dressing for traumatic hemorrhage. Carbohydr Poly. 2020;239. doi: 10.1016/j.carbpol.2020.116106.
[35] ZHANG DF, XU ZY, LI HF, et al. Fabrication of strong hydrogen-bonding induced coacervate adhesive hydrogels with antibacterial and hemostatic activities. Biomater Sci. 2020;8(5):1455-1463.