Deneysel parsiyel splenektomi modelinde sıçanlarda algan hemostatik ajanın kanama kontrolünde etkinliğinin araştırılması

Yıl 2019, , 27 - 32, 29.01.2019

Ahmet Mıdı , Husamettin Ekıcı Ali Kumandas , Omercan Durmus Buse Bodıc Mehmet Tıryakı Mehmet Sabri Balik Erdem Yesılada

https://doi.org/10.5472/marumj.518821

Cited By: 3

Öz

Amaç: Algan hemostatik ajan (AHA), Türkiye’de üretilen bitki

bazlı hemostatik bir maddedir. Hemostatik teknolojilerdeki

büyük gelişmelere rağmen, kanamanın kontrolünde kullanılmak

üzere daha etkili hemostatik ürünlerin üretilmesi gerekmektedir.

Bu çalışmanın amacı, AHA’nın sıçanlarda parsiyel splenektomi

modelindeki etkinliğini göstermektir. Ayrıca bu modelde batın

yapışıklığı değerlendirilmiştir.

Gereçler ve Yöntemler: Bu çalışmada 5-7 haftalık 64 sıçan

kullanıldı. Sıçanların her biri sekiz sıçandan oluşan 8 gruba

ayrıldı (heparinize edilmiş 4 grup ve heparinize edilmemiş 4

grup). Deneysel splenektomi yapıldı ve kontrol grubuna hemoraji

kontrolü için serum fizyolojik emdirilmiş gazlı bez uygulandı,

deney gruplarına AHA sıvı emdirilmiş gazlı bez, jel ve toz formu

uygulandı.

Bulgular: Komple hemostaza ulaşma süresi, tüm AHA

gruplarında kontrol grubuna kıyasla anlamlı olarak daha kısa idi.

AHA’nın toz ve jel formları heparinize ve heparinize olmayan

gruplarda 1 saniyede kanamayı durdurdu. AHA sıvı (sünger)

formu, kontrol grubunda ilk uygulamada tüm sıçanlarda kanamayı

durdurdu (10 saniyenin altında). Kanama, heparinize edilmiş

kontrol grubunda (serum fizyolojik emdirilmiş gazlı bez) ortalama

55 saniyede ve heparinize olmayan kontrol grubunda 38 saniyede

kontrol edilebildi.

Sonuç: Bu çalışma, AHA’nın hemorajinin kontrol edilmesinde

yararlı olabilecek oldukça etkili bir hemostatik ajan olduğunu

göstermiştir.

Anahtar Kelimeler

Algan hemostatik ajan, Hemostaz, Sıçan, Kanama kontrolü, Splenektomi

Investigation of the effectiveness of algan hemostatic agent in bleeding control using an experimental partial splenectomy model in rats

Öz

Objective: Algan hemostatic agent (AHA) is a plant-based

hemostatic agent produced in Turkey. Although, there is a great

improvement in the hemostatic technologies, more effective

hemostatic products are required to be produced. The aim of

this study was to demonstrate the efficacy of AHA in a partial

splenectomy model in rats. In addition, in this model, postoperative

abdominal adhesion was evaluated.

Materials and Methods: In this study 5-7 weeks old 64

rats were used. Rats were randomly divided into 8 groups, each

consisting of eight rats (4 groups heparinized and 4 groups nonheparinized).

Experimental splenectomy was performed and the

gauze impregnated with saline was applied to the control group for

the hemorrhage control, the gauze impregnated with liquid AHA,

gel and powder form of AHA, was applied to the experimental

groups.

Results: The time to reach complete homeostasis was

significantly shorter in all AHA groups compared to the control

group. The powder and the gel forms of AHA stopped the bleeding

in heparinized and non-heparinized groups in 1 second. The AHA

fluid (sponge) form stopped the bleeding in the first application

in the control group less than 10 seconds and the second time

application was not necessary. The bleeding was able to be

controlled in the heparinized control group (saline impregnated

sponge) by 55 seconds and in the non-heparinized control group

by 38 seconds.

Conclusion: This study showed that AHA is a highly effective

hemostatic agent, which would be beneficial in controlling

hemorrhage.

Anahtar Kelimeler

Algan hemostatic agent, Hemostasis, Rat, Bleeding control, Splenectomy

Kaynakça

• 1. Uranus S, Mischinger HJ, Pfeifer J, et al. Hemostatic methods for the management of spleen and liver injuries. World J Surg 1996;20:1107-11. doi: 10.1007/s002689900.
• 2. Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW. Management of blunt splenic injury in children: Evolution of the nonoperative approach. J Pediatr Surg 2009;44:1005-8. doi: 10.1016/j.jpedsurg.2009.01.024.
• 3. Kuzu A, Aydıntuğ S, Karayalçın K, Köksoy C, Yerdel M A, Eraslan S. Use of autologous fibrin glue in the treatment of splenic trauma: an experimental study. Journal of Royal College of Surgeons Edinburgh 1992;37:162-4.
• 4. King H, Shumacker HB Jr. Splenic studies: Susceptibility to infection after splenectomy performed in\wiancy. Ann Surg 1952;136: 239-42.
• 5. Schwartz M, Madariaga J, Hirose R, et al. Comparison of a new fibrin sealant with standard topical hemostatic agents. Arch Surg 2004;139:1148-54. doi:10.1001/ archsurg.139.11.1148
• 6. Hanks JB, Kjaergaard HK, Hollingsbee DA. A comparison of the haemostatic effect of Vivostat patient-derived fibrin sealant with oxidised cellulose (Surgicel) in multiple surgical procedures. Eur Surg Res 2003;35:439-44. doi: 10.1159/000072229
• 7. Ersoy G, Kaynak MF, Yilmaz O, Rodoplu U, Maltepe F, Gokmen N. Hemostatic effects of microporous polysaccharide hemosphere in a rat model with severe femoral artery bleeding. Adv Ther 2007;24:485-92. doi: 10.1007/BF02848770.
• 8. Ward KR, Tiba MH, Holbert WH, et al. Comparison of a new hemostatic agent to current combat hemostatic agents in a swine model of lethal extremity arterial hemorrhage. J Trauma 2007;63:276-83. doi: 10.1097/TA.0b013e3180eea8a5
• 9. Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC. Evaluation of hemostatic effects of Ankaferd as an alternative medicine. Altern Med Rev 2010;15:329-36.
• 10. Uçar Albayrak C, Caliskan U, Haznedaroglu IC, Goker H. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008;36:1447-8.doi: 10.1177/147.323.000803600121.
• 11. Köse R, Sogut Ö, Demir T, Koruk İ. Hemostatic efficacy of folkloric medicinal plant extract in a rat skin bleeding model. Dermatol Surg 2012;38, 760-6. doi: 10.1111/j.1524- 4725.2011.02288.x
• 12. Yavuz E, Kalayci M U, Kesici S, Kesici U, Ozkara S, Yalcin O. Efficacy of ankaferd blood stopper in bleeding control in experimental partial splenectomy model. Kafkas Universitesi Veteriner Fakultesi Dergisi 2012;18: 753-8. doi:10.9775/ kvfd.2012.6324
• 13. Midi A, Kumandaş A, Ekici H, et al. Investigation of the effectiveness of algan hemostatic agent in renal venous bleeding model in rats. EJMI 2018; 2: 129-32. doi: 10.14744/ ejmi.2018.32032.
• 14. Midi A, Ozyurek H E, Karahan S, et al. Investigation of efficacy of the plant based algan hemostatic agent in hepatectomy bleeding model in rats. EJMI 2018; 2: 195-201 | doi: 10.14744/ejmi.2018.35744.
• 15. Schwaitzberg SD, Chan MW, Cole DJ, et al. Comparison of poly-N-acetyl glucosamine with commercially available topical hemostats for achieving hemostasis in coagulopathic models of splenic hemorrhage. J Trauma 2004;57:S29-32. doi: 10.1097/01.TA.000.013.6747.35311.60.
• 16. Chan MW, Schwaitzberg SD, Demcheva M, Vournakis J, Finkielsztein S, Connolly RJ. Comparison of poly-Nacetyl glucosamine (P-GlcNAc) with absorbable collagen (Actifoam), and fibrin sealant (Bolheal) for achieving hemostasis in a swine model of splenic hemorrhage. J Trauma 2000;48:454-8.
• 17. Holcomb JB, McClain JM, Pusateri AE, et al. Fibrin sealant foam sprayed directly on liver injuries decreases blood loss in resuscitated rats. J Trauma 2000;49:246–50.
• 18. Tekin MI, Peşkircioğlu L, Boyvat F, et al. Practical approach to terminate urinary extravasation: percutaneous fistula tract embolization with n butyl cyanoacrylate in a case with partial nephrectomy. Tech Urol 2000;7:67-9.
• 19. Grummet JP, Costello AJ, Swanson LC, et al. Vesicourethral anastomosis with 2-octyl cyanoacrylate adhesive in an in vivo canine model. Urology 2001;60:935-8. doi:10.1016/ S0090-4295(02)01887-3.
• 20. Berrevoet F, de Hemptinne B. Clinical application of topical sealants in liver surgery: does it work?. Acta Chirurgica Belgica 2007;107:504-7. doi: 10.1080/00015.458.2007.116 80111.
• 21. Yucel M O, Polat H, Bagcioglu M, et al. Comparison of the efficacy and histopathological effects of three hemostatic agents in a partial nephrectomy rat model. Int Urol Nephrol 2016; 48:65-71. doi:10.1007/s11255.015.1129-3.
• 22. Taşkın A K, Yaşar M, Özaydın İ, et al. The hemostatic effect of calcium alginate in experimental splenic injury model. Ulus Travma Acil Cerrahi Derg 2013;19:195-99. doi: 10.5505/tjtes.2013.30676.
• 23. Aarons CB, Cohen P A, Gower A, et al. Statins (HMG-CoA Reductase Inhibitors) decrease postoperative adhesions by increasing peritoneal fibrinolytic activity. Ann Surg 2007; 245:176-84.
• 24. Bae JS, Ahn S J, Yim H, et al. Prevention of intraperitoneal adhesions and abscesses by polysaccharides isolated from phellinus spp in a rat peritonitis model. Ann Surg 2005; 241: 534-40.
• 25. Galili Y, Ben-Abraham R, Rabau M, et al. Reduction of surgery-induced peritoneal adhesions by methylene blue. Am J Surg 1998;175:30-2.
• 26. Gomez NA, Iniguez SA, Leon C J. Use of oxidized regenerated cellulose (TC7) to prevent postoperative adhesions in laparoscopic surgery. Surg Endosc 1994; 8:934.
• 27. Cömert M, Karakaya K, Barut F, et al. Does intraabdominal use of Ankaferd Blood Stopper cause increased intraperitoneal adhesions? Ulus Travma Acil Cerrahi Derg 2010; 16:383-9.