止血劑的相關知識
各類止血劑(如高嶺土、殼聚糖等)在不同臨床情境下的效果比較與安全性證據,特別是在凝血障礙或特殊生理狀態(如低溫、酸中毒)下的應用成效,這部分有助於優化止血劑的選擇與臨床決策。
現有醫學文獻顯示,Kaolin(高嶺土)與Chitosan(幾丁聚醣)止血劑在戰場及臨床大出血控制中均具高度有效性與安全性,且在凝血障礙、低溫、酸中毒等特殊生理狀態下仍能維持止血效果。[1][2][3][4][5]
Kaolin止血劑(如QuikClot Combat Gauze®)主要透過活化內源性凝血途徑促進凝血,動物模型證實在低溫、酸中毒及凝血障礙(如大劑量稀釋、抗凝藥物治療)下,仍能顯著減少失血量並提升生存率。Kaolin類止血劑在美國FDA已核准用於戰場與院前急救。[1][4]
Chitosan止血劑(如Celox®、ChitoSAM®、ChitoGauze®)則以陽離子聚合物與紅血球、血小板直接作用,促進細胞聚集與蛋白質吸附,其止血機制不依賴宿主凝血酶系統,因此在凝血障礙、抗凝治療、低溫、酸中毒等情境下仍具優勢。多項動物與體外研究證實,Chitosan止血劑在抗凝血藥物(如heparin、apixaban、phenprocoumon)影響下,仍能顯著縮短凝血時間並提升止血成功率。[3][6][7][8][5]在此推薦台灣的HEMO-bandage®急救填塞繃帶。
兩者在大出血、關節部及軀幹部非壓迫性出血的動物模型中,止血效果相當,且併發症(如組織壞死、炎症反應)發生率低,生物相容性佳。新一代複合型止血劑(Kaolin/Chitosan複合材料)進一步提升止血速度與穩定性。[1][2][9][10][4][5]
總結:
Kaolin與Chitosan止血劑在凝血障礙、低溫、酸中毒等特殊生理條件下,均能有效安全地控制戰場大出血,且臨床選擇可根據傷口型態、操作便利性及可取得性決定。[1][2][3][9][6][10][7][8][4][5]
References
1. Evaluation of Novel Hemostatic Agents in a Coagulopathic Swine Model of Junctional Hemorrhage. Gerling KA, Kersey AJ, Lauria AL, et al. The Journal of Trauma and Acute Care Surgery. 2023;95(2S Suppl 1):S144-S151. doi:10.1097/TA.0000000000004071.
2. User Experience and Hemostatic Efficacy: Comparative Analysis of Commercial Agents in Junctional and Hepatic Hemorrhage Models. Patterson K, Dagher AM, Lackie M, et al. PloS One. 2025;20(8):e0330696. doi:10.1371/journal.pone.0330696.
3. Hemostatics in Patients With Inhibited Coagulation-a Viscoelastic in-Vitro Analysis. Lechner R, Hanke K, Schmid A, et al. Transfusion. 2023;63 Suppl 3:S159-S167. doi:10.1111/trf.17333.
4. Kaolin-Based Hemostatic Dressing Improves Hemorrhage Control From a Penetrating Inferior Vena Cava Injury in Coagulopathic Swine. Koko KR, McCauley BM, Gaughan JP, et al. The Journal of Trauma and Acute Care Surgery. 2017;83(1):71-76. doi:10.1097/TA.0000000000001492.
5. Protonated-Chitosan Sponge With Procoagulation Activity for Hemostasis in Coagulopathy. Huang Z, Zhang D, Tong L, et al. Bioactive Materials. 2024;41:174-192. doi:10.1016/j.bioactmat.2024.07.012.
6. Research Progress and Application of Chitosan Dressings in Hemostasis: A Review. Zhang W, Geng X, Qin S, et al. International Journal of Biological Macromolecules. 2024;282(Pt 1):136421. doi:10.1016/j.ijbiomac.2024.136421.
7. Recent Advances of Chitosan as a Hemostatic Material: Hemostatic Mechanism, Material Design and Prospective Application. Zhang S, Lei X, Lv Y, Wang L, Wang LN. Carbohydrate Polymers. 2024;327:121673. doi:10.1016/j.carbpol.2023.121673.
8. Coagulopathy-Independent Injectable Catechol-Functionalized Chitosan Shape-Memory Material to Treat Non-Compressible Hemorrhage. Xiang D, Wang K, Wang F, et al. Carbohydrate Polymers. 2024;346:122648. doi:10.1016/j.carbpol.2024.122648.
9. Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites With Enhanced Hemostatic Efficiency. Elsabahy M, Hamad MA. Marine Drugs. 2021;19(2):50. doi:10.3390/md19020050.
10. Preparation of Chitosan/Clay Composites for Safe and Effective Hemorrhage Control. Yang Z, Ye T, Ma F, et al. Molecules (Basel, Switzerland). 2022;27(8):2571. doi:10.3390/molecules27082571.
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