The Experimental And Clinical Study On Hemostatic Effect Of Shengji Tongqiao Hemostatic Sponge

Objective:(1) To verify the promotion role of filling the operative cavity with Shengji Tongqiao hemostatic sponge(promoting granulation and freeing the orifices according to TCM theory) on postoperative hemostasis and repair of operative cavity mucosa after FESS;(2) To discuss the possible mechanism of Shengji Tongqiao hemostatic sponge in hemostasis and repair of operative cavity mucosa;(3)To explore the application of TCM in postoperative hemostasis of operative cavity after endoscopic surgery for nasosinusitis and in promotion of postoperative mucosal repair.Methods:(1)30 rabbits were included and randomly divided into 3 groups:normal control group, control I group and treatment I group. Symmetric incisions were made in bilateral dorsal regions. Blood vessels on fascia were cut off, and it was recorded from the time of natural hemorrhage. The normal control group was not given any intervention, while in the treatment I group and control I group Shengji Tongqiao hemostatic sponge and expansion sponge were immediately placed at the hemorrhage site, respectively. And the blood was sucked out with a filter paper every 15 s according the time of camera till natural hemostasis, and the whole duration was calculated with the video analysis software;(2)20 rabbits were included and randomly divided into two groups: treatment II group and control II group, respectively.Symmetric incisions were made in bilateral dorsal regions. The incisions were sutured after placement of Shengji Tongqiao hemostatic sponge and expansion sponge,respectively. The incisions were sutured, and opened again after 48 h. The stuffing was taken out, the incision was observed and HE staining was used to observe the surrounding tissues;(3)20 rabbits were included and randomly divided into two groups:treatment III group and control III group, respectively. Rabbit nasal sinuses were opened, and the incisions were sutured after placement of Shengji Tongqiao hemostatic sponge and expansion sponge, respectively. Specimens(mucosal tissues of operative cavity) were taken after 48 h and HE staining was used to observe the mucosal inflammation;(4)60 cases according to the diagnostic criteria and surgical indications were included and randomly divided into two groups: treatment IV group and control IV group, respectively. All of the patients were given same perioperative treatments,and specimens(mucosal tissues of operative cavity) were taken before the operation and 48 h after filling of operative cavity, and HE staining was used to observe the mucosal inflammation; postoperative-48 h bleeding amount of the two groups of patients was recorded and visual analogue scale was used to record the postoperative-48 h pain degree. Two groups of patients were detected for the peripheral inflammatory cytokines expressions(IL-1, IL-4) at postoperative 48 h;(5)After data processing on the above data, statistical analysis was used to draw the corresponding conclusions.Results: Animal experiment found statistically significant differences in hemorrhage time of the three groups of rabbits(P<0.05). Hemorrhage time of the treatment I group and the control I group was obviously lower than that of the normal control group. Gross observation found local desiccation, without obvious redness and exudation in treatment II group, while there was a large amount of bloody fluid retention, slight swallowing, and obvious adhesion between the expanded sponge and the surrounding tissues in control II group. HE staining of the tissues around stuffing suggested mild inflammation of operative cavity muscles in the treatment II group compared with the control II group; nasal sinus mucosal staining suggested less bleeding of operative cavity mucosa and mild inflammation in the treatment III group compared with the control III group; clinical experiment found no significant difference between two groups of patients in postoperative VAS scores(P>0.05); but there were statistically significant differences in postoperative 48 h blood loss(P<0.05),and the blood loss was obviously lower in the treatment IV group compared with the control IV group; nasal sinus HE staining suggested mild inflammation of operative cavity mucosa in the treatment IV group compared with the control IV group; there were statistically significant differences between two groups of patients in postoperative 48 h inflammatory cytokines(IL-1, IL-4)(P<0.05), and the inflammatory cytokines levels were obviously lower in the treatment IV group than the control IV group.Conclusion:(1)The Shengji Tongqiao hemostatic sponge can effectively stop bleeding,with good histocompatibility.(2)It can regulate the expressions of serum IL-1 and IL-4 in local sinus mucosaand serum and play an anti-inflammation and inflammation-suppression role.(3)TCM operative cavity filling is effective in clinical,which should be further studied and promoted.