국소 지혈 방법

국소 지혈 방법

물리적인 방법	직접적인 압박 fabric pads/sponges/gauzes sutures/staples/ligating clips
열/에너지 기반 방법	전기소작: monopolar, bipolar, bipolar vessel sealing device, argon enhanced coagulation ultrasonic device laser
화학적 방법/약물	epinephrine vitamin K protamine desmopressin lysine analogues rFVIIa
국소 지혈제	수동적(기계적) 제제 collagen based agents cellulose gelatin polysaccharide spheres 능동적 제제 thrombin products
기타	flowables sealants: fibrin sealants, polyethylene glycol(PEG) Polymers: albumin/glutaraldehyde, cyano-acrylate

	종류	장점	단점
부식성 제제(caustic agents)	Aluminum chloride 20-70%	Inexpensive, less likely to cause pigmentation	Used only on superficial wounds
	Ferric Subsulfate 20%	nexpensive	Tattoo effect
	Silver nitrate 10-50%	Inexpensive	Pigments skin, causes thick eschar
비부식성 제제(non-caustic agents)	Porcine gelatins	Absorbs several times its weight, non-antigenic, absorbable	Swelling can lead to damage of surrounding tissues, granulomatous foreign body Reaction
	Microporous polysaccharide spheres (MPH)	Arista AH is a 100% plant based polysaccharide which contains no animal or human components. All are used in closed wounds and wounds that heal by secondary intention; absorbable	Expensive, Perclot only available in Europe
	Hydrophilic polymers with potassium salts (HPPS)	Inexpensive, available over the count	Only used in wounds that heal by secondary intention
	Oxidized Cellulose	Antibacterial, absorbable	Granulomatous foreign body reaction, acidic pH may inactivate Thrombin
	Microfibrillar Collagen	No significant swelling, absorbable	Cannot be used as a surface dressing or for packing wounds, Granulomatous foreign body Reaction
	Hemostatic dressings
	Alginate	Wound protective, Inexpensive	Not effective for high pressure Bleeding
	Mineral zeolite	Inexpensive	foreign body Reactions
	Chitin/chitosan	Antibacteria

참고자료

Glick JB, Kaur RR, Siegel D. Achieving hemostasis in dermatology-Part II: Topical hemostatic agents. Indian Dermatol Online J 2013;4(3):172–6.
Achneck HE, Sileshi B, Jamiolkowski RM, Albala DM, Shapiro ML, Lawson JH. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Ann Surg 2010;251(2):217–28.
Samudrala S. Topical hemostatic agents in surgery: a surgeon’s perspective. AORN J 2008;88(3):S2-11.
Pereira BM, Bortoto JB, Fraga GP. Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir 2018;45(5):e1900.
Vezeau PJ. Topical Hemostatic Agents: What the Oral and Maxillofacial Surgeon Needs to Know. Oral Maxillofac Surg Clin North Am 2016;28(4):523–32.

출혈치료에 사용하는 약물: 국소지혈제 구독