2. Thermal ways of a final stop of bleeding

Physical ways of a final stop of bleeding are based on local use of low and high temperatures, electric current.

Cryosurgery – the method of surgical intervention based on use of very low temperatures. There is a freezing of fabrics liquid nitrogen that promotes a hemostasis. Use at brain, liver operations, vascular tumors.

Hot sterile solutions increase the curtailing ability of blood. The gauze tampon is moistened in sterile hot physiological solution of sodium of chloride and entered for 5-7 minutes into a wound. Temperature of solution is 60 — 70 °C. It is used in case it is impossible or application of mechanical ways of a final stop of bleeding is inefficient. Electrocoagulation, i.e. cauterization of the damaged vessels current of ultrahigh frequency.

Now for the purpose of a hemostasis microwave and ultrasonic knives, laser beams (a laser scalpel) and plasma (a plasma scalpel) are applied. A microwave knife – the tool producing a special type of electromagnetic energy – a microwave which distribution is followed by allocation of heat. It allows to concentrate a high-energy microwave field round a cutting edge of an edge. Thanks to absorption of microwaves fabrics this method provides deep coagulation of fabrics that is especially important for a stop of parenchymatous bleeding. Microwave knife электробезопасен.

Ultrasonic knife. In this adaptation for a section of fabrics use energy of ultrasonic waves. Damage of surrounding fabrics the minimum.

Argon beam coagulator. Use the concentrated bunch of the ionized argon (so-called argon plasma) for impact on fabrics of electric current of high frequency without direct contact. The argon stream – the colourless inert gas which doesn't have a smell allows to coagulate fabrics on extensive sites, provides purity of an operational field, reduces a travmatization of fabrics and risk of contact of medical staff with the patient's blood. This method is used for a bleeding stop, both from superficial wounds, and from parenchymatous bodies (a liver, kidneys, a spleen).

Lasers use for a section, evaporation and simultaneous coagulation of the planned site without damage of surrounding fabrics. The mechanism of operation of the laser consists in accumulation of energy in the bleeding vessel and stimulation of folding. Use of the laser is followed by a good hemostasis that allows to apply it at endoscopic and open surgical interventions.

3. Chemical ways of a final stop of bleeding

For a bleeding stop at the disposal of surgeons there are two main groups of medicines. One have vasoconstrictive effect, and others influence system of a hemostasis. Pathogenetic more reasonable is use of the medicines accelerating a fibrillation, but quite often in clinical practice also the preparations oppressing фибринолиз are applied. For a final stop of bleeding a number of the chemicals having vasoconstrictive effect is used. Solution of adrenaline (1:1000) at local introduction has styptic effect by a spazmirovaniye of the damaged vessels. Thus the gleam of a vessel is blocked that promotes formation of blood clot. Solution of adrenaline can be added to local anesthetic for reduction of bleeding of fabrics during operation. Statizol – the combined preparation having haemo static effect due to formation of the elastic polymeric film closing the bleeding site. The aerosol dosage form at bleeding from stomach ulcers is used and a 12-perstny gut. After drawing on a source of bleeding and evaporation of solvent the elastic film with good adhesion to a mucous membrane which isn't washed away is formed and not torn away within 2-3 days.

Carry oxytocin to uterine means, питуитрин and ergot preparations which cause a spasm, reduction of muscles of a uterus that leads to compression of walls of vessels and a stop of bleeding.

The synthetic analog of a hormone of a back share of a hypophysis of a vazopressin - реместип belongs to group of vasoconstrictive means. The vasoconstrictive effect of a remestip is connected with increase of a tone of smooth muscles of a vascular wall. It causes narrowing артериол, veins, faded, especially in an abdominal cavity.

Epsilon-aminokapronovaya acid belongs to the preparations oppressing фибринолиз. It blocks activators of a plazminogen and partially action of a plazmin oppresses. 5% solution to 100 ml are entered intravenously. It can be entered into a stomach at gastric bleeding. Also treats antifibrinolitichesky means амбен which oppresses фибринолиз by competitive braking of plazminogenaktiviruyushchy enzyme and oppression of formation of a plazmin. Ditsinon (sodium etamsylate) treats group of vasoprotectives, normalizes permeability of a vascular wall, improves microcirculation and has haemo static effect. The haemo static effect is connected with the activating action on formation of a tromboplastin.

Vitamin K participates in formation of a prothrombin and promotes a normal fibrillation. Menadion, Vikasolum are synthetic analogs of vitamin K which are used as specific remedies at bleeding connected with the lowered maintenance of a prothrombin in blood.