CN103403095B - 组合物i – ii及其产品和用途 - Google Patents
组合物i – ii及其产品和用途 Download PDFInfo
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- CN103403095B CN103403095B CN201180065988.4A CN201180065988A CN103403095B CN 103403095 B CN103403095 B CN 103403095B CN 201180065988 A CN201180065988 A CN 201180065988A CN 103403095 B CN103403095 B CN 103403095B
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Classifications
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- A61M1/91—Suction aspects of the dressing
- A61M1/915—Constructional details of the pressure distribution manifold
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F13/00—Bandages or dressings; Absorbent pads
- A61F13/05—Bandages or dressings; Absorbent pads specially adapted for use with sub-pressure or over-pressure therapy, wound drainage or wound irrigation, e.g. for use with negative-pressure wound therapy [NPWT]
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/22—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons containing macromolecular materials
- A61L15/26—Macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds; Derivatives thereof
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/42—Use of materials characterised by their function or physical properties
- A61L15/425—Porous materials, e.g. foams or sponges
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- A—HUMAN NECESSITIES
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/42—Use of materials characterised by their function or physical properties
- A61L15/58—Adhesives
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
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- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/001—Use of materials characterised by their function or physical properties
- A61L24/0036—Porous materials, e.g. foams or sponges
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- A—HUMAN NECESSITIES
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/0047—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
- A61L24/0073—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with a macromolecular matrix
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
- A61L26/0061—Use of materials characterised by their function or physical properties
- A61L26/0085—Porous materials, e.g. foams or sponges
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- A—HUMAN NECESSITIES
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
- A61L26/0095—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
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- C—CHEMISTRY; METALLURGY
- C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
- C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
- C08L83/00—Compositions of macromolecular compounds obtained by reactions forming in the main chain of the macromolecule a linkage containing silicon with or without sulfur, nitrogen, oxygen or carbon only; Compositions of derivatives of such polymers
- C08L83/04—Polysiloxanes
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- C—CHEMISTRY; METALLURGY
- C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
- C08G—MACROMOLECULAR COMPOUNDS OBTAINED OTHERWISE THAN BY REACTIONS ONLY INVOLVING UNSATURATED CARBON-TO-CARBON BONDS
- C08G77/00—Macromolecular compounds obtained by reactions forming a linkage containing silicon with or without sulfur, nitrogen, oxygen or carbon in the main chain of the macromolecule
- C08G77/04—Polysiloxanes
- C08G77/12—Polysiloxanes containing silicon bound to hydrogen
-
- C—CHEMISTRY; METALLURGY
- C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
- C08G—MACROMOLECULAR COMPOUNDS OBTAINED OTHERWISE THAN BY REACTIONS ONLY INVOLVING UNSATURATED CARBON-TO-CARBON BONDS
- C08G77/00—Macromolecular compounds obtained by reactions forming a linkage containing silicon with or without sulfur, nitrogen, oxygen or carbon in the main chain of the macromolecule
- C08G77/04—Polysiloxanes
- C08G77/20—Polysiloxanes containing silicon bound to unsaturated aliphatic groups
Landscapes
- Health & Medical Sciences (AREA)
- Chemical & Material Sciences (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- General Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Materials Engineering (AREA)
- Epidemiology (AREA)
- Hematology (AREA)
- Heart & Thoracic Surgery (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Composite Materials (AREA)
- Dispersion Chemistry (AREA)
- Biomedical Technology (AREA)
- Vascular Medicine (AREA)
- Organic Chemistry (AREA)
- Polymers & Plastics (AREA)
- Medicinal Chemistry (AREA)
- Surgery (AREA)
- Anesthesiology (AREA)
- Materials For Medical Uses (AREA)
- Medicinal Preparation (AREA)
- Compositions Of Macromolecular Compounds (AREA)
- Adhesives Or Adhesive Processes (AREA)
- Apparatus For Disinfection Or Sterilisation (AREA)
- Food Preservation Except Freezing, Refrigeration, And Drying (AREA)
- Sealing Material Composition (AREA)
Abstract
可固化的组合物,其包含或分配在至少一种组分A和至少一种组分B之间,所述至少一种组分A包含:(i)一种或多种含烯基的预聚物,其每分子具有至少一个或至少两个烯基或结构部分和所述至少一种组分B包含:(ⅱ)一种或多种含SiH的预聚物,其每分子具有至少一个或至少两个Si‑H单元或结构部分;所述组合物还包含:(ⅲ)用于通过将含烯基的预聚物(i)加成到含SiH的预聚物(ⅱ)上而固化用的催化剂,其特征在于,预聚物(ⅱ)基本上不存在于组分A中和预聚物(i)基本上不存在于组分B中,制备该组合物的方法、其灭菌方法、其医疗和非医疗用途、包含该组合物的设备及其前体,包括其可灭菌的前体组合物,特别是医用的,特别用于创伤治疗,更特别作为可成型和构造成伤口形状的伤口填塞材料,最特别用于负压伤口疗法(NPWT)的可终端灭菌或终端无菌的组合物。
Description
本发明的实施方案涉及双组分可固化组合物、制备该组合物的方法、其制造及其灭菌方法、其医疗和非医疗用途、其使用或治疗方法、包含该组合物的设备及其前体,包括其可灭菌的前体组合物。特别地,某些实施方案涉及医疗用途的,特别用于伤口治疗,更特别作为可成型和构造成伤口形状的伤口填塞材料或填料或创伤敷料用粘合剂或密封剂,最特别用于负压伤口疗法(NPWT)的可灭菌或无菌的组合物。
发明背景
NPWT是对开放性伤口的相对较新的疗法。简言之,负压疗法通过减轻组织水肿;促进血流和粒状组织形成;除去过量渗出液和可能减轻细菌负荷(和因此感染危险)而有助于许多形式的“难愈合”伤口的闭合和愈合。此外,该疗法较少干扰伤口,以致更快愈合。TNP治疗系统也通过除去体液和有助稳定闭合合并位置中的组织而有助于手术缝合伤口的愈合。在移植物和皮瓣中可发现TNP疗法的另一有益用途,其中除去过量体液是重要的并要求移植物紧邻组织以确保组织活力。
在NPWT中通常用能在对伤口区域施加负压时向创面床传递部分真空(即不会完全塌陷)并能使体液从创面床流向负压源的材料填充或覆盖创腔或创面。有两种主要的NPWT方法,即纱布或泡沫类型。纱布类型涉及使用包裹在纱布中的引流材料(drain),用密封敷料加盖。泡沫类型涉及使用置于伤口上或中的泡沫,也用密封敷料加盖。一个实施方案主要涉及泡沫类型的NPWT。另一些实施方案涉及泡沫或纱布类型的NPWT,或联合使用密封敷料或用附加的吸收或分配层等实施的另一类型的NPWT。
在负载下提供良好抗压缩性的泡沫基NPWT的优秀材料是具有高自由内部体积的疏水网状聚氨酯泡沫。
但是,高自由内部体积的制品由于要求它们的结构在机械上支撑它们的高自由内部体积而往往具有差的悬垂性,在NPWT中采用的泡沫正是这种情况。
因此,用于NPWT的填塞材料必须成型成配合要填塞的伤口。这通常由医务人员(医生或护士)使用手术刀、刀或剪切割预成型的泡沫块以大致契合伤口来实现。这种操作是复杂的并有可能引入污染,此外对医务人员而言耗时且杂乱,并确实有泡沫颗粒有可能污染伤口部位或在切割过程中发生事故的危险。因此,伤口敷料的成型法目前是NPWT领域中未解决的问题。
可浇注组合物已知用于伤口护理。WO2009/156709公开了由有机硅或聚氨酯基材料构成的局部负压或真空伤口疗法伤口覆盖元件或布单,其在伤口上提供基本气密密封,具有模制或胶合就位的用于连至负压源的真空连接管或线路以降低负压泄漏的可能性。可通过在位于模具中的真空管上浇注双组分热固性有机硅弹性体来制造该布单。所得布单可通过辐照灭菌并以无菌形式包装直至需要通过置于泡沫或纱布伤口填料上使用。
RTV-2(加成固化型双组分室温硫化)有机硅泡沫伤口敷料Cavi-Care是非无菌出售的。US 5,153,231公开了能够通过破坏它们各自的包装以将两种组分释放到混合器中、混合并分配或浇注到表面如开放伤口上并使该混合物在室温下固化来提供低密度发泡医用敷料的组合物。
提供RTV-2有机硅泡沫形式的可浇注原位伤口填料是有用的。提供NPWT布单或敷料的可浇注原位粘合剂或密封剂也是有用的。问题在于为了使RTV-2伤口填料、粘合剂、密封剂等可行,该双组分体系必须无菌供应。
当要求医用产品在使用时无菌时,公认的原则是其只有在终端灭菌不可行时才应使用无菌加工制造。为确保医疗材料的最高无菌保证水平,其因此应该在其最终包装中终端灭菌。
尽管无菌发泡伤口敷料可得,如AllevynTM——聚氨酯泡沫伤口覆盖元件,和黑色泡沫(“Granufoam”)——包装在易剥离袋(peel pouch)中供应的聚氨酯伤口填料,但看起来没有双组分RTV-2有机硅组合物或实际上没有任何RTV-2组合物(可发泡或不可发泡)可无菌供应,因为固化前的该双组分体系,或者在初级包装中终端灭菌,或者灭菌然后无菌包装。此外,看起来尚未提供将这些体系灭菌的方法。
本发明的一个目的是提供改进的终端无菌的RTV-2可发泡有机硅组合物。另一目的是提供可依循创腔形状的改进的终端无菌的伤口填料。另一目的是提供终端无菌的RTV-2不可发泡或可部分发泡的有机硅组合物。另一目的是提供可沿创腔密接的(conformed)终端无菌粘合剂或密封剂。
在试图找出将可浇注成所需形状并原位固化以形成成型三维体的双组分可发泡可固化有机硅组合物灭菌的途径时,我们发现通常用于材料灭菌的灭菌技术不合适并且不能将该组合物无降解地灭菌。在试图找出双组分粘合剂或密封剂的灭菌途径时,情况同样如此。
既定的终端灭菌程序提供106的无菌性置信度(confidence in sterility)。一个有吸引力的灭菌途径似乎是辐照。这提出了所需包装是可容易得到的成本有效的途径。
25kGy是用于实现终端无菌所需的微生物杀灭水平的典型剂量。然而,在25kGy下γ射线辐照时,RHODORSIL RTFoam 3240,具有液体预聚物混合物组分A和组分B的RTV-2聚二有机基硅氧烷组合物,遭受了组分A的明显的粘度增加,而组分B形成了固体弹性体。所得的无菌组合物显然不能混合和浇铸(casting)。
这种粘度增加可以通过减小γ射线辐照剂量水平至15kGy和甚至10kGy来影响,但是在很宽的γ射线剂量范围内,该辐照改变组合物组分的物理性能,且在所有剂量水平下观察到粘度的增加。
发明概述
现在,我们已经令人惊讶的发现了灭菌包装的RTV-2组合物途径,该组合物能够承受足以灭菌的辐射剂量,而不会将其降解。
因此,根据本发明的第一实施方案提供可固化的组合物,其包含或分配在至少一种组分A和至少一种组分B之间,所述至少一种组分A包含:
(i)一种或多种含烯基的预聚物,其每分子具有至少一个烯基基团或结构部分
和所述至少一种组分B包含:
(ⅱ)一种或多种含SiH的预聚物,其每分子具有至少一个Si-H单元或结构部分;
所述组合物还包含:
(ⅲ)用于通过将含烯基的预聚物(i)加成到含SiH的预聚物(ⅱ)上而固化用的催化剂,
其特征在于,预聚物(ⅱ)基本上不存在于组分A中和预聚物(i)基本上不存在于组分B中。优选地,所述组分以防止其污染的方式密封在阻隔装置(barrier means)内。
在本发明的进一步的优选实施方案中,提供了用于用作负压伤口疗法伤口填充材料的可固化的组合物,所述组合物包含或分配在至少一种组分A和至少一种组分B之间,所述至少一种组分A包含:
(i)一种或多种含烯基的预聚物,其每分子具有至少一个烯基基团或结构部分,
和所述至少一种组分B包含:
(ⅱ)一种或多种含SiH的预聚物,其每分子具有至少一个Si-H单元或结构部分;
所述组合物还包含:
(ⅲ)用于通过将含烯基的预聚物(i)加成到含SiH的预聚物(ⅱ)上而固化用的催化剂,
其特征在于,预聚物(ⅱ)基本上不存在于组分A中和预聚物(i)基本上不存在于组分B中,
其中,所述至少一种组分A和至少一种组分B适于以协作方式分配以促进其密切接触和固化和形成能够传递负压的多孔泡沫材料。或者该组合物可以用作负压伤口疗法粘合剂或密封剂,其能够粘贴负压伤口疗法布单(drape),或其是气密的。优选所述组分以防止其污染的方式密封在阻隔装置内。
在上述实施方案中,催化剂可以存在于惰性的组分中,或优选在所述至少一种组分A中。适宜地,所述至少一种组分A和/或所述至少一种组分B是可通过辐照灭菌的或通过辐照灭菌,或其之一是可通过辐照灭菌的或通过辐照灭菌,和其另一是可通过其他方式灭菌的或通过其它方式灭菌。
在上述实施方案中,句子“预聚物…基本上不存在于” 是指没有可检测量到所定义的预聚物存在于所定义的组分中,或如果存在的话,其量不足以引起所述组分的粘度的增加,该粘度增加会以形成固化产物的方式导致各自组分不能密切接触,例如为分配和混合目的的流的密切接触。优选的预聚物(i)基本上形成组分A中存在的能够进行氢化硅烷化反应的全部反应性预聚物,和预聚物(ⅱ)基本上形成组分B中存在的能够进行氢化硅烷化反应的全部反应性预聚物。更优选预聚物(i)和/或(ii)基本上形成分别地组分A和/或组分B中存在的全部反应性预聚物。
虽然显然的,预聚物包含许多链长和单元组成不同的分子,和可以微量存在的除(i)或(ii)外的反应性预聚物,某些实施方案包含这样的组合物,其中在辐照灭菌的过程中,该微量不足以与包含在相同组分中的预聚物(i)或(ⅱ)反应,例如在所述组分的粘度增加大于0wt%至5wt%的值和/或以大于0%至5%的体积减少影响泡沫性能的程度。因此,例如,不包含催化剂的组分,如组分B,可包含大于0wt%至5wt%的微量预聚物(i)。组分A,当不含催化剂时,可包含大于0wt%至5wt%的微量预聚物(ⅱ),然而,这不是优选的。优选预聚物(ii)完全不存在于组分A中。
预聚物包含具有不同数目的反应性基团的离散聚合物链的分布。因此,微量的一个组分在另一个组分中的更准确测量通过反应性基团的比例给出。因此,我们已经发现,组分B可包含微量的预聚物(i),其表示为大于或等于2000,优选大于或等于5000,更优选大于或等于10,000的(Si-H单元或结构部分)/(烯基单元或结构部分)摩尔比。
我们惊奇地发现,所述至少一种组分A,优选地,所述至少一种组分A和至少一种组分B两者都是适合于经受足够用于其终端灭菌的辐照剂量。
本文所提及的用于防止各组分A和B污染的阻隔装置是任何化学或机械阻隔,其防止由能增殖的感染物的污染,或防止由能与预聚物(i)/或(ii)反应的污染物的污染,或另外阻止有害地影响组分A和B的反应的物质的通路,例如通过泄漏的组合物成分的损失。优选地,所述阻隔装置是能够防止微生物或病毒的污染,更优选病原微生物或病毒的污染,和组合物成分的逸出。
发明详述
我们惊奇地发现当标准的辐照周期不会在不降低其形成具有所需性能的固化聚合物的能力的情况下灭菌商购组合物时,改性的组合物会经受这样的周期且非常适于提供的迄今未知的和不可获得的终端无菌RTV-2组合物。
本发明的实施方案用于可包含2个或更多个成分或组分的任何RTV、LTV或HTV组合物。本发明的所述组合物优选是用于需要无菌性的任何预期用途的可发泡或不可发泡的RTV-2、LTV-2或HTV-2组合物。双组分RTV、LTV和HTV组合物的加成固化化学基于通过Si-氢化物(Si-hydride)官能预聚物将乙烯基官能预聚物氢化硅烷化。室温硫化通常是指该体系在低于50℃硫化。低温硫化是指该体系在50℃至130℃范围内硫化。高温硫化是指该体系在超过130℃的温度下硫化。该组合物更优选是RTV-2组合物。
本发明的实施方案也可用于任何双组分或更多组分的可固化组合物,其组分适合以协作方式分配或释放以利于其密切接触和固化。这样的组分因此合适地是流体相或能在可接受的分配或释放条件下表现出流体行为或能润湿它们分配或释放至的表面或材料,例如组分A和组分B在协作分配或协作释放时能够相互润湿。
合适的是,至少有一个组分A和组分B被密封在至少两个分别的容器或载体中或上,并适于以协作方式由其分配或释放以促进其密切接触和固化。合适地,所述容器或载体是抗菌密封的。
可提供密封在基本上没有空气的容器内或载体上的组分A和组分B。
在本文中提到组分A和B在基本不存在空气或湿气的情况下存在于容器中合适地是指空气或湿气以小于容器体积的10%,优选小于容器体积的5%存在。合适地在该组合物上方或周围的任何空间,即顶空等中不存在空气或水分,或基本不存在这样的空间。可另外在该组合物本身中不存在空气或湿气,即可以将该组合物脱气或鼓泡(sparged)等以除去空气。要认识到,不存在空气的目的是不存在氧气和湿蒸气。
因此,可以以已知方式通过置换和/或除去空气实现基本不存在空气。空气的置换合适地通过用合适的惰性气体吹扫该组合物周围的空间,如在阻隔装置内存在于该组合物上方的顶空;和/或用合适的惰性气体鼓泡该组合物。空气的除去合适地通过在与组分体积基本等体积的容器中提供组分以基本消除任何顶空。合适的惰性气体是氩气或氮气等。吹扫是用惰性气体置换组分上方的空气。鼓泡是用惰性气体置换组分内的空气。体积匹配除去组分上方的空气。
容器或载体优选包含任何提供如上定义的阻隔装置的合适材料,优选针对微生物或病毒感染或针对化学反应性或污染材料的进入或流出。适当地,容器或载体材料选自任何耐辐照的材料,优选任何耐γ射线、X射线或电子束辐照的材料,其足够致密以致为污染物不可透过的,适宜对于这样的污染物是非多孔的。容器或载体材料可包含任何通常可得的包装材料,并优选选自聚合物材料例如聚烯烃,诸如聚乙烯(PE),聚对苯二甲酸乙二醇酯(PET)和聚丙烯(PP),聚苯乙烯(PS),聚酰胺等,金属例如金属箔,玻璃,有机硅材料,和选自复合材料、层压板和其组合;更优选的是选自PE,PET和PP。
适宜地,将包括容器或载体和任何组成协作装置的组合物包装在另外的外(二级)包装中,该包装是耐EO的或是蒸汽可透过的,其适用于以常规方式灭菌。由此该组合物的内部和外部都是保持无菌的,并且可以携带入无菌区中和打开。
容器或载体可以是挠性或刚性的。刚性容器或载体合适地是本领域中已知的任何管瓶或药筒(cartridge)。挠性容器或载体例如可以由在其各面上具有如前所定义的聚合物膜的金属箔的层合材料制成的,该材料可以热密封或层合。
容器可包含拟用于以释放密封在其中的组合物组分的方式机械打开、破裂或穿透的部分。容器因此可包含不同的材料的组合或不同的可破裂或可穿透和不可破裂或不可穿透厚度的材料的组合。
容器可以在其弱化(weakened)部分手动破裂,或通过例如在用于组合物组分的穿透和协作分配的设备中提供的物理装置机械破裂和穿透。适当的物理装置,包括针、钉、 穿孔器,例如卡口帽(bayonet cap)、推入配合开口装置(push-fit opening means)等。
提到如上定义的协作分配是指用于将一个或多个组分与另外一个或多个组分同时并直接接触地分配(优选同时混合)的任何方法。容器优选适合装在提供将各组分协作释放的装置的、具有提高施加组合物的准确性的设备内。
该组合物优选适合分配到伤口内或周围。该组合物优选适合在无菌区或环境中分配或释放。这在医疗用途的情况中,例如在手术室的无菌区内特别有利,允许在无菌区或环境中直接或间接(例如经由模具)分配到伤口中。这避免了需要接触分配后的组合物,例如为了定位或成型,并使引入感染的风险最小化。
本发明的RTV-2组合物的一个实施方案可包含在氢化硅烷化反应后的任何预聚物。一种预聚物含有烯基,另一种含有Si-H结构部分。硅氧烷聚合物类别基于包含交替的硅和氧原子以及连接到硅的多种有机结构部分的结构。固化是指降低弹性体的流动的处理。通常通过聚合物分子之间的连接反应引起这种变化。如果硅氢(Si-H)结构部分是聚硅氧烷的一部分,烯基可以是硅氧烷预聚物的一部分或非硅氧烷预聚物的一部分。烯基官能团的位置不重要并可以在分子链末端或在沿分子链的非末端位置中。
预聚物(i)和(ii)可购得或可通过已知技术获得。预聚物(i)和/或(ii)合适地独立选自已知和新颖的流体相和可溶的均聚和共聚预聚物和它们的缠结体系及其混合物。该组合物又固化形成共聚物并也可包括它们的缠结体系和与该组合物中可能存在的其它非反应性预聚物的混合物。流体相是指预聚物能够混合以形成分别的组分。优选的各组分具有适于在达1分钟的时间内手工混合的粘度。
术语流体相旨在包括可存在于流体相中或表现得像流体的预聚物,即灭菌的预聚物能混合形成各自的组分。
共聚预聚物包括由两种或更多种单体物类生成的所有杂化物,包括交替、周期、统计、无规、嵌段、线性、支化、星形、接枝和侧接共聚物。缠结体系包括互穿网络(IPN)和半互穿网络(SIPN)。这些预聚物也可以包含有机和无机结构部分。
预聚物(i)和(ii)优选选自有机硅,包括硅氧烷和改性硅氧烷,聚氨酯(PU),包括聚酯和聚醚聚氨酯,弹性体聚醚聚酯,聚乙醇酸、聚乙酸酯如乙烯乙酸乙烯酯(ethyl vinylacetate),聚丙烯酸酯、多糖的多酸衍生物,如羧基烷基纤维素、羧基烷基壳聚糖及其共聚物,和包括共聚物、缠结体系及其混合物的它们的杂化物。
该可固化组合物更优选利用有机基氢硅氧烷单元和有机基烯基硅氧烷单元之间的加成固化反应。这些单元可并入如上定义的多种多样的聚合、共聚、缠结和混合预聚物中。优选的硅氧烷预聚物(i)和(ii)因此包括这些各自的单元,更优选是聚有机基硅氧烷。
已使用硅氧烷和有机单元的杂化有机-无机聚合体系的实例包括:可用在隐形眼镜中的丙烯酸酯官能化硅氧烷共聚物(US 3,808,178);杂化接枝物,其中有机聚合物接枝到聚硅氧烷链上或其中硅氧烷接枝到有机聚合物上,例如在用于可交联HDPE的硅烷接枝技术(US 3,646,155)中,其中杂化接枝物已用于通过硅氧烷键形成交联有机聚合物;杂化嵌段共聚物,例如有机硅-聚碳酸酯嵌段共聚物(US 3,274,155);和已用于涂布织物的与含乙烯基的有机硅共聚物交联的有机硅和乙烯共聚物的杂化物的共聚物(US 2005/0100692);
IPN代表特殊种类的杂化聚合体系,这些体系使用机械缠结和交联的组合,其中一种聚合物围绕另一种固化;这些包括与铂催化的加成固化有机硅缠结的热塑性塑料,如有机硅-聚氨酯IPN和包括有机硅-聚氨酯和有机硅-聚酰胺体系的半-IPN,其具有一般用途或已专门用于涂布织物(US 4,714,739, US 7,543,843);固定在有机硅聚合物中的亲水组分(US 5,397,848),其已用作隐形眼镜材料;和围绕粘合力相当的非反应性聚合物固化的有机硅聚合物,其已用于涂布织物(US 7,132,170)。
预聚物也可以选自用作导管中的粘合剂等的改性有机硅(MS)。
优选组合物包含聚二有机基硅氧烷预聚物(i)和/或(ii)和/或它们各自与上述预聚物的组合。其中预聚物包含或基本由聚二有机基硅氧烷预聚物(i)和(ii)构成的组合物具有特定优点,例如在低毒性有利的用途中,优选在医疗或牙科用途中或在需要低毒性或有利生物相容性的非医疗或非牙科用途中。
预聚物(i)和(ii)可包含沿预聚物链的长度分布和/或作为预聚物链封端单元的各自的含烯基的单元和有机基氢硅氧烷单元,或其组合。预聚物(i)链中和封端的烯基单元优选包含烯基基团或结构部分RAlk,其选自任选被取代或包括一个或多个芳基基团或结构部分的C2-20烯基。RAlk可包含末端或非末端不饱和部分并可具有式i-I:
(i-I)–RAlk1- CRAlk1 = CRAlk2 2
其中基团RAlk1和RAlk2独立地选自H、C1-20烷基和C5-20芳基及其组合,结构部分RAlk1选自单键、C1-20烷基和C5-20芳基及其组合。RAlk2之一可以是连接到聚合物链上的结构部分。各RAlk更优选独立地选自乙烯基、烯丙基、丙烯基和选自末端和非末端不饱和的丁烯基、戊烯基、己烯基、庚烯基、辛烯基、壬烯基和癸烯基,最优选选自乙烯基和己烯基基团。
预聚物(i)优选包含含有式(i-II)的含烯基的单元的聚二有机基硅氧烷聚合物或共聚物:
(i-II) = Si – RAlk,更特别具有式(i-III)和/或(i-IV):
(i-III)– O – Si R1 RAlk – O –
(i-IV)– O – Si R1 2 RAlk
其中RAlk如上定义且一个或多个基团R1是合适地独立选自烷基和芳基,更优选C1-20烷基和C5-20芳基及其组合,例如选自甲基、乙基、丙基、丁基、戊基、己基、庚基、辛基、壬基和/或癸基的有机基基团和结构部分。
预聚物(i)更特别选自式i-V和i-VI:
i-V:Pi – O – Si R1 RAlk – O – Pi
i-VI Pi – O – Si R1 2 RAlk其中Pi是指可包含相同或不同单元的聚合物链的剩余部分,且R1如上定义。
预聚物(i)还可包含聚有机基硅氧烷,其每分子具有至少两个键合到硅的C2-C6烯基并具有例如10至300 000 mPa·s的粘度,其特别可以由至少两个下式的硅氧基(siloxyl)单元形成:
(III)
其中:
- Y是C2-C6烯基,如乙烯基、烯丙基或己烯基,优选乙烯基,
- R是对催化剂活性没有不利影响的一价烃基,其通常选自具有1至8个碳原子(包括1和8在内)的烷基,如甲基、乙基、丙基和3,3,3-三氟丙基,环烷基,如环己基、环庚基和环辛基,和芳基,如二甲苯基、甲苯基和苯基,
- d是1或2,e是0、1或2且d + e = 1、2或3,
任选所有其它单元是下列平均式的单元:
(IV)
其中R具有与上文相同的含义且f = 0、1、2或3。
预聚物(i)的实例是例如包含二甲基乙烯基甲硅烷基末端的二甲基聚硅氧烷、包含三甲基甲硅烷基末端的(甲基乙烯基)(二甲基)聚硅氧烷共聚物或包含二甲基乙烯基甲硅烷基末端的(甲基乙烯基)(二甲基)聚硅氧烷共聚物。
在此使用业内公认的根据键合到硅上的氧原子数标示有机硅单元的惯例。这种惯例使用字母M、D、T和Q(“单”、“二”、“三”和“四”的缩写)标示这种氧原子数。例如在WalterNoll的著作"Chemistry and Technology of Silicones", Academic Press, 1968, 第2版, 第1至9页中描述了有机硅的这种命名法。
预聚物(i)也可以是带有至少两个烯基,优选乙烯基的有机硅树脂。这样的有机硅树脂包含选自式R3SiO1/2的M硅氧烷单元、式R2SiO2/2的D硅氧烷单元、式RSiO3/2的T硅氧烷单元和式SiO4/2的Q硅氧烷单元的至少两个不同的硅氧烷单元,
其中R是指一价烃基,条件是这些硅氧烷单元的至少一个是T或Q硅氧烷单元,且M、D和T硅氧烷单元的至少两个包含烯基。
该有机硅树脂可以选自:
- 式MTViQ的有机聚硅氧烷树脂,其基本由如下构成:
- (a) 式R'SiO3/2的三价硅氧烷单元TVi;
- (b) 式R3SiO1/2的一价硅氧烷单元M,和
- (c) 式SiO4/2的四价硅氧烷单元Q
- 式MDViQ的有机聚硅氧烷树脂,其基本由如下构成:
- (a) 式RR'SiO2/2的二价硅氧烷单元DVi;
- (b) 式R3SiO1/2的一价硅氧烷单元M,和
- (c) 式SiO4/2的四价硅氧烷单元Q
- 式MDDViQ的有机聚硅氧烷树脂,其基本由如下构成:
- (a) 式RR'SiO2/2的二价硅氧烷单元DVi;
- (b) 式R2SiO2/2的二价硅氧烷单元D,
- (b) 式R3SiO1/2的一价硅氧烷单元M,和
- (c) 式SiO4/2的四价硅氧烷单元Q,
- 式MViQ的有机聚硅氧烷树脂,其基本由如下构成:
- (a) 式R'R2SiO1/2的一价硅氧烷单元MVi;和
- (b) 式SiO4/2的四价硅氧烷单元Q,和
- 式MViTViQ的有机基聚硅氧烷树脂,其基本由如下构成:
- (a) 式R'R2SiO1/2的一价硅氧烷单元MVi;
- (b) 式R'SiO3/2的三价硅氧烷单元TVi,和
- (c) 式SiO4/2的四价硅氧烷单元Q,
其中R是指一价烃基,如甲基,且R'是指乙烯基:
这样的树脂是市售的公知支化有机聚硅氧烷低聚物或聚合物。它们以溶液,优选硅氧烷溶液的形式提供。
预聚物(ii)链中和封端的聚有机基氢硅氧烷单元优选选自式ii-I和ii-II:
ii-I–O - Si R2H – O –
ii-II –O - Si R2 2H,预聚物(ii)更优选选自式ii-III和ii-IV:
ii-III Pii – O - Si R2H – O - Pii
ii-IV Pii –O - Si R2 2H,其中
Pii是指可包含相同或不同单元的聚合物链的剩余部分,且一个或多个基团R2是合适地独立选自C1-20烷基、C5-20芳基及其组合,例如选自甲基、乙基、丙基、丁基、戊基、己基、庚基、辛基、壬基和/或癸基的有机基团。
预聚物(ii)优选包含聚有机基氢硅氧烷 – 聚二有机基硅氧烷共聚物,其包含一个或多个单元ii-I和/或ii-II:
ii-I – O - Si R2H – O -
ii-II –O - Si R2 2 H和一个或多个单元ii-V和/或ii-VI:
ii-V – O - Si R2 2 - O -
ii-VI – O - Si R2 3其中R2如上定义,更优选为包含聚有机基氢硅氧烷封端单元的共聚物,即以基团或结构部分ii-VII封端的预聚物链:
ii-VII = Si – H,更特别具有式ii-II的单元:
ii-II 如上定义的–O - Si R2 2 H。预聚物(ii)最优选包含甲基氢硅氧烷-二甲基硅氧烷共聚物。
预聚物(ii)还可包含每分子具有至少两个键合到硅上的氢原子和优选至少三个≡SiH单元并具有例如1至5000 mPa·s的粘度的聚有机基硅氧烷,其特别可以由下式的硅氧基单元形成:
(V)
其中:
- X是对催化剂活性没有不利影响的一价烃基,其通常选自具有1至8个碳原子(包括1和8在内)的烷基,如甲基、乙基、丙基和3,3,3-三氟丙基,环烷基,如环己基、环庚基和环辛基,和芳基,如二甲苯基、甲苯基和苯基,
- g = 1或2,优选= 1,i = 0、1或2且g + i = 1、2或3,
任选所有其它单元是下列平均式的单元:
(VI)
其中X具有与上文相同的含义且j = 0、1、2或3。
预聚物(ii)的实例是聚甲基氢硅氧烷或甲基氢二甲基硅氧烷共聚物。
或者或另外,预聚物(i)和(ii)如US5,153,231中对Cavi-Care RTV-2型组合物所规定,也如US 2006/0217016、US 3,928,629和US 4,529,553、US 4,714,739和US2002/0010299中规定,其内容经此引用并入本文,或可购得(Rhodorsil RTFoam 3240、Mepiseal、Silpuran 2111 A/B、Silpuran 2400/18 A/B等)。
在预聚物除iIII、iIV、iiI和iiII外还包括其它单元外,例如这些合适地在环境温度下或在灭菌条件下不与各自的预聚物反应。
(ii)提供的硅键合氢原子与(i)提供的硅键合烯基结构部分的比率合适地为至少0.5 :1,优选1:1。
优选地,可固化组合物的实施方案遵循根据下列图式的催化加成固化反应:
Pi –RAlk1-CRAlk1=CRAlk2 2 + Pii – SiHR2R2/P →[催化剂]
Pi –RAlk1-CHRAlk1CRAlk2 2 – SiR2R2/PPii
更优选:
其中整数如上定义,R1/P选自如上定义的Pi和R1且R2/P选自如上定义的Pii和R2。
预聚物(i)和(ii)和催化剂(iii)以提供在分隔时在环境温度下和在灭菌条件下都不反应的各组分A和B的方式合适地分配在至少一种组分A和至少一种组分B中。也可以根据体积和粘度决定分配。所述至少一种组分A和至少一种组分B可以基本等体积和粘度或具有不同体积和/或粘度。组分A或组分B可包含提高或降低体积和/或粘度的量的合适的粘度调节剂或稀释剂。借此,具有不同体积和粘度的组分A和组分B可以在体积和粘度上配比以改进混合和分配的简易性和密切性。合适的稀释剂是例如可以以增稠或稀释作用所需的任何粘度供应的硅油。有利地,我们发现,包含硅油的组分A可辐射灭菌,而对所得固化组合物的性质没有有害影响。
在组分A具有比组分B大的体积和高的粘度的情况下,组分A可以分配在等体积的两个或更多个组分A1、A2等之间,以提供大致等体积的3个或更多个组分A和B。或者或另外,组分B可包含硅油作为基本惰性的稀释剂和/或增稠剂。
如上定义的催化剂可以是有效催化如上定义,更优选如上文图解的加成固化反应的任何催化剂。合适的催化剂选自如US 5,153,231、US 2006/0217016、US 3,928,629和US4,529,553(其内容经此引用并入本文)中公开的铂、铑、钯、镍和类似的加成固化氢化硅烷化催化剂的任何已知形式。
铂催化剂可选自铂黑、沉积在载体(包括二氧化硅,如硅胶或碳,如木炭粉)上的铂、氯化铂或氯铂酸及其醇溶液、铂酸和氯铂酸的盐和铂配合物,如铂/烯烃、铂/烯基硅氧烷、铂/β-二酮、铂/膦等。氯铂酸可以是六水合物或无水形式。可以由氯铂酸及其六水合物或由氯化亚铂、二氯化铂、四氯化铂和它们与二乙烯基四甲基二硅氧烷的中和配合物制备铂配合物,任选用二甲基乙烯基甲硅烷氧基封端的聚二甲基硅氧烷稀释。
钯催化剂可选自碳载钯、氯化钯等。
铑催化剂可选自氯化铑和一种或多种具有通式iii-I或iii-II的铑配合物:
(iii-I) RhX3 (SR2)3
(iii-II) Rh2(CO)4X2
其中各X代表卤素原子且各R代表具有1至8个碳原子(包括1和8在内)的烷基或芳基或其组合,或R’3SiQ基团,其中Q代表具有1至6个(包括1和6在内)碳原子的二价脂族烃基,且R’代表具有1至8个碳原子(包括1和8在内)的烷基或芳基或其组合或(CH3)3Si-基团,每分子不多于一个R’是(CH3)3Si-。例如氯化铑/二(正丁基)硫(di(n-butyl)sulfide)配合物等。
镍催化剂优选是选自M2Ni(0)如双(1,5-环辛二烯基)镍(Ni(COD)2)和选自MNi(0)G的零价镍,其中M是C8-12的二齿烯环烃环,且G选自具有键合在磷基团的磷原子上的氢原子、取代或未取代烃基或其混合物的单齿和二齿磷基团。
该组合物可包含催化剂抑制剂。合适的抑制剂是本领域已知的。例如,催化剂抑制剂可以选自聚甲基乙烯基硅氧烷环状化合物和炔醇,例如甲基丁炔醇,如在Cavi-Care中。
该组合物优选包含加成反应阻滞剂或交联抑制剂,其选自例如下列化合物:
- 被至少一个可任选为环状形式的烯基取代的聚有机基硅氧烷,四甲基乙烯基四硅氧烷特别优选,
- 有机膦和亚磷酸盐,
- 不饱和酰胺,
- 马来酸烷基酯,和
- 炔属醇。
属于氢化硅烷化反应的优选热阻滞剂的这些炔属醇(见FR-A-1 528 464和FR-A-2372 874)具有式:
(R’)(R”)C(OH)-C≡CH
在该式中
- R’是直链或支链烷基或苯基;
- R”是H或直链或支链烷基或苯基;基团R’、R”和在三键的α位置的碳原子可形成环;且
- R’和R”中所含的碳原子总数为至少5,优选9至20。
可提到的实例包括:
- 1-乙炔基-1-环己醇;
- 3-甲基-1-十二炔-3-醇;
- 3,7,11-三甲基-1-十二炔-3-醇;
- 1,1-二苯基-2-丙炔-1-醇;
- 3-乙基-6-乙基-1-壬炔-3-醇;
- 2-甲基-3-丁炔-2-醇;
- 3-甲基-1-十五炔-3-醇。
这些α-炔属醇是商品。这种阻滞剂以该有机硅组合物中的聚有机基硅氧烷总重量的3000 ppm的最大比例存在。可以如Cavi-Care中那样选择甲基丁炔醇。
该组合物可以是不可发泡或可发泡的,包含(iv)发泡剂,其选自作为固化反应的一部分或在固化反应过程中释放气体或蒸气的任何试剂,例如选自H-给体、含OH的试剂、H-键合剂,如:
- 醇,包括甲醇、乙醇、正丙醇、异丙醇、正丁醇、2-丁醇、叔丁醇、正己醇、正辛醇和苄醇。正丙醇、正丁醇、正己醇和正辛醇特别优选,
- 多元醇,如二醇,包括4-丁二醇、1,5-戊二醇和1,7-庚二醇,
- 具有至少一个硅醇基团的硅烷或聚硅烷,或
- 水。
可发泡组合物可产生具有任何所需孔隙率或孔隙结构的泡沫。特别有利地,可发泡组合物提供开孔泡沫。优选的可发泡组合物适合提供具有例如大约70%至90%的极高自由内部体积的泡沫。优选的多孔泡沫具有防止泡沫结构在使用中塌陷的机械强度,更优选适合形成可弹性变形的固化三维体。
可发泡组合物优选适合提供固化形成具有潮湿或湿润表面的开放界面的泡沫。这样的开放界面泡沫适合经由例如泡沫体与创面接触。特别有利地,我们已经发现,由有机硅组合物提供这样的开放界面泡沫。进一步有利地,该组合物适合提供所需形状的固化多孔三维体。
当所述组合物是非发泡性时,其可在氢化硅烷化后长生有机硅弹性体或硅凝胶。在本发明的含义内,术语“硅凝胶”表示交联有机硅产物,其特征在于针入度(penetration)例如为20-500个十分之一毫米( tenths of a mm )(按ASTM D 2137针入度测量法(penetrometry)测得,杆和椎体的重量:62.5克)。
当所述组合物制备硅凝胶时,它可以具有至少一种非官能化的聚有机基硅氧烷,其包含:
a)M = (R6)3SiO1/2型的端基硅氧基单元
在其中的R6基团相同或不同的,对应于任选取代的直链或支化C 1-C 6烷基和/或取代或未取代的芳基,和
b)D = (R7)2SiO2/2 型的相同的或不同的硅氧基单元
其中R7基团对应于R 6的相同定义。
这些凝胶的物理性质根据用途通过改变携带Si-烯基和SiH官能团的硅氧基单元的含量,和当其存在时通过改变现有技术中公知的非官能化聚有机基硅氧烷的重量百分比调节。
为提高硅凝胶的粘合性能,该组合物可进一步包含每分子携带单个Si-烯基的单官能聚有机基硅氧烷,如欧洲专利申请EP-1633830-A2所教导的。
另外,该组合物还可以包括无机填料如增强或增量填料。这些填料可以非常细碎的产品形式提供,其平均粒径小于0.1μm。这些填料包括特别是煅制二氧化硅和沉淀二氧化硅,其比表面积一般大于10 m2/g,和一般在20-30010 m2/g范围内。
这些填料也可以更粗粒(coarsely divided)产品的形式提供,其平均粒径大于0.1μm。可以特别提及作为这类填料的例子是石英粉,碳酸钙,硅藻土二氧化硅,煅烧粘土,金红石型氧化钛,铁、锌、铬、锆和镁氧化物,各种形式的氧化铝(水合的或非水合的),氮化硼,锌钡白或偏硼酸钡,其比表面积一般小于30 m2/g。
所述填料可以具有疏水表面,其可以通过例如用合适的硅烷、短链硅氧烷、脂肪酸或树脂有机硅材料处理该填料获得。已经在文献中描述了使填料的表面疏水的、本领域技术人员已知的合适的材料和工艺。所述填料也可以由多种类型的具有不同颗粒尺寸的填料的混合物构成。
该组合物可包含具有用于预期用途的任何所需活性的活性剂,例如医学活性剂等。合适的活性剂或API如上定义的那样辐射稳定,优选在实现本文中公开的组合物的终端无菌性所需的辐射水平下稳定。这些通常选自抗微生物剂和消毒剂,如银和衍生物,包括氧化银、硝酸银、乙酸银和氯化银、双胍,包括聚六亚甲基和二葡萄糖酸氯己定(chlorhexidine digluconate)及其乙酸盐、活性剂,如药剂、杀生物剂、生长因子、止血剂等、营养素、止痛药和将不适减至最低的试剂等和组合材料。
抗微生物剂、杀生物剂和消毒剂可选自银,特别是纳米结晶银,和衍生物,包括银配合物和盐,如离子银、银沸石、氧化银、硝酸银、乙酸银、氯化银、银磺胺嘧啶)、双胍,包括聚六亚甲基双胍和二葡萄糖酸氯己定及其乙酸盐(乙酸氯己定和二乙酸氯己定)、麦卢卡蜂蜜、过氧化物(例如过氧化氢)、碘(例如聚维酮碘)、次氯酸钠、铜、铜配合物;锌(例如氧化锌、吡啶硫酮锌)、金、金配合物;磷酸盐、胺、酰胺和磺酰胺(例如合克替啶(hexatidine)、原黄素、磺胺米隆、呋喃西林、诺氟沙星;抗生素(例如庆大霉素、杆菌肽、利福平;醇和酸(例如乙醇、苯氧基乙醇、莫匹罗星);已知的辐照稳定的抗微生物剂包括醋酸氯己定、银磺胺嘧啶(SSD)和纳米结晶银,这些分别是终端无菌的市售产品BactigrasTM、Allevyn AgTM和ActicoatTM的活性组分;营养素、止痛药和其它疼痛管理技术合适地包括镇痛剂和麻醉剂(anasthetics)并可以选自丁卡因、利多卡因、非甾类抗炎药);
止血剂可选自甲壳质、壳聚糖、高岭土;抗纤维蛋白溶解药,如氨基酸、氨基己酸、氨甲环酸、氨基甲基苯甲酸;蛋白酶抑制剂,包括抑肽酶、α1抗胰蛋白酶、C1-抑制剂、卡莫司他;维生素K和其它止血剂,包括维生素K、植物甲萘醌、甲萘醌;纤维蛋白原,包括人纤维蛋白原;局部止血药,包括吸收性明胶海绵、氧化纤维素、四半乳糖醛酸羟基甲基酯、肾上腺酮、凝血酶、胶原、藻酸钙、肾上腺素;凝血因子,包括组合的凝血因子IX、II、VII和X、凝血因子VIII、因子VIII抑制剂旁路活性(factor VIII inhibitor bypassing activity)、凝血因子IX、凝血因子VII、组合的血管性血友病因子和凝血因子VIII、凝血因子XIII、依他凝血素α(活化)、诺那凝血素α、凝血酶。全身止血剂:酚磺乙胺、卡巴克洛、巴曲酶、罗米司亭、艾曲波帕;
组合材料,包括超强吸水剂、气味管理剂、织物和非织造物、可胶凝纤维;生长因子、伤口清创材料 – 机械、自溶和酶促;影响细胞生长的可再吸收敷料和微结构;细胞、组织(例如自体治疗);指示剂;
染料和着色剂。
组合物可包括选自辅助剂、防腐剂、增量剂等的附加组分。辅助剂优选选自填料、着色剂、有色指示剂。防腐剂包括没食子酸丙酯。
组合物优选包含,按重量%计:
组分A:
一种或多种预聚物(i) (80-99%)
发泡剂 (0-10%)
催化剂 (>0-5%)
防腐剂 (0 – 0.1%)
组分B:
一种或多种预聚物(ii) (94 – 100%)
泡沫稳定剂 (0 – 11%)
催化剂抑制剂 (0 – 0.1%)
防腐剂 (0 – 0.1%)
稀释剂或粘度改性剂 (0 – 75%)。
在含有或不含添加的稀释剂或粘度改性剂的情况下,组分A : B可以分别以1:99:99:1,例如30:70至99 : 1体积%比存在。组分A : 组分B优选以30:70至70:30体积%比,更优选45 : 55至55: 45,如基本50:50存在。组分A和B优选具有允许其混合和基本完全反应的相容粘度。组分A : 组分B的粘度合适地为6:1 – 1:8,优选5:1 – 1:5,更优选基本1:1。可以例如在具有长度提高的混合头的装置中混合具有不同粘度的组合物。组合物的灭菌可能引发一定的粘度提高,因此该粘度比优选为灭菌后的组分粘度比。
该组合物优选包含与预期灭菌预聚物相比长度相对较短的预聚物。预聚物在照射过程中链增长至所需最终粘度或密度。每分子具有至少一个烯基单元或结构部分的组分A预聚物优选与相应的灭菌组分A预聚物相比长度相对较短。
各个灭菌组分优选具有适合在最多1分钟时段内用手混合的粘度。特别有利地,组分A和/或组分B可包含缩短的预聚物,其分子量在灭菌过程中提高以产生在灭菌后具有所需性质的物类。更特别地,组分A和任选地,组分B,包含确定链长的预聚物,该链长使得辐照灭菌后的分子量增加赋予灭菌后的预聚物所需分子量、粘度、流变学等。最优选地,组分A包含这样的缩短的预聚物。优选缩短至与该组分在灭菌过程中的分子量和粘度的增加百分比对应的百分比。这种百分比随任何给定组合物的化学性质而变。例如对聚二有机基硅氧烷组合物而言,组分A预聚物通常缩短至使得粘度降低9 – 11%的程度,组分B预聚物通常缩短至使得粘度降低17 – 23%的程度。
分配在范围5-300 Pa*s下部的低粘度组合物时面对的问题是使该组合物在预期位置保持就位直至固化完成。如果没有围堵,低粘度组合物在固化初期倾向于在预期位置内流动或从预期位置流开。WO2004/108175(Molnlycke Health Care AB)公开了在该组合物受身体活动、压力或摩擦影响时遇到的配混问题。该组合物优选在初始混合时具有在10-120Pa*s范围内,更优选在20-80 Pa*s范围内的粘度。该组合物可包含一种或多种填料以赋予其触变性质。合适的填料可以是煅制二氧化硅,例如Wacker Chemie, Wacker HDKTM。WO2004/108175公开了Wacker HDKTM对此用途尤其有效。
预聚物(i)和(ii)具有交联功能,预聚物(ii)也可以与发泡剂协作以造成发泡。
组合物更优选包含,按重量份计,如US 5,153,231实施例栏 7中描述的Cavi-Care组合物的改进,其内容经此引用并入本文,例如其中所有预聚物(i)移至组分A:
成分 | 重量份 |
组分A | |
二甲基乙烯基甲硅烷基封端的PDMS,粘度 450mm2/s,0.01摩尔%乙烯基 | 64 |
二甲基乙烯基甲硅烷基封端的PDMS,粘度 9000mm2/s,0.002摩尔%乙烯基 | 93 |
乙醇 | 3 |
氯铂酸 | 4 |
没食子酸丙酯 | 0.01 |
组分B | |
甲基丁炔醇 | 0.05 |
三甲基甲硅烷基封端的聚甲基氢硅氧烷,粘度 30mm2/s,1.5摩尔%氢 | 16 |
聚甲基氢-PDMS,粘度5mm2/s,0.75摩尔%氢 | 16 |
泡沫稳定剂 –六甲基二硅氧烷涂布的聚硅酸酯,用醇F(CF2)8CH2CH2OH处理 | 4 |
没食子酸丙酯 | 0.01 |
硅油 | 余量(直至128) |
本发明的再一方面,提供由其组合物前体制备如上定义的组合物的方法,包含步骤:-
混合如上定义的预聚物(i)、(ii)和催化剂(iii)以形成如上定义的至少一种组分A和至少一种组分B;和
将组分A和组分B密封在如上定义的具有阻隔装置的容器中。
优选按如上定义的重量百分比与附加组分混合。
在本发明的再一个方面,提供了灭菌组合物的方法,包括辐照组分A和组分B的至少之一,更优选用X射线、γ射线和/或电子束辐照来辐照,最优选γ射线辐照。优选以灭菌剂量辐照。优选辐照组分B或组分A和B两者。在辐照仅组分A和B之一的情况下,另一组分合适地通过另外的已知知或新颖的手段适当灭菌。
由于难以通过回顾试验查证经过灭菌周期的产品是否实际上无菌,灭菌被视为特殊工艺。通过验证的灭菌法的组合、适合该灭菌法的包装的选择和使用质量保证原则控制原材料、中间产物、最终产物和制造环境上的微生物生物负荷,实现对医疗设备的灭菌控制。
尤其使用γ射线辐照法进行医疗设备和医疗产品的终端灭菌,如在 BS EN 556 –1:2001 医疗设备灭菌 – 待标记为无菌的终端灭菌设备的要求中定义的。
使用γ射线辐照,短波长的电磁辐射(光子)在核跃迁过程中从放射性物质中发射。可以使用任何辐射源用于产品灭菌,并优选同位素钴60(钴-60)。辐射灭菌与在限定的有效条件下将物品暴露于电离辐射相关。使用电子束辐射,发射高能电子的连续或脉冲流。
放射性同位素钴60是用于γ射线辐照装置的能量源,并为此目的特别地制造。辐照过程在一个专门设计的室(cell)内,其由通常达两米厚的钢筋混凝土构造。这种设计确保辐射衰减,使得在外部背景水平上没有增加。钴60球粒密封在不锈钢圆筒中,称为源棒(source pencil)。将这些棒放入位于混凝土室内的金属源架中。所述金属源架只能在两个位置之一:贮存位置,其最通常是在是在深水池
中,或在升高的(raised )工作位置。在操作期间,所述金属源架被在输送系统上循环的产品所包围。钴60的衰变所给出的能量不足以诱导任何材料中放射性,不论暴露于所述源的长度。
(http://www.synergyhealthplc.com/PDF/Gamma-Processing.pdf)。
电子束加工是公认为用于引发作为薄部件(thin sections),例如热收缩管材和线和电缆绝缘层形式存在的聚合物中分子水平上的化学变化的技术。作为可从新一代设备获得的增加的能量的结果,这项技术已经确立自身为对可用于灭菌医疗设备、敷料和药品的灭菌方法范围的有价值的添加。电子束产生通常是通过电子加速器得到的。电子加速器才能最好地描述为电视管的类似物。加热的钨丝形成电子枪,沿该钨丝设置的高电压将电子拉离该钨丝和将其沿着抽成真空的电子管(evacuated tube)加速。然后,所述电子束通过往复'扫描'其(类似于电视管的水平扫描)的振荡磁场,使得它通过通常由钛制成的、扇形结构的薄金属窗由扫描角(scan horn)形成。产品然后通过此电子帘以接受所需剂量的辐照。
(http://www.synergyhealthplc.com/PDF/Electron-Beam.pdf)。
X射线辐照适合用于对于电子束而言过于致密的产品。比电子束更穿透得多,X射线非常类似于由钴产生的γ射线,关键区别是X射线是由电供能的。高能X射线是高频、短波长的电磁光子。它们在高能电子被具有高原序数(high atomic number)的材料停止时发射。
使用高能量束从电子加速器产生X射线。电子加速器以与老式电视中的大型阴极射线管类似的方式工作。它们利用电场从围绕钨丝的等离子体加速电子至所需的能量(或速度)。因此,它们的辐射可以被开启和关闭。为了产生X射线,电子加速器需要装备以X-射线转换器。X-射线转换器设计成停止所述加速的电子和通常是在适当的机械装置中的水冷钨或钽板。
X射线发射的效率随电子能量和靶材料的原子序数增加。X-射线能谱是宽的;最大的光子能量与入射电子的动能是相同的。 利用5 MeV和7MeV的X射线能量,产品穿透大于由未准直钴-60源的γ射线提供的穿透。
X-射线和γ射线都是光子。它们以相同的方式失去其在物质中的能量并具有良好的穿透力。然而,它们的产生方法不同导致不同的发射特性:
• X射线发射是沿着一维集中的,这表示大部分X-射线是在向前的方向上发射的。
• γ射线发射是各向同性的。60Co棒通常布置在具有2D延伸的源架中。
因此,X射线和γ射线源是不同的,且在产品中的剂量率(dose rates)也会是不同的。剂量率是每单位时间提供的辐射量,如kGy/min。基于X-射线和γ射线医疗设备灭菌设施模型的模拟示出了与γ射线相比高2倍的X射线剂量率。
(http://www.emdt.co.uk/article/x-ray-sterilisation-technology-future和http://www.emdt.co.uk/article/x-ray-sterilisation)。
作为“生物负荷”测定结果,这是产品和/或包装上的活微生物数。如果不含活微生物,产品被确定为“无菌”。
作为在灭菌后在产品单元上存在活微生物的可能性给出无菌保证水平(SAL)。SAL通常表示为10-n。要求终端灭菌设备被标作“无菌”是指10-6的SAL或换言之,在设备上存在活微生物的理论可能性等于或小于1 x 106(BS EN 556 – 1:2001 Sterilisation ofmedical devices – Requirements for terminally sterilised devices to belabelled sterile)。
用于组合物的合适γ辐照剂量为15-42 kGy (Isotron)。不同的辐照过程(连续和短暂的)是合适的。实现更敏感的组合物组分的终端无菌的减少的剂量为15-25kGy。优选的剂量为15 kGy+/-10%或15- 20kGy。
电子束辐照是适于低容器壁密度和低体积的组合物灭菌。合适的剂量是以10MeV电子束(Isotron)供应。
该组合物可以是终端无菌的,即在它的(初级)包装中灭菌,或以其他方式,例如是无菌填充的。
在本发明的再一个方面,提供了制备弹性体的方法,包括将如上定义的组合物的所述至少一种组分A和至少一种组分B混合,且将其固化或交联。
该方法可以是制备多孔泡沫、粘合剂或密封剂的方法,包括将如上定义的可发泡和/或粘合剂或密封剂组合物的至少一种组分A和至少一种组分B混合,且将其固化或交联。
优选所述方法是在无菌区中进行。
在本发明的再一个方面,提供了弹性体,其包含如上定义的固化或交联的组合物。
适当地通过将如上定义的组合物的所述至少一种组分A和至少一种组分B混合,且将其固化或交联来获得所述弹性体。
所述弹性体可以是多孔泡沫、粘合剂或密封剂,其包含如上定义的固化或交联的可发泡和/或粘合剂或密封剂组合物。
所述多孔泡沫、粘合剂或密封剂弹性体可以通过将如上定义的可发泡和/或粘合剂或密封剂组合物的所述至少一种组分A和至少一种组分B混合,且将其固化或交联来获得。
优选地,所述弹性体是终端无菌的。“弹性体”是指在将所述至少一种组分A和至少一种组分B混合或掺混以形成混合物,且将其固化或交联后获得的所得最终产品。固化或交联是通过施加低温(低于室温(约20℃))、环境温度(室温)或高温(大于室温到190℃)适当地引发的。
在本发明的再一方面中,提供 如上定义的组合物或弹性体的医疗或非医疗、牙科或非牙科用途。这样的用途包括如染料;防腐剂;凝胶;泡沫;气雾剂;药剂;粘合剂;包囊剂;头发/皮肤护理;化妆品用途;牙科用途;防粘涂料;涂料;粘合剂和密封剂;伤口护理;皮肤护理,包括疤痕减轻;腔护理;医疗设备封装,如用于生物医学用途的电子设备封装;模具制造;整形外科;给药系统,包括抗微生物系统;止血和药物系统;营养学,包括食品的制造;航空航天、海洋和海底用途;生态敏感用途;紧闭或隔离的生物体或它们的栖息地,或紧闭或隔离的介质或气氛,如具有低免疫力的那些;消毒、清洁或无菌用途;活物质如植物或生物体的萌芽或繁殖;包括用于任何上述用途,特别是航空航天、海底、消毒、清洁或无菌、萌芽或繁殖用途的设备、装置或部件的制造和修理的用途。
特别有利的医疗用途是作为如上定义的可发泡组合物。可发泡组合物特别适用于伤口治疗,更特别用作伤口填料或伤口填塞材料或创腔泡沫敷料,最特别在NPWT中。该可发泡组合物特别有利的是,其可以在无菌区或环境中使用。在此区域中(处理非常严重的伤口)可分配可成型泡沫的优点最有关系,并且不能使用非无菌组合物。因此,本文中公开的实施方案首次实现在无菌区中使用可固化泡沫组合物。
用于伤口护理或伤口治疗的可发泡组合物适用于提供多孔固化的可弹性变形的三维体。这特别有利于在伤口愈合和闭合时为伤口提供支撑,同时可压缩。
该可发泡组合物优选提供开孔固化三维体。在适合NPWT的组合物的情况下,开孔系统允许在伤口处形成经开孔发泡体传递的负压。经由发泡体排出伤口渗出液(woundfluid)。
在泡沫基NPWT中,用多孔泡沫填塞材料填充或覆盖创腔并用相当不透液的柔性片材(布单)覆盖和密封。在纱布基NPWT中,遵循相应程序,但使用纱布填塞材料代替多孔泡沫填塞材料。如果要使用纱布或泡沫,可以遵循联合敷料或预成型敷料基NPWT程序。真空管在布单下方或穿过布单插入伤口位置并将其远端连至真空源(通常是泵)。被布单和组织包封的创腔在大气压力下收缩并明显压缩填塞材料。在数十秒后肉眼可见的组织运动停止,流体接着从伤口流走(从组织取出)。流体经过填塞材料和沿真空管向上传递至位于真空管远端与真空源之间的收集容器。伤口填塞材料机械支撑其施加至的组织,并且甚至在压缩时也允许在施加真空时流体从该位置自由流走。
孔隙率取决于孔隙数和它们的尺寸。其可以便利地与体积增加相关地测量。该可发泡组合物合适地提供与该组合物相比具有3至10的体积增加量的泡沫。可以通过发泡剂的选择和量调节体积增加量,但也取决于聚合物。特别有利地,所述组合物,特别是某些聚二有机基硅氧烷组合物提供非常适合伤口护理用途的孔隙率。如前所述,该泡沫体优选具有极高自由内部体积,例如70%至90%。
通常,孔隙尺寸影响负压的传递。因此,孔隙越小,可建立的负压越小且其持续时间越短,因为周围组织生长逐渐压缩该泡沫。但是,孔隙越大,拉伸强度越低且该泡沫能提供的支撑越低。
所述组合物适宜地提供发泡的固化材料,其具有能够承受低于环境大气压的宽范围地-40至-200毫米汞柱,如8-120毫米汞柱的负压而不导致泡沫塌陷的弹性和拉伸强度。在一个优选的实施方案中,所述孔对于组织收缩是呈弹性的,且在收缩下不会塌陷,从而负压可以保持。
优选,可发泡组合物适于提供泡沫,该泡沫在其与湿润或湿表面的界面处是开放的,更优选是聚二有机基硅氧烷组合物。这产生了用于在创面产生负压同时保持与伤口本身开放连通的理想材料。
所述聚二有机基硅氧烷组合物适于选择性地对湿润的创面提供负压,例如通过孔或阀,其可以容易直接地在其远离创面的密封面,或间接地通过连接到这样的密封面的真空连接管插入。
在一个优选实施方案中,孔隙能顺应组织收缩并在收缩下不塌陷,由此可保持负压。该组合物合适地提供具有能承受大于– 150mmHg,优选比环境大气压低60 – 120mmHg,如60 – 100mmHg,或比环境大气压低80 – 120 mmHg的负压而不造成泡沫塌陷的弹性和拉伸强度的发泡固化材料。
可发泡组合物优选适合提供在其与湿润或湿表面的界面处开放的泡沫,更优选是有机硅组合物。这产生在创面处生成负压同时保持与伤口本身的开放连通的理想材料。进一步有利地,该组合物适合提供所需形状的固化多孔三维体。
该聚二有机基硅氧烷组合物适合选择性地向湿润的创面提供负压,例如通过孔或阀,其容易直接在其远离创面的密封面或间接经由连至这样的密封面的真空连接管被插入。
要认识到,在本说明书通篇中,通常提到伤口。在此意义上,要理解的是,术语伤口应广义解释并包括开放性和闭合性伤口,其中皮肤破损、切破或刺伤,或其中外伤造成挫伤。伤口因此广义地定义为可能产生或不产生渗出液的任何受损组织区。这样的伤口的实例包括,但不限于,切口、裂伤、擦伤、挫伤、烧伤、糖尿病性溃疡、压疮、气孔、外科伤口、外伤和静脉性溃疡等。本发明的某些实施方案不限于用于如下文将更详细论述的伤口。用作伤口填料,优选如上定义的负压伤口疗法伤口填料包括用在选自慢性、急性、外伤、亚急性和裂伤、溃疡(如压迫性或糖尿病性)、部分皮层烧伤和皮瓣和移植物的伤口上。这些包括开放、湿润、肉芽性伤口,优选手术伤口,如来自溃疡、癌组织如肛周和会阴伤口等的切除的那些。为了这样的伤口的最佳愈合,应防止伤口自己闭合并积聚渗出液,同时允许伤口周围的组织逐渐收缩并允许伤口收缩。NPWT中的伤口填料因此充当一种类型的“支架”,支撑伤口和使其保持打开。
该组合物特别有利的进一步医疗或非医疗用途包括用作如上文规定的粘合剂或密封剂组合物。粘合剂或密封剂组合物特别适用于清洁、无菌或消毒用途,更特别作为用于物品如药剂、或营养品等的清洁无菌储存或包装(特别是将药剂包装在医疗器材内)的粘合剂或密封剂的粘合剂或密封剂,或适用于在消毒、无菌或清洁设备或机器的修理和/或维护和/或制造中。
用作消毒、清洁或无菌条件中的粘合剂或密封剂的该组合物优选包装在如上文规定的进一步阻隔装置中。进一步阻隔装置提供感染屏障。该组合物因此是双包装品,这允许除去无菌密封包装的第一层以暴露出包含在注射器、胶带等中的容器或载体如药筒,其内外完全无菌,有利于进入无菌环境。省略进一步阻隔装置的该组合物会包含容器或载体和相关阻隔装置的非无菌外表面。由于不可能使用如上文描述的医疗器材的标准条件将该组合物灭菌,无法将这种组合物带入无菌区。
该粘合剂或密封剂组合物适合引入清洁或无菌区中并分配或释放与要粘合或密封的物品接触。任选在其上施加闭合装置。例如,可以在施加闭合装置之前围绕无菌瓶边缘,或向想要密封的任何表面分配密封剂珠。合适地施加闭合装置或其它相对或相邻表面并同时施加轻压力,由此确保在边缘与盖子或其它相对或相邻表面之间产生密封。由此为外科医生或临床医生、实验室技术员、食品制造商或机械师提供通用无菌密封剂。该密封剂可以在袋装双注射器施加器中提供并在使用时经静态混合器分配。由此方便地为使用者提供无菌分配器和密封剂。
某些密封剂组合物可例如用于密封医用敷料,可用于例如限制伤口渗出液流出或感染侵入,或提供用于NPWT用途的真空密封;或作为实验室管瓶和其它容器(例如陪替氏皿盖、样品储存罐、bijou瓶、培养瓶、坛子和杜瓦瓶)在清洁或无菌技术下的原位无菌盖密封剂;或在包装营养品,例如食品,包括乳品、果汁、蛋的无菌制造中;或在消毒、无菌或清洁装置或机器等的修理和/或维护和/或制造中。
医用敷料密封剂可以以任何已知或新颖的方式施加。WO 00/74738 (Guyuron)公开了i.a使用有机硅基RTV-2组合物密封伤口以使可能的感染最小化。本发明的密封剂因此适合通过浇注在伤口和周围的皮肤上并使其固化来使用。
WO2004/108175 (Molnlycke Health Care AB)公开了在破裂皮肤或伤口周围的皮肤上使用有机硅基RTV-2组合物i.a以使可能的感染最小化和防止伤口渗出液的有害影响。可如下使用密封剂:通过施加到伤口周围的皮肤或破裂皮肤上、在伤口上与密封剂接触地施加粘性或非粘性敷料并使其固化,或通过施加到粘性或非粘性敷料上、将该敷料施加到伤口上并使其固化。在任一情况下,将敷料密封到伤口周围的皮肤上。该组合物通过为外科医生、临床医生或患者提供以这些已知方式或其变体使用的无菌密封剂而构成这些方法上的极大改进。
食品可密封在如上描述的容器,例如Tetra Pak内。由此该密封剂可以散装供应给在无菌条件中的工业规模自动化混合和分配(例如使用Rampf Dosiertechnik GMBH供应的机器人分配系统)。可以制造该双组分的无菌袋装药筒以插入分配机中。由此可以将该双组分的无菌药筒输送到无菌制造区中并插入分配机中。
在机械的修理和/或维护中,特别考虑垫圈的更换。在此可以将密封剂以珠粒形式施加到凸缘区或密封表面,接着将部件合在一起以形成密封。这降低在引入无菌环境之前将各个垫圈灭菌的需要和降低购买或制造多个垫圈的需要。在装置或机械的无菌制造中,特别考虑宇宙飞船、海上船舶或潜水艇或其部件的制造以满足行星保护要求。在此可以分配密封剂组合物以制造如上文规定的原位垫圈。或者,该可发泡组合物可作为抗震材料或热或电隔绝材料分配。该密封剂可以在袋装双注射器施加器中提供并在使用时经静态混合器分配。由此方便地为使用者提供无菌分配器和密封剂。或者,可以将组合物组分的无菌袋装容器,如药筒输送到无菌制造区中并插入分配机中。
再一方面,提供包含如上文规定的可发泡或发泡组合物、粘合剂或密封剂或其组合物的伤口敷料。
在本发明的再一方面中,提供分配或释放和固化如上文规定的组合物的方法,包括在固化温度下分配到所需位置或孔中达到固化时间。
该组合物可以手工混合和分配。或者,可以使用任何形式的分配设备。
在本发明的再一方面中,因此提供包含如上文规定的终端无菌组合物的组合物分配设备。该装置优选是NPWT设备。该设备合适地包含混合头,其具有容纳包含组分A和B的2个或更多个药筒的装置。药筒适于在该设备中安置和原位锁定。适用于NPWT的设备是适合装载40克预聚物并配有混合头的双筒注射器。
在本发明的再一方面中,提供治疗方法,包括将如上文规定的无菌组合物,优选终端无菌组合物分配到伤口位置。
在本发明的再一方面中,提供如上文规定的治疗方法,其是负压伤口治疗法,包括将如上文规定的终端无菌组合物直接或间接分配到伤口中并使其发泡和固化,密封包括该发泡固化组合物并任选包括负压连接装置的伤口并向伤口施加负压。
可以将该组合物直接分配到开放创腔中并覆盖,或经由覆盖物中的孔分配到被覆盖的腔中,或分配到模具中并插入创腔中。生成开孔表面或表面凹陷,其可直接或间接连向负压源。
现有伤口填料要求定期,通常每8、12或24小时移除和清洗或更换,敷料保持就位的最大推荐期在例如泡沫的情况下为48小时,在黑色泡沫的情况下高达72小时,在纱布的情况下为72小时。在更长时段后,可能发生组织向内生长(tissue in-growth)。在泡沫的情况下,洗过的敷料可再使用最多1周,但随着伤口愈合的进行,应制造越来越小的填料。
特别有利地,该组合物可以在无菌区中分配到准备好的伤口中并可保持在原位而不需要清洗和更换,因为该成型法简单和非常准确,而用过的填料弃置并简单分配新的填料。可通过监测施加的负压的降低或通过固化组合物的弹性变形的降低来测定已发生的组织收缩程度,如果观察到充分收缩,可以移除该固化组合物并将新的组合物分配到伤口中以继续治疗。该可发泡的可固化组合物优选具有能在组织收缩时在适中压力下压缩而没有孔隙坍塌的孔隙结构。
该组合物可以是手动混合和分配。或者,可以采用任何形式的分配设备。因此在本发明的再一个方面提供了组合物分配设备,其包含如上定义的终端无菌组合物。优选地,该设备是NPWT设备。适宜地,设备包含混合头,其具有容纳2个或更多个包含组分A和B的药筒的装置。药筒适于在设备内安置并原位锁定。 合适的NPWT设备40g混合头。
在再一方面中,提供处理伤口位置的方法,其包括:
在伤口位置的至少一部分周围分配终端无菌组合物,其中所述组合物包含能产生基本液密密封的密封剂;
用基本液密布单覆盖伤口位置,所述布单接触分配的终端无菌组合物的至少一部分并在伤口上形成液密密封;和
使用连至伤口位置的负压源对伤口位置施加负压。
该组合物优选包含第一组分和第二组分。该方法优选进一步包括在覆盖伤口位置的过程中或之后固化该组合物。
该方法优选进一步包括将填料如泡沫、纱布等放入伤口位置中。
该布单合适地包含孔以连接负压源。该孔可以位于布单中心,一侧或在布单周缘。该方法可进一步包括在布单中或下方制造至少一个孔以连接负压源。
该终端无菌组合物优选在分配前通过将组合物以终端灭菌剂量暴露于辐射来灭菌。
该终端无菌可发泡组合物优选是如上文规定的组合物。
在本发明的再一方面内,提供处理伤口位置的方法,其包括:
将敷料施加至伤口位置
在伤口位置的至少一部分周围从载体释放终端无菌组合物的第一组分A并暴露出所述组分,
暴露出负载在液密布单上的终端无菌组合物的第二组分B
用布单覆盖伤口位置,由此接触和粘合暴露出的第一和第二组分并将布单粘贴在伤口位置周围;和
使用连至伤口位置的负压源对伤口位置施加负压。本发明的某些实施方案的负压范围被认为可以为大约-20 mmHg和-200 mmHg(要指出,这些压力相对于正常环境大气压,因此,-200 mmHg在实践中为大约560 mmHg)。该压力范围适当地为大约-40 mmHg至-150mmHg。或者,可以使用最多-75 mmHg、最多-80 mmHg或超过-80 mmHg的压力范围。也可以合适地使用低于-75 mmHg的压力范围。或者,可以使用超过-100 mmHg或超过-150 mmHg的压力范围。
要认识到,根据本发明的某些实施方案,可以根据一个或多个所需和预定的压力模式调节所提供的压力。例如,这种模式可包括在两个预定负压P1和P2之间调节负压以使压力在P1保持基本恒定预定时段T1,然后通过合适的手段,如改变泵功或限制流体流速等调节至新的预定压力P2,此压力保持基本恒定另一预定时段T2。可任选采用两个、三个或四个或更多个预定压力值和各自的时段。也可以适当地提供更复杂的振幅/频率波形的压力流量分布,例如正弦、锯齿(sore tooth)、收缩-舒张等。
在本发明的再一方面中,提供包含如上文规定的发泡组合物的伤口敷料。该伤口敷料优选是NPWT伤口敷料。
在本发明的再一方面中,提供包含液密伤口敷料、可分配或可释放的终端无菌可固化组合物和用于向敷料供应负压的真空泵连接装置的NPWT试剂盒。该终端无菌可固化组合物优选是如上文规定的本发明的组合物。
现在参照附图以非限制方式图解本发明的实施方案,其中
图1和2图解NPWT泡沫填料伤口敷料;
图3和7、8、9和10图解在患者上使用和施加可分配的无菌泡沫填料伤口敷料;
图4、5和6图解包括密封剂组合物和伤口敷料的试剂盒;
图11至15图解在患者上使用和施加伤口覆盖试剂盒、器械和密封剂的实施方案。
现在参照图1,在传统泡沫基NPWT中,创腔(1)用可能需要按形状切割(2x显示为2a)的多孔泡沫填塞材料(2)填充或覆盖并用相当不透液的粘性柔性片(布单,3)覆盖和密封。
参照图2,真空管(4)在布单(3)下方或穿过布单(3)插入(5)伤口位置(1)中,在各种实施方案中这插在泡沫(6)中的孔或凹槽中或包裹在纱布中。真空管(4)的远端(未显示)连至真空源(通常是泵,未显示)。被布单和组织包封的创腔在大气压力下收缩并明显压缩填塞材料或敷料。但是该系统容易真空泄漏。
在图3A中,显示无菌可发泡组合物(10),其从注射器(11)分配到伤口位置(1)中。在图3B中,该组合物一分配就固化以形成接触创面床(1)的发泡块(12)。在图3C中,在其上放置布单(3)并以传统方式密封就位。以传统方式穿过布单(3)插入(5)真空管(4),此后经由真空管(4)引发真空。创腔表现为参照图2描述的相应方式。这种系统改进泡沫填料的契合并降低粘性密封布单上的应力。
图4A图解用作NPWT密封剂的组合物。密封剂(20)通过施加到伤口位置(1)附近或周围的皮肤上或施加到破裂皮肤上使用。施加粘性或非粘性布单(3),在伤口(1)上与密封剂(20)接触地存在任选敷料(未显示),使该密封剂与布单接触地固化。以传统方式穿过布单(3)中的孔(5)插入真空管(4),此后经由真空管(4)引发真空。密封剂改进传递至创面床的负压的品质。图5显示图4的一个变体,其中泵(8)穿过布单(3)中的孔(5b)可移除地连接(5a)。
图6显示另一变体,其中将包含一体式真空管护套(34)和孔(5)的预成型布单(33)置于经由注射器(11)施加的密封剂(30)上。在这种情况下,布单(33)包含粘性背衬(39),密封剂因此如步骤3中所示以传统方式分配在伤口周围,或密封剂(33)如步骤4中所示分配至粘合布单(33)的边缘。
图7至10显示对图3A至3C的进一步变体,其中在穿过孔(5)从注射器(11)分配组合物(10)之前在伤口位置(1)上放置布单(3)。该组合物发泡并固化形成发泡块(12),其包括穿过孔(5)伸出的凸钮(13)。将凸钮(13)折断以提供进入泡沫体的孔。图10显示以传统方式连接至孔(5)并连至真空泵(8)的真空管(4)。
图11至15显示对图4a、5和6的变体,其涉及分配密封剂20以密封包括用于真空管(4)的一体式端口(5)的组合敷料/布单(2a, 3)。对这些组合敷料(2a, 3)而言,必须如图15中所示将密封剂(20)分配至在围绕敷料部分(2a)的布单(3)外周部分下方的皮肤区域(1a)。在难以预断这种外周部分在哪里接触皮肤(1a)的情况下,如图11和12那样围绕组合敷料(2a, 3)的边缘分配是有利的。或者,可以在布单边缘在观察到泄漏或怀疑泄漏的位置分配密封剂(20)。或者,密封剂(20)可以也如图15中所示作为垫片(2)直接分配到组合敷料上,然后将该敷料施加在伤口上。在所有情况下,可以覆盖粘性胶带(3a)以确保粘合和密封令人满意。在所有情况下,固化、密封和真空操作如上所述。
本发明可以以各种方式投入实践,现在仅举例描述其实施方案。
对比例
实施例CE1
组合物的制备
RTV-2聚二甲基硅氧烷组合物Cavi-Care是市售(Smith & Nephew)RTV-2 Pt催化的可发泡有机硅弹性体,具有30-105秒起发时间(rise time)、作为组分A和B包装在箔袋(由在任一面上与PE层合的铝箔制成)中
Rhodorsil RT 泡沫3240 A/B (Bluestar Silicones)是RTV-2 Pt催化的可发泡有机硅弹性体,具有7.5分钟起发时间。
灭菌
该组合物经受在10,15,20和25kGy下的使用钴源辐照 的γ射线辐照和10MeV下的电子束辐照。
在灭菌后,测定下列内容并与未灭菌的聚合物比较:
粘度
在每一种情况下,该组合物组分B形成固体弹性体(γ射线)并经历粘度提高(电子束)。
组合物组分A通过利用25 - 42kGy下的γ射线的辐射方式经历了粘度的增加,粘度增加为230%(Cavi-Care)或850%(RHODORSIL)。
固化
γ射线辐照的Cavi-Care和RHODORSIL组分B其后不能反应以提供可接受的发泡固化产品。在γ射线和电子束的情况下,与未辐照的组分B固化的辐照的RHODORSIL组分A给出了不可接受的长固化时间。
泡沫密度和可压缩性
未测试。
无菌性测试
因为所述灭菌的组合物不是可固化的,没有对此测试。
γ射线辐照剂量预期已经实现了灭菌。
实施例1 –下面将描述双组分组合物和其制备方法
下面的实施例的粘度对应于按本身已知的方式、在25℃下测量的动态粘度量。所述粘度使用Brookfield粘度计根据1982年5月的AFNOR NFT76 106标准的指示测量。这些粘度对应于在25℃下的“牛顿”动态粘度量,即,以本身已知的方式,在对于粘度(测得独立于所述剪切速率梯度)足够低的剪切速率梯度下测得的动态粘度。
制备一些双组分组合物,所述组合物包含组分P1和P2,其组成在表1中描述,:
1)测试组合物的组分A中的成分:
- M= (CH3)3SiO1/2, MVi= (CH3)2ViSiO1/2 或 (CH2=CH-)(CH3)2SiO1/2, DVi= (CH3)(Vi)SiO2/2 或 (CH2=CH-)(CH3)SiO2/2 和 Q= SiO4/2
- a : 包含M, DVi 和Q 硅氧基基团的乙烯基化聚有机基硅氧烷树脂(也称为 «MDViQ » 树脂) 与:
- b1 : 在各链末端被 MVi 单元封端的、在25℃下的粘度为3500 mPa.s的聚二甲基硅氧烷;
- b2 : 在各链末端被 MVi 单元封端的、在25℃下的粘度为100 000 mPa.s的聚二甲基硅氧烷;
- b3 : 在各链末端被 MVi 单元封端的、在25℃下的粘度为1 500 mPa.s的聚二甲基硅氧烷;
- b4 : 在各链末端被 MVi 单元封端的、在25℃下的粘度为230 mPa.s的聚二甲基硅氧烷;
- c1 : 硅藻土,以CELITE-SF©商品名销售;
- c2 : 煅制的处理的二氧化硅,具有30m2/g (BET)的低表面积, 以AEROSIL®RY50商品名销售;
-d : 己醇;
-e : Karstedt铂催化剂;
- f1 : 在各链末端被 M单元封端的、在25℃下的粘度为1000 mPa.s的聚二甲基硅氧烷;
- g : 聚(乙烯基甲基)(二甲基)硅氧烷油,其具有2wt%的DVi单元含量和0.4wt%的MVi单元含量。
2) 测试组合物的组分B中的成分:
- a : 包含M, DVi 和Q 硅氧基基团的乙烯基化聚有机基硅氧烷树脂(也称为 «MDViQ » 树脂) ;
- b1 : 在各链末端被(CH3)2ViSiO1/2单元封端的、在25℃下的粘度为3500 mPa.s的聚二甲基硅氧烷;
- b2 : 在各链末端被(CH3)2ViSiO1/2单元封端的、在25℃下的粘度为100 000mPa.s的聚二甲基硅氧烷;
- f1 : 在各链末端被 (CH3)3SiO1/2单元封端的、在25℃下的粘度为1000 mPa.s的聚二甲基硅氧烷;
- f2 : 在各链末端被 (CH3)3SiO1/2 单元封端的、在25℃下的粘度为100 000mPa.s的聚二甲基硅氧烷;
- i : 在各链末端被(CH3)2HSiO0,5单元封端的聚二甲基硅氧烷油;
- h : 在各链末端被(CH3)3SiO0,5单元封端的聚甲基氢硅氧烷油;
- j : 包含1%的在聚二甲基硅氧烷油中的乙炔基环己醇的溶液,所述聚二甲基硅氧烷油在各链末端被(CH3)2ViSiO1/2单元封端并具有在25℃下为600 mPa.s的粘度。
在下表1中描述所测试的组合物:
表 1 :组成 :重量份
在实施例6中,该组合物是通过将三个组分A、B和C(组分C的成分通过“*”术语表示)混合制成的。
实施例1-7是发泡。
实施例8是非发泡。
3)灭菌和交联
通过γ射线、电子束或X射线以包括在10kGy至35kGy之间不同剂量辐照组分A和B。
灭菌后,然后根据表1中提到的比率,将各组分与灭菌的(或与未经灭菌的,如实施例6或8中)相应组分混合。固化后,评价所得到的固体或泡沫弹性体并与未灭菌的弹性体比较(结果记录在表2至5中)。
4)测试
如实施例1,2,3,4和6的结果所示,可以甚至在高剂量(10kGy至35kGy)下通过γ射线、电子束或X-射线辐照组分A和B,而没有或具有可接受的轻微粘度增加。此外,弹性体泡沫的性能与未灭菌的泡沫相似。在组分B中作为稀释剂的惰性硅油的添加使组分A和B的粘度和体积是平衡的。
比较例7表明,具有SiH单元的聚硅氧烷和具有Si乙烯基单元的聚硅氧烷在组分B中的存在在组分B的灭菌后导致凝胶或固化的预聚物。因此,不能混合组分A和B以产生泡沫。然而,实施例5表明,0.5wt%的在各链末端被 (CH3)2ViSiO1/2 (MVi )单元封端的聚二甲基硅氧烷的存在是可接受的。
表2 :
表2 (续) :
表3 :
表3 (续):
表4 :
由表5中的结果所示,可以甚至在高剂量(25kGy)下通过γ射线或电子束辐照组分A和B,而没有或具有可接受的轻微粘度增加。此外,弹性体的性能与未经灭菌的聚合物的那些相似。
表 5 :
实施例3 – 确定在组分B中容许的(tolerated)污染物预聚物(i)
制备在组分B中包含不同量的乙烯基的组合物,并在25kGy下通过γ射线或电子束辐照。
在下表6中描述所述组合物 :
表 6 :
结果如下 :
组合物 | 辐照的影响 | 在组分B中的%wt (i) | H/Vi 比 |
比较实施例7 | 不可接受 | <1000 | |
实施例 9 | 可接受, 对密度轻微影响 (0.18至0.28) | (1%的短乙烯基链) | 10 000 - 15 000 |
实施例5 | 可接受 | 0.5%的长链 = 实施例5 | 80 000 - 120 000 |
这些结果表明,低水平的预聚物(i)在组分B中是可接受的,其不足以影响该组合物的性质。
我们确定了在组分B中不可接受的预聚物(i)的边界水平。
在H/Vi比 = 2,000下,组分B的性质被改变,但所述组合物保持为功能性的。
在此边界水平内,在H/Vi比 = 5,000下,组分B的性质是极小改变的且功能良好。
在这个优选水平内,在H/Vi比 = 10,000下,组分B的性质是基本未变且功能优异。
Claims (32)
1.用于伤口护理的可固化的组合物,其能够承受足以灭菌的辐射剂量,其分配在至少一种组分A和至少一种组分B之间,所述至少一种组分A包含:
(i)一种或多种含烯基的预聚物,其每分子具有至少一个或至少两个烯基基团或结构部分,
和所述至少一种组分B包含:
(ⅱ)一种或多种含SiH的预聚物,其每分子具有至少一个或至少两个Si-H单元或结构部分;
所述组合物还包含:
(ⅲ)用于通过将含烯基的预聚物(i)加成到含SiH的预聚物(ⅱ)上而固化用的催化剂,
和任选地(iv)发泡剂,其选自作为固化反应的一部分或在固化反应过程中释放气体的任何试剂;
其特征在于,预聚物(ⅱ)不存在于组分A中和预聚物(i)不存在于组分B中,或组分B包含微量的预聚物(i),其表示为大于或等于2000的(Si-H单元或结构部分)/(烯基单元或结构部分)摩尔比。
2.如权利要求1中所述的组合物,其中所述至少一种组分A包含催化剂。
3.如权利要求1或2中所述的组合物,其是终端无菌的,其特征在于无菌保证水平(SAL)为10-6。
4.如权利要求1或2所述的组合物,其中所述组分A和/或所述组分B通过辐照灭菌。
5.如权利要求1或2所述的可固化的组合物,其中预聚物(i)和(ii)选自有机硅包括硅氧烷和改性硅氧烷,聚氨酯(PU)包括聚酯聚氨酯和聚醚聚氨酯,弹性体聚醚聚酯,聚乙醇酸、聚乙酸酯,聚丙烯酸酯、多糖的多酸衍生物、羧基烷基壳聚糖及其共聚物,和包括共聚物、缠结体系及其混合物的它们的杂化物。
6.如权利要求1或2所述的可固化的组合物,其利用有机基氢硅氧烷单元和有机基烯基硅氧烷单元之间的加成固化反应,所述单元任选并入如权利要求5所定义的聚合、共聚、缠结和混合聚合物中,其中预聚物(i)和(ii)是有机硅氧烷。
7.如权利要求1或2所述的可固化的组合物,其中组分A或组分B包含提高或降低体积和/或粘度的量的粘度调节剂或稀释剂。
8.如权利要求1或2所述的可固化的组合物,其按重量%计包含:
组分A,其中所含的所有成分含量总和为100%:
一种或多种预聚物(i)(80-99%)
发泡剂(0-10%)
催化剂(>0-5%)
防腐剂(0–0.1%)
组分B:
一种或多种预聚物(ii)(94–100%)
泡沫稳定剂(0–11%)
催化剂抑制剂(0–0.1%)
防腐剂(0–0.1%)
稀释剂或粘度改性剂(0–75%)。
9.如权利要求1或2所述的可固化的组合物,其中组分A:组分B的粘度比为6:1–1:8。
10.如权利要求1或2所述的可固化的组合物,其用作泡沫、气雾剂、粘合剂、防粘涂料、涂料、粘合剂和密封剂、与NPWT相关的伤口护理。
11.如权利要求1或2所述的可固化的组合物,其用作负压伤口治疗伤口填充材料、粘合剂或密封剂,其中所述至少一种组分A和至少一种组分B适合以协作方式分配以利于其密切接触和固化以及形成能传递负压、粘贴负压伤口治疗布单或气密的多孔泡沫。
12.如权利要求1或2所述的可固化的组合物,其包含在组合物分配设备中,其中所述分配设备包含混合头,所述混合头具有容纳2个或更多个包含各自组分A和B的药筒的装置。
13.制备如权利要求1至12任一项中所述的组合物的方法,包含步骤:
混合如权利要求1定义的预聚物(i)、(ii)和催化剂(iii)和任选的发泡剂(iv)以形成如权利要求1定义的至少一种组分A和至少一种组分B。
14.灭菌如权利要求1至12任一项中所述的组合物的方法,包括以灭菌剂量辐照所述组合物组分,或辐照组分A和组分B至少之一并用可替代的方式将其另外的组分灭菌。
15.制备弹性体的方法,其包括混合如权利要求1至12任一项中所述的组合物的所述至少一种组分A和至少一种组分B并使其固化或交联。
16.弹性体,其包含固化或交联的如权利要求1至12任一项中所述的组合物。
17.如权利要求16所述的弹性体在伤口护理中的用途。
18.在其中具有如权利要求1至12任一项中所述的可固化的组合物的组合物分配设备。
19.如权利要求18中所述的设备,其中所述设备包含混合头和具有容纳2个或更多个包含组分A和B的料筒的装置。
20.如权利要求18或19中所述的设备,其用于NPWT并包含适于装载40g预聚物和配有混合头的双筒注射器。
21.如权利要求1至12任一项中所述的组合物用于处理伤口位置的方法,所述方法包括:将如权利要求1至12任一项中所述的可固化的组合物分配到所述伤口位置的至少一部分中,其中所述可固化的组合物形成能传递负压的多孔泡沫材料;
或
在所述伤口位置的至少一部分周围分配如权利要求1至12任一项中所述的组合物,其中所述组合物包含在混合时形成能产生基本液密密封的材料的第一组分和第二组分,并用基本液密布单覆盖所述伤口位置,所述布单覆盖所述分配的组合物的至少一部分;
或
将敷料施加至伤口位置,
在所述伤口位置的至少一部分附近或周围从载体释放如权利要求1至12中所述的组合物的第一组分并暴露出所述组分,
暴露出负载在液密布单上的所述组合物的第二组分
用所述布单覆盖所述伤口位置,由此接触和粘贴所述暴露出的第一和第二组分并将所述布单粘贴在伤口位置附近或周围;
所述方法进一步包括
在该伤口上形成液密密封;和
使用连至所述伤口位置的负压源对伤口位置施加负压。
22.如权利要求1或2所述的组合物,其中所述组分A和/或所述组分B通过辐照灭菌,所述辐照选自γ射线、x-射线和电子束和其组合。
23.如权利要求1或2所述的可固化的组合物,其利用有机基氢硅氧烷单元和有机基烯基硅氧烷单元之间的加成固化反应,所述单元任选并入如权利要求5所定义的聚合、共聚、缠结和混合聚合物中,其中预聚物(i)和(ii)是聚有机基硅氧烷。
24.如权利要求1或2所述的可固化的组合物,其中组分A:组分B的粘度比为5:1–1:5。
25.如权利要求1或2所述的可固化的组合物,其中组分A:组分B的粘度比为基本1:1。
26.如权利要求1或2所述的可固化的组合物,其中所述预聚物的灭菌可引发一定的粘度增加,因此组分A:组分B的粘度比为灭菌后的组分粘度比。
27.如权利要求1或2所述的可固化的组合物,其中组分A或组分B包含提高或降低体积和/或粘度的量的任何所需粘度的硅油。
28.如权利要求1或2所述的可固化的组合物,其用作在无菌区或环境中的伤口护理。
29.如权利要求5所述的可固化的组合物,其中聚乙酸酯为乙烯乙酸乙酯。
30.如权利要求5所述的可固化的组合物,其中多糖的多酸衍生物是羧基烷基纤维素。
31.灭菌如权利要求1至12、22至30任一项中所述的组合物的方法,包括使用γ射线、X射线或电子束辐照以灭菌剂量辐照所述组合物组分,或辐照组分A和组分B至少之一并用可替代的方式将其另外的组分灭菌。
32.NPWT试剂盒,其包含具有如权利要求1至12、22至30中任一项所述的可固化的组合物的液密伤口敷料、可分配或可释放的终端无菌可固化或固化的可发泡组合物;或可固化粘合剂或密封剂组合物或弹性体,和用于向所述敷料供应负压的真空泵连接装置。
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Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
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US5145933A (en) * | 1987-12-18 | 1992-09-08 | Dow Corning France S.A. | Organosiloxane gel-forming compositions and use thereof |
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MX337627B (es) | 2016-03-10 |
US11730876B2 (en) | 2023-08-22 |
CA2819032A1 (en) | 2012-05-31 |
US20200254139A1 (en) | 2020-08-13 |
RU2013128336A (ru) | 2014-12-27 |
RU2597393C2 (ru) | 2016-09-10 |
US10537657B2 (en) | 2020-01-21 |
EP2643412B1 (en) | 2016-08-17 |
CA2819032C (en) | 2020-06-23 |
CN103403095A (zh) | 2013-11-20 |
AU2011333538A1 (en) | 2013-05-02 |
EP2643412A1 (en) | 2013-10-02 |
ES2603152T3 (es) | 2017-02-23 |
ZA201303600B (en) | 2014-01-29 |
BR112013012785A2 (pt) | 2020-10-20 |
JP6078472B2 (ja) | 2017-02-08 |
WO2012069794A1 (en) | 2012-05-31 |
JP2017020051A (ja) | 2017-01-26 |
JP2014505118A (ja) | 2014-02-27 |
US20130310781A1 (en) | 2013-11-21 |
CN107033596A (zh) | 2017-08-11 |
MX2013005923A (es) | 2013-10-03 |
AU2011333538B2 (en) | 2015-04-16 |
AU2011333538C1 (en) | 2015-07-30 |
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