Kameneva M V, Antaki J F, Yeleswarapu K K, Watach M J, Griffith B P, Borovetz H S
McGowan Center for Artificial Organ Development, Department of Surgery, University of Pittsburgh School of Medicine, PA 15219, USA.
ASAIO J. 1997 Sep-Oct;43(5):M571-5.
Hemodilution with plasma expanders is a widely applied practice during extracorporeal circulation and hemodialysis. Despite the immediate beneficial effects of hemodilution, such as reduction of blood viscosity and red blood cell (RBC) aggregation, elevation of blood flow in the microcirculation, etc., the dilution of plasma may cause some unfavorable effects on RBCs, amplifying the mechanical damage caused by circulatory assist devices. The authors investigated the effect of partial and total replacement of plasma on susceptibility of human and bovine RBCs to mechanical stress in vitro. Hemolysis was measured after the exposure of RBCs suspended in different media to similar mechanical stress. Experiments were performed at room temperature with control of osmolality and viscosity of the suspension media. The lowest hemolysis was obtained for RBCs suspended in serum, plasma, and albumin solutions. Hemolysis in PBS and Dextran suspensions was more than three times higher than that in plasma (p < 0.001). The protective effect depended upon protein concentration. Human RBCs were found to be significantly more sensitive to mechanical stress than bovine RBCs in all investigated suspension media (p < 0.005). Human RBCs from men suspended in plasma were found to be significantly (p < 0.05) more fragile than RBCs from women. The presence of even small amounts of plasma (such as 25%) in the suspension media significantly (p < 0.001) decreased hemolysis. However, a 30% replacement of plasma with PBS or Dextran solutions caused a statistically significant (p < 0.001) increase in mechanical hemolysis. This suggests that a decrease in the concentration of plasma proteins due to hemodilution may elevate blood damage during extracorporeal circulation and hemodialysis.
在体外循环和血液透析过程中，使用血浆扩容剂进行血液稀释是一种广泛应用的做法。尽管血液稀释具有即时的有益效果，如降低血液粘度和红细胞（RBC）聚集、提高微循环中的血流量等，但血浆稀释可能会对红细胞产生一些不利影响，加剧循环辅助装置造成的机械损伤。作者研究了部分和完全替代血浆对人和牛红细胞体外机械应激敏感性的影响。将悬浮在不同介质中的红细胞暴露于相似的机械应激后，测量溶血情况。实验在室温下进行，同时控制悬浮介质的渗透压和粘度。悬浮在血清、血浆和白蛋白溶液中的红细胞溶血率最低。悬浮在PBS和右旋糖酐溶液中的红细胞溶血率比血浆中的高出三倍多（p < 0.001）。保护作用取决于蛋白质浓度。在所有研究的悬浮介质中，发现人红细胞对机械应激的敏感性明显高于牛红细胞（p < 0.005）。发现悬浮在血浆中的男性人红细胞比女性红细胞明显更脆弱（p < 0.05）。悬浮介质中即使存在少量血浆（如25%）也能显著（p < 0.001）降低溶血率。然而，用PBS或右旋糖酐溶液替代30%的血浆会导致机械溶血在统计学上显著增加（p < 0.001）。这表明血液稀释导致的血浆蛋白浓度降低可能会增加体外循环和血液透析期间的血液损伤。
