Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation.
Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation.
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DOI：
10.1177/1076029620982374
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Wu ZJ
中科院分区：
文献类型：
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作者：
Wang S;Griffith BP;Wu ZJ
机械辅助循环 (MAC) 可以维持接受心肺旁路 (CPB) 心脏手术或使用心室辅助装置 (VAD) 进行心室辅助或使用泵氧合器系统进行体外膜肺氧合 (ECMO) 的患者体内的血液循环。虽然 MAC 为心脏和/或肺提供短期（数天至数周）和长期（数月至数年）支持，但由于机械泵送作用以及与人造表面的接触，血液不可避免地会受到非生理剪切应力 (NPSS) 的影响。众所周知，NPSS 会导致血液损伤和血细胞功能改变。在这篇综述中，我们讨论了 MAC 期间剪切诱导的血小板粘附、血小板聚集、血小板受体脱落和血小板凋亡、剪切诱导的获得性血管性血友病综合征 (AVWS)、剪切诱导的溶血和微粒形成。这些改变与 MCS 患者的围手术期出血和血栓事件、发病率和死亡率以及生活质量相关。了解剪切诱导止血障碍的机制将有助于我们开发低剪切应力装置并选择更有效的治疗方法以获得更好的临床结果。
Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.