Flow-induced trauma to blood cells.
Flow-induced trauma to blood cells.
复制标题
血流引起的血细胞损伤。
作者：
S. Sutera
植入式人造血管和体外循环技术在现代医学中已是司空见惯。该技术的基本功能是以某种方式通过和/或处理血液，这不可避免地需要血液与各种人造装置之间的密切和长期接触，泵、阀、管道、膜等。一些系统，例如体外心肺旁路，可以仅在几个小时内急性使用，但其他系统则无限期植入。在任何一种情况下，相关的血液创伤都必须保持在可容忍的范围内。在外科实践中，血液创伤通常是急性手术持续时间的限制因素。在血液透析等慢性暴露过程中，它也会导致显著的异常生理状态。为了科普这些问题，需要彻底了解血液在通过人造器官循环过程中是如何受到创伤的。只有通过这样的理解，这些系统的设计的合理标准才能发展。与人工器官相关的血液降解报告已在文献中出现至少20年。大多数非常早期的论文涉及溶血性贫血，通常发现后安装瓣膜假体。直到20世纪60年代中期，对这个问题的攻击才开始转向更科学的方向，专注于造成血液创伤的机制，而不仅仅是报告特定设备或程序产生的创伤量。由于该问题具有挑战性的流体机械和运输方面，许多在这些学科有经验的工程师加入了医学同行的行列，制定了流动诱导血液创伤的理论和实验研究。因此，在这一领域作出持续贡献的大多数研究小组往往是高度跨学科的。事实上，就像整个人工器官领域一样，血液降解问题为生命科学家和工程师提供了一个富有成效的会议场地。
THE TECHNOLOGY of implantable vascular prostheses and extracorporeal circulation is now commonplace in modern medicine. The essential function of this technology is the passage and/or processing of blood in some manner, and this inevitably requires intimate and prolonged contact between the blood and various manmade devices, e.g., pumps, valves, tubing, membranes, etc. Some systems, such as the extracorporeal heart-lung bypass, may be used acutely for periods of only a few hours but others are implanted for indefinite terms. In either case the associated blood trauma must be kept within tolerable limits. In surgical practice blood trauma is often a limiting factor in the duration of an acute procedure. It can also cause significantly abnormal physiological states during chronic exposures such as hemodialysis. To cope with these problems will require a thorough understanding of how blood is traumatized during circulation through artificial organs. It is only through such understanding that rational criteria for the design of these systems can evolve. Reports of blood degradation associated with artificial organs have been appearing in the literature for at least 20 years. The majority of the very early papers dealt with the hemolytic anemia generally found following the installation of valvular protheses. It was not until the mid-1960's that the attack on the problem began to take a more scientific turn by focusing on the mechanisms responsible for blood trauma rather than the mere reporting of the amount of trauma produced by particular devices or procedures. Attracted by the challenging fluid-mechanical and transport aspects of the problem, many engineers with experience in these disciplines joined medical colleagues in formulating theoretical and experimental studies of flow-induced blood trauma. As a result, most of the research groups which have contributed consistently in this area tend to be highly interdisciplinary. Indeed, like the entire field of artificial organs, the blood degradation problem has provided a fruitful meeting ground for the life scientist and the engineer.