血液机械损伤体外模拟剪切装置研究进展

doi:10.3969/j.issn.0258-8021. 2016. 03.013

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摘要近年来,由于饮食环境及社会老龄化等多方面因素,心血管患者越来越多,且在中低收入国家的发病率呈上升趋势。机械循环辅助装置(MCSDs)可辅助或替代人体天然器官的泵血及氧合功能,是挽救终末期心衰患者生命的重要治疗手段,临床需求十分迫切。但在中长期临床应用中,MCSDs中非生理性流场引起的血液机械损伤已成为其发展的严峻挑战。研究人员已开发多种体外模拟血液机械损伤的血液剪切装置(BSDs)来研究血液机械损伤,但其损伤机理到目前为止尚未得到很好的阐释。回顾具代表性的锥板型和环形库特流血液剪切装置及其优缺点,对目前主流的环形库特流血液剪切装置进行了较为详尽的阐述和对比分析,讨论装置中影响实验结果的重要因素,从间隙精度、流道设计、密封及支撑方式、温度控制等方面对血液机械损伤体外模拟剪切装置的发展提出展望。

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	陈汐
	尹成科
	吴鹏
	徐博翎

关键词 ：机械循环辅助, 血液机械损伤, 血液剪切装置, 剪应力, 作用时间

Abstract：Due to the increase of dietary changes and aging population, cardiovascular disease (CVD) has surged in modern society. Mechanical circulatory support devices (MCSDs) have become a viable therapeutic solution to assist or replace the failing heart and/or lung, maintaining patients′ physiological circulation. Despite that MCSDs have been developed as bridges to save patients′ lives, blood damage due to non-physiological high shear stress in the flow field within MCSDs has been a major disadvantage. To date, the underlying mechanism has not been studied thoroughly. Therefore, various types of blood shearing devices (BSDs) have been developed. In this paper, a number of representative BSDs were reviewed, including cone-plate and annular Couette types of BSDs. The annular Couette BSDs that are being widely-used were discussed in details. Furthermore, this review discussed the influence of certain parameters and experimental setup on the results. At last, from gap precision, flow design, method of seal and support, even temperature controlling, an outlook for future BSDs was given.

Key words： mechanical circulatory support devices blood damage blood shearing device shearing stress exposure time

收稿日期: 2015-09-18

PACS:	R54
	TH122

基金资助:江苏省高校自然科学研究面上项目(15KJB310020);江苏省高等学校大学生创新创业训练计划(201410285035Z);国家青年自然科学基金(51406127)

通讯作者: E-mail: yinck@suda.edu.cn

引用本文:

陈汐, 尹成科, 吴鹏, 徐博翎. 血液机械损伤体外模拟剪切装置研究进展[J]. 中国生物医学工程学报, 2016, 35(3): 348-356.
Chen Xi, Yin Chengke, Wu Peng, Xu Boling. Shearing Device for in-vitro Simulation of Mechanical Blood Damage: A Review. Chinese Journal of Biomedical Engineering, 2016, 35(3): 348-356.

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http://cjbme.csbme.org/CN/10.3969/j.issn.0258-8021. 2016. 03.013 或 http://cjbme.csbme.org/CN/Y2016/V35/I3/348

[1] Joshi R, Jan S, Wu Y, et al. Global inequalities in access to cardiovascular health care: Our greatest challenge[J]. Journal of the American College of Cardiology, 2008, 52(23): 1817-1825.
[2] Farmer SA, Lenzo J, Magid DJ, et al. Hospital-level variation in use of cardiovascular testing for adults with incident heart failure: Findings from the cardiovascular research network heart failure study [J]. JACC: Cardiovascular Imaging, 2014, 7(7): 690-700.
[3] Piepoli MF, Corrà U, Abreu A, et al. Challenges in secondary prevention of cardiovascular diseases: A review of the current practice [J]. International Journal of Cardiology, 2015, 180: 114-119.
[4] 贾明, 邵涓涓, 陈英, 等. 机械循环辅助装置治疗围手术期急性心肺功能衰竭 [J]. 心肺血管病杂志, 2008, 27(6): 340-343.
[5] Shreenivas SS, Rame JE, Jessup M. Mechanical circulatory support as a bridge to transplant or for destination therapy [J]. Current Heart Failure Reports, 2010, 7(4): 159-166.
[6] 李崇剑, 王喜梅. 心源性休克的机械循环辅助装置治疗进展 [J]. 心血管病学进展, 2012, 33(1): 36-38.
[7] 马旭东, 杨碧波. 机械循环辅助装置的临床应用 [J]. 医疗装备, 2007, 20(3): 190-192.
[8] 吴龙, 翁渝国, 孙宗全, 等. 心室辅助装置临床应用现状及进展[J]. 中华胸心血管外科杂志, 2012, 28(10): 627-631.
[9] Song X, Throckmorton AL, Untaroiu A, et al. Axial flow blood pumps [J]. ASAIO Journal, 2003, 49(4): 355-364.
[10] Kirklin JK, Cantor RS, Myers SL, et al. Interagency registry for mechanically assisted circulatory support [EB/OL]. http://www.uab.edu/medicine/intermacs/images/descriptive_slides/Federal_Partners_Report_2015_Q1_Slides.ppt. 2015-03-31/2015-09-18.
[11] Topkara VK, O'neill JK, Adam C, et al. HeartWare and HeartMate II left ventricular assist devices as bridge to transplantation: a comparative analysis [J]. Annals of Thoracic Surgery, 2014, 97(2): 506-512.
[12] Sheikh FH, Russell SD. HeartMate II continuous-flow left ventricular assist system [J]. Expert Review of Medical Devices, 2011, 8: 11-21.
[13] Romano MA, Haft J, Pagani FD. HeartWare HVAD: Principles and techniques for implantation [J]. Operative Techniques in Thoracic and Cardiovascular Surgery, 2013, 18(3): 230-238.
[14] 胡盛寿. 全人工心脏离我们有多远 [EB/OL]. http://www.365heart.com/n/shownews.asp?newsid=97397&Page=2. 2014-02-20/2015-09-18.
[15] Whitson BA, Eckman P, Kamdar F, et al. Hemolysis, pump thrombus, and neurologic events in continuous-flow left ventricular assist device recipients [J]. Annals of Thoracic Surgery, 2014, 97(6): 2097-2103.
[16] Bhat G, Mohamedali B, Yost G. Hemolysis: Predictors of risk factors post left ventricular assist device implantation [J]. Journal of the American College of Cardiology, 2015, 65: A896.
[17] Katz JN, Jensen BC, Chang PP, et al. A multicenter analysis of clinical hemolysis in patients supported with durable, long-term left ventricular assist device therapy [J]. J Heart Lung Transplant, 2014, 34(4): 701-709.
[18] Fraser K. Mechanical stress induced blood trauma [J]. Heat Transfer & Fluid Flow in Biological Processes, 2015: 305-333.
[19] Giersiepen M, Krause U, Knott E, et al. Velocity and shear stress distribution downstream of mechanical heart valves in pulsatile flow [J]. International Journal of Artificial Organs, 1989, 12(4): 261-269.
[20] Li TY, Ye L, Hong FW, et al. The simulation of multiphase flow field in implantable blood pump and analysis of hemolytic capability [J]. Journal of Hydrodynamics, Ser B, 2013, 25(4): 606-615.
[21] Bente T, Bastian B, Jens S, et al. Numerical analysis of blood damage potential of the HeartMate II and HeartWare HVAD rotary blood pumps [J]. Artificial Organs, 2015, 39: 651-659.
[22] Jessup ML, Goldstein D, Ascheim DD, et al. 5 risk for bleeding after MCSD implant: An analysis of 2358 patients in INTERMACS [J]. The Journal of Heart and Lung Transplantation, 2011, 30(4): S9.
[23] Alkhamis TM, Beissinger RL, Jr C. Artificial surface effect on red blood cells and platelets in laminar shear flow [J]. Blood, 1990, 75(7): 1568-1575.
[24] Shankaran H, Neelamegham S. Nonlinear flow affects hydrodynamic forces and neutrophil adhesion rates in cone-plate viscometers [J]. Biophysical Journal, 2001, 80(6): 2631-2648.
[25] Shankaran H, Neelamegham S. Effect of secondary flow on biological experiments in the cone-plate viscometer: Methods for estimating collision frequency, wall shear stress and inter-particle interactions in non-linear flow [J]. Biorheology, 2001, 38(4): 275-304.
[26] Williams AR, Escoffery CT, Gorst DW. The fragility of normal and abnormal erythrocytes in a controlled hydrodynamic shear field [J]. Br J Haematol, 1977, 37(3): 379-389.
[27] Schwartz JA, Keagy BA, Jr J G. Determination of whole blood apparent viscosity: experience with a new hemorheologic technique [J]. Journal of Surgical Research, 1988, 45(2): 238-247.
[28] Giorgio TD, Hellums JD. A cone and plate viscometer for the continuous measurement of blood platelet activation [J]. Biorheology, 1988, 25(4): 605-624.
[29] Nobili M, Sheriff J, Morbiducci U, et al. Platelet activation due to hemodynamic shear stresses: Damage accumulation model and comparison to in vitro measurements [J]. ASAIO Journal, 2008, 54(1): 64-72.
[30] Blackman BR, García-Cardeña G, Gimbrone MJ. A new in vitro model to evaluate differential responses of endothelial cells to simulated arterial shear stress waveforms [J]. Journal of Biomechanical Engineering, 2002, 124(4): 397-407.
[31] Yasuda T, Funakubo A, Miyawaki F, et al. Influence of static pressure and shear rate on hemolysis of red blood cells [J]. ASAIO Journal, 2001, 47(4): 351-353.
[32] Taylor GI. Stability of a viscous liquid contained between two rotating cylinders [J]. Philosophical Transactions of the Royal Society of London, 1923, 233(605-615): 289-343.
[33] Chandrasekhar S. Hydrodynamic and hydromagnetic stability [M]. Oxford: Clarendon Press, 1961: 652.
[34] Pohl M, Wendt MO, Koch B, et al. Mechanical degradation of polyacrylamide solutions as a model for flow induced blood damage in artificial organs [J]. Biorheology, 2000, 37(4): 313-324.
[35] Klaus S, Paul R, Reul H, et al. Investigation of flow and material induced hemolysis with a Couette type high shear system [J]. Materialwissenschaft und Werkstofftechnik, 2001, 32(12): 922-925.
[36] Giersiepen M, Wurzinger LJ, Opitz R, et al. Estimation of shear stress-related blood damage in heart valve prostheses—in vitro comparison of 25 aortic valves [J]. International Journal of Artificial Organs, 1990, 13(5): 300-306.
[37] Wurzinger LJ, Opitz R, Eckstein H. Mechanical bloodtrauma. An overview [J]. Angéiologie, 1986, 38: 81-97.
[38] Heuser G, Opitz R. A Couette viscometer for short time shearing of blood [J]. Biorheology, 1980, 17(1-2): 17-24.
[39] Leverett LB, Hellums JD, Alfrey CP, et al. Red blood cell damage by shear stress [J]. Biophysical Journal, 1972, 12(3): 257-273.
[40] Sutera SP, Mehrjardi MH. Deformation and fragmentation of human red blood cells in turbulent shear flow [J]. Biophysical Journal, 1975, 15(1): 1-10.
[41] Sutera SP, Croce PA, Mehrjard M. Hemolysis and subhemolytic alterations of human RBC induced by turbulent shear-flow [J]. Transactions American Society for Artificial Internal Organs, 1972, 18: 335-341.
[42] Paul R, Apel JR, Klaus S, et al. Shear stress related blood damage in laminar Couette flow [J]. Artificial Organs, 2003, 27(6): 517-529.
[43] Boehning F, Mejia T, Schmitz-Rode T, et al. Hemolysis in a laminar flow-through Couette shearing device: An experimental study [J]. Artificial Organs, 2014, 38(9): 761-765.
[44] Maruyama O, Nishida M, Yamane T, et al. Hemolysis resulting from surface roughness under shear flow conditions using a rotational shear stressor [J]. Artificial Organs, 2006, 30(5): 365-370.
[45] Zhang T, Taskin ME, Fang HB, et al. Study of flow-induced hemolysis using novel Couette-type blood-shearing devices [J]. Artificial Organs, 2011, 35(12): 1180-1186.
[46] Chen Z, Mondal NK, Ding J, et al. Shear-induced platelet receptor shedding by non-physiological high shear stress with short exposure time: glycoprotein Ibα and glycoprotein VI [J]. Thrombosis Research, 2015, 135(4): 692-698.
[47] Wu J, Antaki JF, Snyder TA, et al. Design optimization of blood shearing instrument by computational fluid dynamics [J]. Artificial Organs, 2005, 29(6): 482-489.
[48] Blackshear PL, Dorman FD, Steinbach JH, et al. Shear, wall interaction and hemolysis [J]. Asaio Journal, 1966, 12(1): 113-120.
[49] Hellums JD. 1993 Whitaker Lecture: biorheology in thrombosis research [J]. Annals of Biomedical Engineering, 1994, 22(5): 445-455.
[50] Yeleswarapu KK, Antaki JF, Kameneva MV, et al. A mathematical model for shear-induced hemolysis [J]. Artificial Organs, 1995, 19(7): 576-582.
[51] 韩青. 人工心脏液力悬浮支承结构设计及其血液相容性研究 [D]. 杭州:浙江大学, 2012.
[52] Chen C, Yin C, Ma Y, et al. Preliminary evaluation of implantability and biocompatibility of a miniaturized magnetically suspended centrifugal blood pump of a miniaturized magnetically suspended centrifugal blood pump [C]//Slaughter MS, Schneditz D, eds. ASAIO Journal. Philadelphia: Celia Braithwait, 2012: 26.
[53] De RF, Birks EJ, Rogers P, et al. Clinical performance with the levitronix centrimag short-term ventricular assist device [J]. Journal of Heart & Lung Transplantation, 2006, 25(2): 181-186.
[54] John R, Liao K, Lietz K, et al. Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure [J]. The Journal of Thoracic and Cardiovascular Surgery, 2007, 134(2): 351-358.
[55] Wu G, Lin C, Li H, et al. Initial in vivo evaluation of a novel left ventricular assist device [J]. Bio Med Research International, 2015, 2015: 1-7.
[56] 寇丽筠, 张淑萍, 杨大鹏, 等. 红细胞压积及温度对血黏度的影响 [J]. 北京医学院学报, 1981, 13(1): 34-36.
[57] 王翠兰, 崔娜. 温度在医学检验中的重要性分析 [J]. 齐齐哈尔医学院学报, 2010, 31(8): 1260.