Abstract: Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass (CPB) of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation (ECMO) in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2.2±0.8L and 0.6±0.3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9±1.8L and 2.4±1.3L respectively.The electrolytes and bloodgas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after peration.Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left thehospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient (68mg/L), and normal in 2 patients (lt;40mg/L). Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.
Red blood cells are destroyed when the shear stress in the blood pump exceeds a threshold, which in turn triggers hemolysis in the patient. The impeller design of centrifugal blood pumps significantly influences the hydraulic characteristics and hemolytic properties of these devices. Based on this premise, the present study employs a multiphase flow approach to numerically simulate centrifugal blood pumps, investigating the performance of pumps with varying numbers of blades and blade deflection angles. This analysis encompassed the examination of flow field characteristics, hydraulic performance, and hemolytic potential. Numerical results indicated that the concentration of red blood cells and elevated shear stresses primarily occurred at the impeller and volute tongue, which drastically increased the risk of hemolysis in these areas. It was found that increasing the number of blades within a certain range enhanced the hydraulic performance of the pump but also raised the potential for hemolysis. Moreover, augmenting the blade deflection angle could improve the hemolytic performance, particularly in pumps with a higher number of blades. The findings from this study can provide valuable insights for the structural improvement and performance enhancement of centrifugal blood pumps.
Objective To investigate the effect of chaiqin chengqi decoction (CQCQD) on serum lipid metabolism in experimental acute pancreatitis. Methods A total of 27 C57BL/6 mice were randomly divided into three groups (n=9 for each group). The mice in the acute pancreatitis model group (AP group) and the acute pancreatitis model + CQCQD treatment group (APQ group) received seven intraperitoneal injections of cerulein (50 μg/kg) at hourly intervals, while the mice in the control group (CON group) received phosphate-buffered saline injections at the same regimen of cerulein. Oral gavage of CQCQD (5.5 g/kg) or same volume of distilled water was commenced 1 h after the first cerulein injection for three times at intervals of 4 h for the APQ group and AP group, respectively. Animals were sacrificed 12 h after the first cerulein / phosphate-buffered saline injection for collecting serum and tissue samples. The levels of serum lipase and amylase, pancreatic histopathology assessment, as well as pancreatic myeloperoxidase activity, were used to assess the severity of acute pancreatitis and the efficacy of CQCQD. Additionally, serum lipid metabolites were analyzed in all groups. Results In comparison to the CON group, the mice in the AP group exhibited significant edema, inflammatory cell infiltration, necrosis of pancreatic tissues, as well as elevated levels of serum amylase, lipase, and pancreatic myeloperoxidase activity (P<0.05); in comparison to the AP group, inflammatory cell infiltration and necrosis of pancreatic tissue, as well as elevated level of serum amylase significantly reduced in the APQ group (P<0.05). A total of 319 lipid molecules were identified in serum, and 13 lipid metabolites were significantly increased in the AP group and successfully decreased in the APQ group, of which 9 were lyso-phosphatidylethanolamine (LPE) molecules involved in the glycerol phospholipid metabolic pathway. Further statistical analysis revealed that six of these LPE molecules could serve as potential biomarkers. Conclusions CQCQD ameliorated pancreatic injury and serum lipid metabolism disorder of acute pancreatitis model induced by cerulein and significantly improved the abnormal increase of serum LPE level. However, the role of LPE in acute pancreatitis and the underlying mechanisms of CQCQD on LPE metabolic pathways still need further study.
【摘要】 目的 對市場上流通使用的血塞通注射液在溶血性方面的狀況進行考察與研究。 方法 按《中國藥典》2005年版一部附錄ⅩⅧ B中藥注射劑安全性檢查法應用指導原則和中藥、天然藥物刺激性和溶血性研究的技術指導原則，對11 個廠家共計27 批血塞通注射液每批次樣品制備4 個濃度，進行溶血實驗研究，并采用分光光度法（545 λ/nm）測定計算溶血率，比較各批次樣品的溶血率。 結果 不同廠家甚至同一廠家不同批次的血塞通注射液溶血率存在一定差異。 結論 在臨床使用中應注意用量，過量使用可能導致溶血引起的不良反應；同時，應注意溶血引起的臨床不良反應的觀測。【Abstract】 Objective To explore the hemolysis of Xuesaitong injection. Methods According to the Guiding Principles of safety tests on traditional Chinese medicine injection in Annex ⅩⅧ B, Chinese Pharmacopoeia, 2005 Edition 1, and Technical Guidelines of studies on the irritability and hemolytic activity of traditional Chinese medicine and natural medicine, a total of 27 samples of Xuesaitong injections (each sample was diluted into four concentrations) produced by 11 manufacturers had been examined. Spectrophotometry (545 λ/nm) was used to calculate the hemolytic rate. Results There was a certain difference in the hemolytic rate among several samples of Xuesaitong injections produced by different manufacturers, or even different batches by the same manufacturer. Conclusion The dosage of Xuesaitong injections should be noted in clinical use. Excessive use may lead to adverse reactions caused by hemolysis; at the same time, clinical adverse reactions caused by hemolysis should be observed.
The impeller, as a key component of artificial heart pumps, experiences high shear stress due to its rapid rotation, which may lead to hemolysis. To enhance the hemolytic performance of artificial heart pumps and identify the optimal combination of blade parameters, an optimization design for existing pump blades is conducted. The number of blades, outlet angle, and blade thickness were selected as design variables, with the maximum shear stress within the pump serving as the optimization objective. A back propagation (BP) neural network prediction model was established using existing simulation data, and a grey wolf optimization algorithm was employed to optimize the blade parameters. The results indicated that the optimized blade parameters consisted of 7 impeller blades, an outlet angle of 25 °, and a blade thickness of 1.2 mm; this configuration achieved a maximum shear stress value of 377 Pa—representing a reduction of 16% compared to the original model. Simulation analysis revealed that in comparison to the original model, regions with high shear stress at locations such as the outer edge, root, and base significantly decreased following optimization efforts, thus leading to marked improvements in hemolytic performance. The coupling algorithm employed in this study has significantly reduced the workload associated with modeling and simulation, while also enhancing the performance of optimization objectives. Compared to traditional optimization algorithms, it demonstrates distinct advantages, thereby providing a novel approach for investigating parameter optimization issues related to centrifugal artificial heart pumps.
ObjectiveTo investigate the clinical features, diagnosis, treatment and prognosis of pulmonary tumor thrombotic microangiopathy (PTTM).MethodsA patient with PTTM was reported. Literatures about PTTM searched by WanFang databases and PubMed were reviewed for its clinical characteristics.ResultsA 62-year-old female was admitted with chief complaint of dry cough, dyspnea and hemoptysis. Progressive dyspnea, pulmonary hypertension and hypoxemia occurred during hospitalization. Computed tomography angiography (CTA) of the lung excluded pulmonary embolism. Peripheral blood appearing a large number of late erythroblasts and erythrocyte debris and progressively decreasing platelets suggested that the patient suffer from thrombotic microvascular disease. CT showed widely metastatic lesions at the vertebrae and sternum. On the basis of above clinical characteristics, PTTM was diagnosed clinically. Although the patient accepted respiratory support therapy, anticoagulation therapy and resuscitation, she still died 5 days later after hospitalization. Literatures about PTTM with complete clinical information were reviewed. A total of 92 PTTM cases were reviewed and the main reasons of these patients admitted were progressive dyspnea and chronic cough. During hospitalization, they all suffered varying degrees of hypoxia, while radiological findings of the lungs lack specificity. No abnormal sighs were found by lung CTA. The results of ultrasonic cardiography or the Swan–Ganz catheter indicated varying degrees of pulmonary hypertension, some patients were proved with disseminated intravascular coagulation and/or microangiopathic hemolytic anemia. The definite diagnosis of PTTM depended on the histologic evidence which were often obtained from post-mortem examination, because many patients couldn’t tolerate the lung biopsy due to rapid aggravation. The treatment of PTTM included respiratory support therapy, anticoagulation therapy, antipulmonary hypertension and the chemotherapy of primary or metastatic tumour. The prognosis of PTTM was poor and almost all of the patients died in a short term, ranged from 48 hours to 3 months.ConclusionIf a patient with a history of cancer or evidence of cancer metastasis has hypoxemia and pulmonary hypertension but without abnormal lung CTA signs, PTTM should be considered.
Objective To optimize the hemodynamics of a disk blood pump in children.
Method We used the computational fluid dynamics technology to simulate the flow in a pediatric blood pump numerically, and finally analyzed the results for deep study about the thrombosis and hemolysis produced in it, to improve the design according to the results of the flow field analysis.
Results We calculated results between the flow rate and the pressure elevation at different rotational speed: 2 500 rpm, 3 000 rpm, and 4 000 rpm, respectively. Under each rotational speed, it was selected five different discharge outlet boundary conditions. The simulation results conformed to the experimental data. The increased pressure of the blood pump was effective. But the phenomenon of flow separation was increased the at blade surface in the low speed region. The maximum wall shear stress was maintained within 100 Pa.
Conclusion The design of disc blood pump has a good fluid dynamic performance. And the flow line is fluent, the probability of thrombosis and hemolysis occurred is in the range of control. But the phenomenon of flow separation is appeared. There is a room to improve.
