체외순환에서 박동성 및 비박동성 혈류가 적혈구 응집과 혈관 내피세포 활성화에 미치는 영향
The Effect of Pulsatile versus Nonpulsatile Blood Flow on Red Blood Cell Aggregation and Endothelial Cell Activation in Extracorporeal Circulation
- 주제(키워드) pulsatile , nonpulsatile , extracoporeal circulation , endothelial cell activation , RBC aggregation
- 발행기관 고려대학교 대학원
- 지도교수 선경
- 발행년도 2009
- 제출일 2009-01-02
- 학위수여년월 2009. 2
- 학위명 박사
- 학과 일반대학원 의학과
- 세부전공 흉부외과학 전공
- 원문페이지 43 p
- 실제URI http://www.dcollection.net/handler/korea/000000007173
- 본문언어 한국어
- 제출원본 000045530816
초록/요약
Background: The extracorporeal circulation(ECC) could induce alterations of blood rheology such as increased blood viscosity and RBC aggregation and decreased RBC deformability. The blood shear stress at the venular wall during ECC can change due to RBC aggregation, plasma viscosity and non-physiologic flow conditions. These hemodynamic alterations could represent mechanical triggers of endothelial cell activation. Endothelial activation can lead to activation of the inflammatory system associated with increased post-operative morbidity and prolonged hospital stay. This study has been designed to demonstrate the hypothesis that nonpulsatile flow could change the blood rheology and activate the endothelial cell more than pulsaltile flow under ECC. Methods: Twelve mongrel dogs, weighing 20-30 ㎏, were randomly assigned to two groups: N group of nonpulsatile centrifugal pump (Biopump, n=6) and P group of pulsatile pump (T-PLS, n=6). After median sternotomy, a ECC circuit was constructed from the right atrium to the aorta. ECC was started with an pump flow rate, 80 ㎖/㎏/min and cardiac fibrillation was induced. All blood sampling were done at basal (before ECC start), 1, 2 and 3 hrs after ECC. Viscoelasticity and aggregation index could change depending on hematochrit, plasma, and character of RBC. To eliminate bias induced by hematochrit and plasma, all blood sampling were adjusted to a hematocrit of 45%, using plasma of the baseline with RBC of each time. Viscosity of plasma was measured. CD 146 as maker of endothelial cell activation was measured using ELISA. Hematochrit, ABGA, central venous O₂ saturation, and lactate were also measured. Results: Viscoelasticity, viscosity of plasma, and aggregation index were not different significantly between groups. Viscosity of two groups decreased abruptly 1 hr after ECC but elasticity of two group did not change as time goes by. Hematochrit of two groups decreased abruptly 1 hr after ECC due to using priming solution. Aggregation index was associated with hematochrit, lactate, and central venous O₂ saturation. For both group, echinocyte increased after ECC start. CD 146 was not different significantly between groups. Conclusion: After ECC, elasticity was not change but viscosity and aggregation decreased significantly, regardless of group. Hypoxia induced by hemodilution might impact on the decreased aggregation more significantly than pulsatility of pump flow.
more목차
Ⅰ. 서론 = 1
Ⅱ. 연구재료와 실험방법 = 3
1. 실험디자인 및 모델 = 3
2. 실험동물 및 실험군 = 3
3. 실험동물 관리 = 3
4. 마취 방법 = 4
5. 실험 방법 = 4
6. 관찰지표 측정 = 5
7. 통계 처리 = 7
Ⅲ. 결과 = 8
1. 기초 지표 = 8
2. 혈역학 지표 = 8
3. 혈액의 점탄성(Viscoelasticity) = 8
4. 혈액 검사 및 적혈구 응집력 = 9
5. 혈관 내피 세포 활성화 지표(CD 146) = 10
6. 적혈구 모양 = 10
Ⅳ. 고찰 = 11
Ⅴ. 결론 = 18
Ⅵ. 참고문헌 = 19
표 및 그림 = 28
