体外循环30 min 对红细胞膜的表面结构及力学特性的影响

摘要

目的：应用原子力显微镜（AFM）观察和分析体外循环（又称心肺分流术，CPB）30 min对红细胞膜表面的超微结构和生物力学性能的影响。方法：择期行体外循环心脏手术患者10例，分别取手术前和体外循环转机30 min的中心静脉血各2 mL，分为对照（ CON）组和CPB组，肝素抗凝。正立荧光显微镜观察计数2组非圆红细胞；AFM观察红细胞膜表面超微结构并进行力曲线测定。结果：与CON组比较，CPB组非圆红细胞比例差异无统计学意义；与CON组比较，CPB组细胞膜表面隆起呈紊乱排列，凹凸性增强，均匀度下降，膜表面颗粒分布有差异（P＜0．05），平均粗糙度（Ra）和均方根粗糙度（Rq）增大（P＜0．05），细胞膜黏附力升高（P＜0．05），但膜形变恢复力和力曲线斜率差异无统计学意义。结论：体外循环转机30 min可以引起红细胞膜的表面形貌和超微结构改变，黏附性增大。%AIM:To observe and analyze the effect of cardiopulmonary bypass ( CPB) for 30 min on surface ultra-structure and mechanical properties of the erythrocyte membrane by atomic force microscopy (AFM).METHODS:Ten cases of elective patients in cardiac surgery were selected in the study and divided into control ( CON) group and CPB group.The central venous blood (2 mL) before surgery and 30 min after CPB was collected with heparin anticoagulation . The non-circular red blood cells were counted under a stand fluorescence microscope .AFM was used to examine the ultra-structure of the membrane surface and measure the force curve of the erythrocytes .RESULTS:The percentage of non-cir-cular red blood cells in CPB group showed no statistically significant differences as compared with CON group .AFM images showed that the significant differences of membrane surface concave and convex , evenness , particle distribution , the sur-face average roughness (Ra), the surface root mean square roughness (Rq) and cell membrane adhesion between CPB group and CON group were observed .However, the membrane deformation resilience and curve slope had no significant difference between the 2 groups.CONCLUSION:Cardiopulmonary bypass for 30 min changes the morphology and ultra-structure of the erythrocyte membrane surface , and increases the adhesion between cells .