96例高血压病患者血液流变学改变与微循环变化观察

目的研究96例高血病患者血液流变学改变与微循环变化,旨在探讨二者关系。方法血液流变学检测6项血液流变学指标;微循环观察采用徐州医用光学议器厂生产的WX-753型微循环显微镜,观察微循环8项指标。结果血液流变学改变为红细胞压积、全血比粘度、血浆比粘度、红细胞电泳时间、血沉、纤维蛋白原与对照组比较均有显著性差别(P<0.001);微循环改变为管袢长度变长、数目减少,管袢轮廓模糊率,异常形态率增高,血液流速减慢,袢顶瘀血程度、红细胞聚集程度加重,管袢排列紊乱,经t测验,X2检验均有显著性差别(P<0.01-0.001)。结论甲襞微循环与血液流变学指标在高血压病患者中均有改变,且二者相互影响,互为因果,通过测定二者指标变化,对临床指导用药,疗效观察有重要意义。     

Rheopheresis: rheologic, functional, and structural aspects.

Rheopheresis is a specific application of membrane differential filtration, synonymous with double filtration plasmapheresis for extracorporeal hemorheotherapy, eliminating an exactly defined spectrum of high molecular weight proteins from human plasma (e.g.: fibrinogen, alpha-2-macroglobulin, low-density lipoprotein cholesterol, IgM). This results in the improvement of blood flow and microcirculation initiated by lowering blood and plasma viscosity, and erythrocyte aggregation. In this context, microcirculation stands not only for the patency of small blood vessels, but for the complete interactive network between plasma, blood cells, the vessel wall, and cellular and extracellular compartments of the surrounding tissue. Insufficient tissue oxygenation leads to tissue damage, e.g., a microcirculatory disorder develops, creating acute as well as chronic symptoms. Therefore, impaired microcirculation has a rheologic, functional, and structural dimension with respect to involved organs or tissues. Rheopheresis represents a specific therapeutic approach with an acute rheologic as well as chronic functional and structural effects, which was confirmed in pilot and controlled clinical studies for several organ systems. Data from 2 controlled clinical trials are available for the safe and effective treatment in patients with age-related macular degeneration.     

夏至草生物碱对大鼠实验性弥散性血管内凝血转归时血流动力学的调节

目的:从微循环、器官血流量和血液流变学角度,探讨夏至草生物碱对弥散性血管内凝血(DIC)的治疗作用.方法:通过静脉注射高分子右旋糖酐Dextran 500复制34只DIC大鼠模型,采用肠系膜微循环、器官微区血流量和血液流变学测定方法,观察夏至草生物碱对DIC转归时微血管口径、器官微区血流量、血黏度及血小板功能的干预作用.结果:大鼠静脉注射Dextran 500后,出现了明显的微循环障碍,表现为微血管收缩、微血流变慢、微血栓形成,且血液流变性异常,表现为血黏度增高、血小板聚集性增强.夏至草生物碱治疗后微血管明显扩张,其流态和微血栓积分值均明显低于生理盐水(NS)对照组(P均<0.05),并能改善胃、肠、肝的微区血流量,效果优于NS对照组(P<0.05),全血黏度、相对黏度、血小板黏附率和聚集率也均明显低于NS对照组,红细胞变形能力则明显增强(P均<0.05).结论:夏至草生物碱通过扩张微血管、增加器官血流量、降低血黏度和抑制血小板聚集,对DIC具有较好的治疗作用.     

复方丹参液对银屑病血液流变特性影响

银屑病患者存在有微循环障碍及全血粘度增高等血液流变特性的改变。活血化瘀中药治疗银屑病是一种可靠而行之有效的方法。我们选用复方丹参注射液治疗银屑病患者116例荻得较满意的疗效，并测定其治疗前后血液流变出标进行对照，发现随病情的缓解，血液流变学指标有明显改善的趋势，二者是平行关系。     

无症状性心肌缺血与微循环-血液流变学

目的 通过67例无症状性心肌缺血(SMI)的血液流变学及微循环变化,探索SMI发病的病理生理,以及SMI治疗及预防的原则。方法 将经过24h Holter监测而诊断为SMI的患者,进行血液流变学及甲襞微循环检测,并将结果与同期收治的不稳定型心绞痛(UAP)46例作对比。结果 SMI的血流变呈高粘、高聚、高凝状态,微血管管径变窄,流速变慢,各项指标均明显高于正常人(P<0.01)。而与UAP对比,差异无明显性(P>0.05)。结论 血液的高粘滞状态,导致微循环障碍,是SMI发生的主要病理生理。改善血液粘滞性,活跃微循环,将提高SMI的治疗效果。定期监测,并及早处理血液粘稠性,有助于预防SMI的发生。     

Sauna effects on hemorheology and other variables

Acute sauna induces decreased blood fluidity as quantified by measurements of blood and plasma viscosity, hematocrit, red cell filterability, and aggregation. The effect is far less prominent when sauna treatment is continued regularly for eight weeks. In this case there are only minor changes in native blood viscosity and hematocrit together with slight variations in hematologic measurements, calcium, and serum protein pattern. Thus, from the hemorheology point of view, sauna leads to adverse effects predominantly acutely, while long-term effects seem negligible. Such aspects are worth considering in patients with high cardiovascular risks, and marked hypoperfusion.     

Blood viscosity and circulatory shock

Conclusions Rheological features of the whole blood and blood components are of potential importance for microcirculatory blood flow in circulatory shock. The relative contribution of vascular geometric and rheological factors to the resistance to blood flow in the various shock states in man, however, are hard to elucidate [73]. Blood viscosity is mainly determined by haematocrit. In low flow states RBC aggregation in the venules might sustain the arrest of flow and hamper reflow. Lowering haematocrit may be beneficial in improving microcirculatory flow in hypovolaemic conditions as haemorrhagic shock. A decrease in RBC deformability is seen in critically ill, septic patients and this may reduce capillary flow. The WBC is likely to contribute to the maldistribution of microcirculatory flow in both hypovolaemic and septic shock and might even block capillary flow. The exact contribution of changes in haematocrit, RBC aggregation, RBC deformability, WBC deformability and plasma viscosity on blood viscosity and thus (micro)circulatory flow in human shock states, especially in septic shock, remains to be elucidated.     

Plasmapheresis for hyperviscosity syndrome in macroglobulinemia Waldenstr?m and multiple myeloma: influence on blood rheology and the microcirculation.

The efficacy of plasmapheresis in improving blood flow properties in patients with hyperviscosity syndrome was studied during 22 plasmapheresis treatments in four patients with hyperviscosity syndrome (three with macroglobulinemia Waldenstr?m, one with multiple myeloma). Immediately before and after plasmapheresis (exchange volume 3 liters) the following parameters were determined: standard hematologic parameters, serum proteins, plasma viscosity, whole blood viscosity, and blood flow velocity in finger nailfold capillaries by video microscopy. The hematocrit remained unchanged. Paraprotein concentrations were markedly reduced by plasmapheresis (average 35%). Plasma viscosity fell from 5.0 +/- 3.3 cp to 2.1 +/- 1.0 cp (p less than 0.0001, normal range 1.1 to 1.4 cp). Whole blood viscosity changed accordingly. The plasma viscosity before plasmapheresis (x) determined the drop in viscosity after plasmapheresis, according to the following regression: y = 0.97 - 0.77 x; r = 0.962, p less than 0.001. The spontaneous capillary blood cell flow velocity increased from 0.33 +/- 0.14 mm/sec to 0.55 +/- 0.21 mm/sec (p less than 0.01) and the change in spontaneous flow velocity (y) was correlated with the change in plasma viscosity (x): y = 0.02 - 0.05 x; r = 0.833, n = 7, p less than 0.05. We conclude that plasma viscosity is a major determinant of capillary blood flow and that plasmapheresis is an efficient treatment of abnormal microcirculation caused by increased plasma viscosity. Our data make it possible to predict the benefit of plasmapheresis in a given situation and contribute to a better use of this valuable method.     

中西医结合血液稀释治疗冠心病的临床研究

本研究采用中西医结合稀释液和自体血浆回输进行等容血液稀释治疗冠心病，并与对照组（消心痛）进行随机对照临床研究。结果表明：中西医结合血液稀释组总有效率８７．２３％，显效率达４４．６８％，对心电图缺血性ＳＴ—Ｔ改变改善率达７７．２％，疗效明显优于对照组。     

无症状性心肌缺血与微循环血流变关系初探

本文观察冠心病（ＣＡＤ）无症状性心肌缺血（ＳＭＩ）１６０例血液流变性的主要改变为血液粘滞性增高、血液聚集性增高、血液凝固性增高等；微循环的主要改变为微血管中血流缓慢、红细胞聚集、管袢数减少、管袢畸形等。与同朗急性梗塞４８例比较有类似血液变－微循环改变。提出血液流变性改变对触发和恶化某些可导致心肌梗塞（ＡＭＩ）的血液动力学过程起重要作用，改善血液流变性、微循环是 ＣＡＤ治疗的一个重要方面。有关微循环－血液流变学指标的普查和监测，对 ＣＡＤ预测，治疗监测以及预防心肌梗塞，瘁死有重要意义。     

Status of capillary blood flow in the lungs in various outcomes of acute pneumonia

The method of perfusion scanning of the lungs with albumin microaggregate 131I was used for studying the state of pulmonary blood flow in patients with acute pneumonia (AP). The outcome of the disease was chronic non-specific lung disease (CNLD). The results of study demonstrated the improvement of microcirculation by the time of discharge from a hospital, but in 54.2 per cent of the patients blood flow was reduced. It was proved that reduced blood flow, by the time of discharge, together with impaired external respiration function, X-ray changes and biochemical blood shifts are the unfavourable factors with respect to prognosis which contribute to the transition of AP into CNLD. Combined therapy of AP should include measures directed to the improvement of pulmonary microcirculation.     

Abnormal rheology of oxygenated blood in sickle cell anemia

The viscosity of oxygenated blood from patients with sickle cell anemia (Hb SS disease) was found to be abnormally increased, a property which contrasts with the well recognized viscous aberration produced by deoxygenation of Hb SS blood. Experiments designed to explain this finding led to considerations of deformation and aggregation, primary determinants of the rheologic behavior of erythrocytes as they traverse the microcirculation. Deformability of erythrocytes is in turn dependent upon internal viscosity (i.e. the state and concentration of hemoglobin in solution) and membrane flexibility. Definition of the contribution made by each of these properties to the abnormal viscosity of oxygenated Hb SS blood was made possible by analysis of viscosity measurements, made over a wide range of shear rates and cell concentrations, on Hb SS erythrocytes and normal erythrocytes suspended in Ringer's solution (where aggregation does not occur) and in plasma. Similar measurements were made on the two cell types separated by ultracentrifugation of Hb SS erythrocytes: high density erythrocytes composed of 50 to 70% irreversibly "sickled" cells (ISC) and low density erythrocytes composed of over 95% non-ISC.Under all experimental conditions (hematocrit, shear rate, and suspending medium) the viscosity of ISC exceeds that of normal erythrocytes. The viscosity of non-ISC is elevated only in the absence of aggregation and over intermediate ranges of hematocrit. Analyses of the data reveal (a) an elevated internal viscosity of ISC: (b) a reduced membrane flexibility of both ISC and non-ISC, particularly at low shear rates; and (c) a reduced tendency for aggregation displayed by both cell types.The abnormal viscosity of oxygenated Hb SS blood can be attributed to the altered rheology of ISC and, to a lesser extent, of non-ISC. These studies assign a role to the abnormal rheology of Hb SS erythrocytes in the pathogenesis of sickle cell anemia, even under conditions of complete oxygenation.     

Low‐shear red blood cell oxygen transport effectiveness is adversely affected by transfusion and further worsened by deoxygenation in sickle cell disease patients on chronic transfusion therapy

BACKGROUND: Simple chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia, but its effects on hemodynamics are poorly characterized. Transfusion improves oxygen‐carrying capacity, reducing demands for high cardiac output. While transfusion decreases factors associated with vasoocclusion, including percent hemoglobin (Hb)S, reticulocyte count, and circulating cell‐free Hb, it increases blood viscosity, which reduces microvascular flow. The hematocrit‐to‐viscosity ratio (HVR) is an index of red blood cell oxygen transport effectiveness that varies with shear stress and balances the benefits of improved oxygen capacity to viscosity‐mediated impairment of microvascular flow. We hypothesized that transfusion would improve HVR at high shear despite increased blood viscosity, but would decrease HVR at low shear. STUDY DESIGN AND METHODS: To test this hypothesis, we examined oxygenated and deoxygenated blood samples from 15 sickle cell patients on CTT immediately before transfusion and again 12 to 120 hours after transfusion. RESULTS: Comparable changes in Hb, hematocrit (Hct), reticulocyte count, and HbS with transfusion were observed in all subjects. Viscosity, Hct, and high‐shear HVR increased with transfusion while low‐shear HVR decreased significantly. CONCLUSION: Decreased low‐shear HVR suggests impaired oxygen transport to low‐flow regions and may explain why some complications of sickle cell anemia are ameliorated by CTT and others may be made worse.     

无症状性心肌缺血与微循环-血液变关系初探

本文观察冠心病（CAD）无症状性心肌缺血（SMI）160例血液流变性的主要改 变为血液粘滞性增高、血液聚集性增高、血液凝固性增高等；微循环的主要改变为微血管中血 流缓馒、红细胞聚集、管 数减少、管 畸形等。与同期急性梗塞48例比较有类似血液变－微 循环改变。提出血液流变性改变对触发和恶化某些可导致心肌梗塞（AMI）的血液动力学过程 起重要作用，改善血液流变性、微循环是CAD治疗的一个重要方面。有关微循环－血液流变 学指标的普查和监测，对ＣＡＤ预测，治疗监测以及预防心肌梗塞，瘁死有重要意义。     

Estimation of aortic and pulmonary blood flow in a paediatric population using Doppler ultrasound: an in-vitro study

The noninvasive measurement of blood flow using ultrasound has been attempted by numerous workers. In order to evaluate the technique of duplex scanning applied to the problem of noninvasive assessment of aortic and pulmonary blood flow in a paediatric population with ventricular septal defect, we attempted an in-vitro simulation of these flow conditions. The factors which have been considered in the design of the apparatus include the availability of a range of tube diameters, an aortic-"like" waveform, laminar flow, variable downstream peripheral resistance, a compliance factor and viscosity of the flow medium. The ultrasound probe beam characteristics, sample volume size and shape were also determined. From the results of the beam plots it was apparent that the region of sensitivity of the CW Doppler probes were inappropriate for the measurement of blood flow in neonates. In order to simulate physiological parameters in a paediatric population as closely as possible, five tubes of diameters ranging from 9-18 mm were used, in each tube a range of flow values from 0.8 L min-1 to 5 L min-1 were measured. The flow values were measured by both "bucket and stopwatch" and duplex scanner for both steady and pulsatile flow conditions. The results are presented as correlations between the direct and noninvasive pulsed Doppler assessment of flow measurement and are in the range 0.92-0.99 significant at p less than .001. A discussion of the reliability of flow measurements made using a conventional duplex scanner is given.     

Lipid-apheresis improves microcirculation of the upper limbs

Lipid-apheresis (LA) is thought to improve microcirculation. However, limited data are available on the effects on peripheral microcirculation. We investigated upper limb microcirculation of 22 patients undergoing regular LA on a weekly basis before and after LA. Using standardized semiquantitative scales, we analyzed blood flow, vasomotor function, and erythrocyte aggregation by capillary microscopy. In addition, capillary blood flow in quiescence and under heat and cryo-stress was evaluated by photoplethysmographic and laser Doppler anemometry. Moreover, levels of vasoactive mediators adrenalin, noradrenalin, endothelin-1 (ET-1), atrial natriuretic peptide (ANP), asymmetrical dimethyl-arginine (ADMA), as well as total protein and fibrinogen were measured. We found a significant increase in blood flow, the number of perfused capillaries and an improvement of erythrocyte aggregation by capillary microscopy. Using laser Doppler anemometry, we were able to show that this increase was predominantly located in the superficial layer capillaries (Δ44.53 ± 135.81%, n.s.) and less so in deeper layer arterioles (Δ2.75 ± 24.84%, n.s.). Vascular response to heat and cryo stress was also improved after LA but failed to reach significance. LA significantly reduced levels of epinephrin (-33 ± 39.2%), ANP (-28.8 ± 20.2%), ADMA (-74.1 ± 23%), and fibrinogen (-45.4 ± 19.7%) when comparing before LA and after LA values. In summary, we found an improvement in the microcirculation of the upper limbs under LA, which may result from a decrease of vasoconstrictors, improvement of vasomotor function, and a decrease in blood viscosity or erythrocyte aggregation.     

Neuronal survival and revival during and after cerebral ischemia

Factors influencing survival of neurons during ischemia and neuronal revival after ischemia are reviewed. During ischemia, biochemical and electro-physiological changes depend on residual blood flow rate: below 30 to 40 ml/100 g/min EEG amplitude decreases, below 18 ml/100 g/min spontaneous neuronal activity ceases, and below 10 ml/100 g/min cell membranes depolarize. Attempts to improve blood flow after middle cerebral artery occlusion with vasoactive drugs were not successful but there was an indication that the calcium antagonist nimodipine reduced ischemia-induced disturbances of ion homeostasis. Revival after ischemia depends mainly on post-ischemic hemodynamic factors, such as the no-reflow phenomenon or delayed post-ischemic hypoperfusion. No-reflow was successfully treated by induced hypertension, anticoagulation, and osmotherapy. Delayed post-ischemic hypoperfusion and the associated metabolic disturbances could not be ameliorated by either vasoactive drugs including prostacyclin, nor by metabolic inhibition with barbiturates and hypothermia. The disturbance of metabolic regulation of blood flow during post-ischemic hypoperfusion, therefore, remains one of the main problems of post-ischemic resuscitation.     

Microcirculation, hemostasis, and hemorheology in influenza and acute respiratory viral infections in patients with hypertension]

AIM: To study microcirculation (MC), hemostasis (HS) and blood viscosity (BV) in influenza and acute respiratory viral infection (ARVI) in hypertensive patients. MATERIAL AND METHODS: The study group consisted of 67 hypertensive patients with influenza or ARVI. 45 influenza and ARVI normotensive subjects served control. HS and BV tests were made, conjunctival biomicroscopy was performed. RESULTS: Patients with influenza and ARVI in the acute period had distinct perivascular and vascular abnormalities, sludge phenomenon in the majority of postcapillary venules and capillaries. In convalescence microcirculation improved. HS in the acute stage of infections was characterized by fast coagulation, depression of fibrinolysis; in convalescence, a significantly enhanced platelet aggregation was seen. The highest BV occurred at low shift speeds. Hypertensive patients had higher vascular permeability and more severe intravascular changes which presented with disseminated intravascular red cell aggregation, slowing down of blood flow, its partial block. In hypertension there was also significantly higher platelet aggregation, lower disaggregation, higher BV increase in convalescence. CONCLUSION: Hypertensive patients with influenza or ARVI had serious disorders of microcirculation, HS and BV threatening cardiovascular complications in such patients.     

老年高血压中医证候分型的粘附分子表达与血微循环的关系

目的 探讨老年高血压中医证候分型细胞间黏附分子（ICAM-1）、单核细胞趋化因子-1（MCP-1）表达水平和全血粘度与血微循环相关性。方法对156例老年高血压患者进行中医证候分型，采用双抗体夹心KIISA法检测技术测定ICAM-1、MCP-1水平；以全自动血流变仪锥板稳态测量技术检测全血粘度、红细胞变形性，从微循环角度观察血液流变学、ICAM-1表达与中医证候各型关系。结果三组ICAM-1、MCP-1明显高表达（P〈0．01），全血粘度依次为正常对照组〈肝火亢盛组〈痰湿壅盛组〈阴虚阳亢组。红细胞变形指数与正常人比较差异显著（P〈0．05）。结论老年高血压中医不同证候型与血微循环之间存在一定关系，ICAM-1、MCP-1水平高表达、血液流变异常可作为高血压早期血微循环障碍时检测指标。     

Microcirculatory changes over the tender points in fibromyalgia patients after acupuncture therapy (measured with laser-Doppler flowmetry)

Apart from widespread pain which is the main symptom of fibromyalgia, a great variety of functional and vegetative changes occur in the presence of this disease. Such changes include alterations in microcirculation, which may cause pain. A preliminary study demonstrated a reduction in regional blood flow above "tender points" in fibromyalgia patients compared with healthy controls. A consensus statement of the National Institutes of Health (NIH) states that acupuncture is a sufficient adjuvant method to treat patients with fibromyalgia. The aim of the present study was to determine parameters to measure the effectiveness of a specific treatment modality (such as acupuncture) in addition to the patient's subjective assessment of acupuncture treatment. Twenty patients with fibromyalgia according to the ACR and the Müller/Lautenschl?ger criteria were included in the study. Acupuncture was performed and adapted to individual needs in accordance with a specific protocol. Five representative "tender points" were examined before and after therapy by laser flowmetry, and the data were compared with temperature measurement and dolorimetry. Increased blood flow was registered above all "tender points" after acupuncture. Skin temperature had increased in 10/12 tender points by a mean of 0.45 degree C. The number of "tender points" were reduced from 16.1 to 13.8 after therapy. The pain threshold increased in 10/12 "tender points". These data suggest that acupuncture is a useful method to treat patients with fibromyalgia. Besides normalisation of clinical parameters, the improvement in microcirculation above "tender points" may alleviate pain.