高容量血液稀释复合回收对红细胞形态与力学性能的影响

目的利用原子力显微镜（AFM），观察对患者行急性高容量血液稀释（acute hypervolemic hemodilution, AHH）复合自体血
液回收（intraoperative blood salvage, IOBS）后红细胞超微结构和机械力学性能的变化，探讨AHH复合IOBS对红细胞形态和力
学的影响。方法择期全麻下拟行骨科手术患者20例，入室后对患者行急性高容量血液稀释，术中使用血液回收机行自体血回
收，分别于入室后（T1）、急性高容量血液稀释后（T2）取外周静脉血2 mL，在自体血液回收后（T3）取回收血2 mL，使用荧光显微
镜观察并计算红细胞畸形率；利用原子力显微镜，观察红细胞的纳米形态结构和机械力学性能的变化。结果患者在T1、T2和
T3的红细胞畸形率分别为（2.6±1.3）%、（19.3±1.6）%、（17.6±1.4）%。在T1 的红细胞畸形率显著低于T2和T3（P<0.05），而T2和
T3两个时点的红细胞畸形率并无显著差异。经过AHH后静脉血红细胞AFM形貌虽然仍为双凹圆盘状，但较T1 时点呈肿胀改
变，直径增大；中心凹陷处明显变浅，部分出现重叠和褶皱。血液回收后红细胞AFM形貌则较为接近术前状态，但红细胞膜表
面和中心位置均较为粗糙，有不规则隆起，并有不规则附着物杂乱分布。T1、T2、T3 时点红细胞的压痕深度和膜形变恢复力相
互比较无显著差异，T3时点红细胞黏附吸引力和调理线程明显高于T1、T2两个时点（P<0.05）。结论AHH复合IOBS可增加红
细胞的畸形率，改变红细胞的AFM形貌结构和黏附特性。

Effects of acute hypervolemic hemodilution and intraoperative blood salvage on erythrocyte morphology and biomechanics

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) and intraoperative blood salvage
(IOBS) on the morphology and biomechanics of erythrocytes using atomic force microscopy (AFM). Methods Blood samples
were collected from 20 patients undergoing orthopedic surgery before operation (T1), immediately after AHH (T2), and after
blood salvage (T3). AFM at nanometer resolution was used to examine the morphology and biomechanics of the collected
erythrocytes. Results The blood samples collected at T1 showed a significantly lower ratio of heteromorphous erythrocytes
than those collected at T2 and T3 [(2.6±1.3)% vs (19.3±1.6)% and (17.6±1.4)%, P<0.05]. AFM revealed significant differences in
the morphology and biomechanics of the single erythrocyte in salvaged blood and blood after AHH compared with those of
venous blood. Conclusion AHH and IOBS may cause significant changes in the morphology and biomechanics of erythrocytes
in the salvaged blood．