改良B-T手术与中央分流术的血流动力学比较  

Hemodynamics-based numerical comparison between modified B-T shunt and central shunt

作　　者：丁金立[1] 刘有军[1] 王枫[1] 任晓辰[1] 乔爱科[1] 

机构地区：[1]北京工业大学生命科学与生物工程学院,北京100124

出　　处：《医用生物力学》2013年第1期63-71,共9页Journal of Medical Biomechanics

基　　金：国家自然科学基金资助项目(11172016;10872013);北京市自然科学基金项目(3092005)

摘　　要：目的对比分析改良B-T手术(modified B-T shunt,MBTS)和中央分流术(central shunt,CS)两种手术方式的血流动力学特征。方法采集法洛氏四联症(tetralogy of fallot,TOF)病人的医学图像,三维重建真实的解剖模型;对模型进行虚拟血管搭桥等操作,模拟手术过程;采集病人的生理数据,建立集中参数模型(lumped parameter mod-el,LPM);通过LPM计算提供计算流体力学仿真模型的边界条件;利用ANSYS软件对模型的血流动力学进行数值模拟。结果无论是快速射血期还是舒张期,MBTS和CS模型中搭桥管内的血液始终流向肺循环,但是两个模型中的血液最高流速明显不同。CS模型中分流管两端的压差相比MBTS模型较大。MBTS模型中分流管的壁面切应力分布不均匀,在0.025～340 Pa。而CS模型中分流管上的壁面切应力分布相对较均匀,约在32.2～72.6 Pa。结论两种手术方式都提供了足够的肺动脉血流量;MBTS方式对右上肢的血液供应有较大影响;CS方式分流率偏高;两个模型前端吻合口部位压力梯度很大,应引起临床重视。本研究为临床治疗TOF的手术术式决策提供了重要的理论依据。Objective Modified BT shunt （MBTS） and central shunt （CS） are two common surgical procedures for the treatment of tetralogy of fallot （TOF）. The purpose is to analyze and compare the hemodynamic features of MBTS and CS. Methods 3D anatomy was reconstructed by medical images obtained from a patient with TOF, and two computational models were generated through virtual operations. A lumped parameter model was constructed to predict the postoperational boundary conditions. Computational fluid dynamics （CFD） was per formed for the two models. Results A persistent pulmonary blood perfusion was observed in each model both during the systolic phase and diastolic phase, but the maximum velocities in the shunt were different for the two models. The pressure drop of the shunt in CS model was higher than that in MBTS model. The wall shear stress of the shunt in the MBTS model ranged unevenly from 0. 025 to 340 Pa, while the wall shear stress in CS model ranged relatively evenly from 32.2 to 72.6 Pa. Conclusions Pulmonary artery blood was increased effectively for both options. The blood perfusion of right upper extremity was decreased in the MBTS model. More blood was di rected into the pulmonary artery in CS model. Attention should be paid to the fact that the pressure gradient was large at the proximal anastomosis in both models in clinic. This study provides important theoretical references for surgeons to make choice from the surgery options in the treatment with TOF.

关 键 词：法洛氏四联症 血流动力学 计算流体动力学 集中参数模型 

分 类 号：R318.01[医药卫生—生物医学工程]