肝周下腔静脉流体力学分析  

Hemodynamic analysis of the juxtahepatic inferior vena cava

作　　者：王铁功[1] 刘汝海[1] 李凤山[1] 于淑靖[1] 张执全[1] 杨冬山[1] 孙蓉蓉[1] 董家鸿[2] 

机构地区：[1]沧州市中心医院肝胆外科 ,061001 [2] 解放军总医院肝胆外科

出　　处：《中华肝胆外科杂志》2014年第7期481-485,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 建立肝周下腔静脉模型,分析其血流量以及血流类型.探讨保证肝后下腔静脉血流通畅的最小管径.方法 首先收集120例患者临床及CT数据,并建立肝周下腔静脉数字模型.然后根据上述数据,建立肝后下腔静脉体外流体力学实验平台.以猪血作为研究流体,水流作为对照,在不同流体条件下测量肝后下腔静脉两端压强差并观察血流状态,同时根据上述数据,使用ANSYS 13.0软件模拟肝周下腔静脉血流类型.结果 肝周下腔静脉是一个中间略微突出的柱形立体结构.在大管径、低流量时,血流在肝后下腔静脉两端产生的压强差高于水流;而在小口径、高流量时血流所产生的压强差低于水流.若要将两端压强差控制在5 cmH2O（500 kPa）,当肝后下腔静脉内流量为3 000 ml/min时,其最小管径为10 mm;流量为5000 ml/min时,最小管径需要达到12 mm.多数情况下肝后下腔静脉内血流为层流,少数为过渡流,未发生湍流.而水流多见湍流,部分为过渡流,少见层流.结论 为保证肝后下腔静脉血流通畅,应维持有效的心脏负荷,肝后下腔静脉最小管径为10 mm.对于肝及肝后下腔静脉损伤患者,在全肝血流阻断的情况下,维持肝后下腔静脉血流,且管腔愈接近生理状态,对患者循环影响愈小.Objective To establish a digital model of the juxtahepatic inferior vena cava （IVC） by analyzing the blood flow and the flow type,and to determine the minimal diameter of the retrohepatic IVC which maintained a normal blood flow through the retrohepatic inferior vena cava.Methods Firstly,120 patients＇ data,including CT images,were collected to establish a digital model of the juxtahepatic IVC.Secondly,an in vitro model of the juxtahepatic IVC was built,using pig＇s blood to determine the pressure differences on the two ends.Water was then used as control.Finally,ANSYS13.0 was used to simulate the blood flow through the juxtahepatic IVC.Results As the juxtahepatic IVC was a 3-dimensional cylinder,the pressure difference at the 2 ends of the juxtahepatic IVC was higher for blood than water when the diameter was bigger,and the flow was low.On the contrary,the pressure difference for blood was lower than water when the diameter was small and the flow was high.When the blood flow in the juxtabepatic IVC was 3 000 ml/min,the minimal diameter of the retrohepatic IVC was 10 mm to maintain a pressure difference of less than 5 cmH2O （500 kPa）.When the blood flow was 5 000 ml/min,the diameter required 12 mm.In most cases the blood flow in the retrohepatic IVC was laminar,but transitional flow was observed in some cases.However,no turbulence was observed in the blood flow.On the other hand,much more turbulence or transitional flow was observed for water flow.Conclusions To maintain a normal blood flow in the juxtahepatic IVC,and an effective preload was required.The minimal diameter of the retrohepatic IVC was found to be 10 mm.The bigger the diameter,the safer it would be for patients with liver and retrohepatic vena cava injury.

关 键 词：肝周下腔静脉 肝后下腔静脉 流体力学分析 数字模型 

分 类 号：R657.3[医药卫生—外科学]