左前降支冠状动脉瘤搭桥手术血流动力学研究  

Study on hemodynamics of bypass grafts with or without ligation of left anterior descending artery aneurysm

作　　者：王浩然 张慧霞[1] 王文馨 赵夕[1] 毛伯龑 刘有军[1] WANG Haoran;ZHANG Huixia;WANG Wenxin;ZHAO Xi;MAO Boyan;LOU Youjun(School of Life Science and Bioengineering,Beijing University of Technology,Beijing 100124)

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：《北京生物医学工程》2018年第5期448-454,466,共8页Beijing Biomedical Engineering

基　　金：国家自然科学基金(11172016;11472022)资助

摘　　要：目的采用计算流体力学方法,研究大隐静脉(saphenous vein graft,SVG)与左乳内动脉(left internal mammary artery,LIMA)分别作为移植管搭桥手术旷置与结扎冠脉瘤(coronary artery aneurysm,CAA)时移植管的血流动力学,并以此为根据探讨冠脉瘤搭桥手术移植管的选择与冠脉瘤的结扎与否,为临床手术提供可靠帮助。方法首先分别构建SVG和LIMA搭桥旷置冠脉瘤手术模型、SVG和LIMA搭桥结扎冠脉瘤手术三维模型(three-dimensional model,3D Model) 4个模型。然后在建立集中参数模型(lumped parameter model,LPM,zero-dimensional,0D)的基础上,采用几何多尺度方法,将0D集中参数模型与3D冠脉模型耦合计算。研究SVG和LIMA为移植管时流量、壁面切应力(wall shear stress,WSS)、振荡剪切指数(oscillatory shear index,OSI)血流动力学参数。结果不同手术术式左前降支总流量基本相同,约为82 m L/min。OSI:模型1为0. 014 044、模型2为0. 283 494、模型3为0. 0130 35、模型4为0. 023 263。一个周期内平均WSS:模型1为0. 474 5 Pa、模型2为0. 8600 Pa、模型3为0. 442 4Pa、模型4为1. 699 Pa。结论当采用SVG桥时,冠脉瘤旷置与结扎两种方式都有较好的手术效果;当采用LIMA桥时,结扎冠脉瘤有较好的手术效果。旷置冠脉瘤移植管会因高OSI与竞争流较高、桥流量不足导致较不利的血流动力学环境,从而影响手术预期效果。Objective Saphenous vein graft（SVG） and left internal mammary artery （LIMA） are used to bypass with or without ligation of the coronary artery aneurysm（CAA）. Hemodynamics of bypass grafts are calculated by using the computational fluid dynamics （CFD） method. Hemodynamics can provide reliable help for clinical surgery about hemodynamic basis. Methods The 3D models were established. SVG and LIMA werechosen as bypass grafts with or without ligation of CAA, respectively. Lumped parameter model （LPM, zero.dimensional, 0D） of cardiovascular system was established. 3D models were coupled with 0D model tocalculate the hemodynamics of bypass grafts. Hemodynamics parameters included wall shear stress （WSS）,oscillatory shear index（OSI） and mass flow rate. Results The total mass flow of LAD was about 82 mL / min.OSI on graft of model 1 was 0. 014044. OSI on graft of model 2 was 0. 283494. OSI on graft of model 3 was 0. 013035. OSI on graft of model 4 was 0. 023 263. Theaverage WSS on the graft of model 1 was 0. 474 5Pa in a cycle. The average WSS on the graft of model 2 was 0. 8600 Pa in a cycle. The average WSS on the graft of model 3 was 0. 4424 Pa in a cycle. The average WSSon the graft of model 4 was 1. 699 Pa in a cycle. Conclusions Hemodynamics of the SVG were good with or without ligation of CAA. When selecting the surgical procedure with SVG, with or without ligation of CAA bothmay provide better surgical outcomes. Hemodynamics of the LIMA were good with ligation of CAA. However,hemodynamics of the LIMA was not good without ligation of CAA. The OSI was high and graft flow was low.The competitive flow was high. These abnormal hemodynamic parameters could cause bypass grafts becoming invalid. When selecting the surgical procedure with LIMA, research suggests that ligation of CAA may provide better surgical outcomes.

关 键 词：冠状动脉瘤 冠状动脉搭桥术 血流动力学 计算流体力学 几何多尺度方法 

分 类 号：R318.01[医药卫生—生物医学工程]