缺血性脑卒中的体外反搏血流动力学效应及治疗策略优化  

The Hemodynamic Effects of Enhanced External Counterpulsation and Optimization of Treatment Strategies for Cerebral Ischemic Stroke

作　　者：许可 李鲍 刘有军[1] 张丽媛 杨奔 XU Ke;LI Bao;LIU Youjun;ZHANG Liyuan;YANG Ben(Faculty of Environment and Life,Beijing University of Technology,Beijing 100124,China;Suzhou Inlite Medical Technology Co.,Ltd.,Suzhou 215163,Jiangsu,China)

机构地区：[1]北京工业大学环境与生命学部,北京100124 [2]苏州英莱特医疗科技有限公司,江苏苏州215163

出　　处：《医用生物力学》2024年第1期32-39,共8页Journal of Medical Biomechanics

基　　金：国家重点研发计划项目(2020YFC2004400);国家自然科学基金项目(12202022,11832003,3221361);中国博士后科学基金项目(2022M710281);北京市博士后工作经费(2022-ZZ-035)。

摘　　要：目的 探究增强型体外反搏(enhanced external counterpulsation,EECP)对于不同狭窄程度脑动脉的血流动力学效应。方法 建立4个不同狭窄程度的0D/3D耦合几何多尺度血流动力学模型,开展不同反搏模式下的EECP数值模拟,定量计算脑动脉各血流动力学指标。其中,处于4~7 Pa范围的狭窄下游TAWSS均值、低TAWSS危险区域百分比、高狭窄支流量被认为可抑制动脉粥样硬化的发展,形成良好的血流动力学环境。结果 对于50%、60%、70%、80%狭窄,在反搏气囊放气时刻分别为心动周期内0.5、0.6、0.7、0.7 s的反搏模式下,血流动力学环境最优。结论 对于50%狭窄脑动脉,应选择放气时刻为0.5 s的反搏模式;对于60%狭窄脑动脉,应选择放气时刻为0.6 s的反搏模式;对于70%、80%狭窄脑动脉,应选择放气时刻为0.7 s的反搏模式。随着脑动脉狭窄程度增加,应当适当延长加压时长。研究结果可为临床上对不同狭窄程度缺血性脑卒中患者EECP治疗方案提供理论参考。Objective To investigate the hemodynamic effects of enhanced external counterpulsation(EECP) on cerebral arteries with different stenoses.Methods Zero-dimensional/three-dimensional multiscale hemodynamic models of cerebral arteries with different stenoses were constructed.Numerical simulations of the EECP hemodynamics were performed under different counterpulsation modes to quantify several hemodynamic indicators of the cerebral arteries.Among them,the mean time-averaged wall shear stress(TAWSS) downstream of the stenosis was in the range of 4-7 Pa,a low percentage of TAWSS risk area,and high narrow branch flow were considered to inhibit the development of atherosclerosis and create a good hemodynamic environment.Results For cerebral arteries with 50%,60%,70%,and 80% stenosis,the hemodynamic environment was optimal in counterpulsation mode when the moment of cuff deflation was 0.5,0.6,0.7,and 0.7 s within the cardiac cycle.Conclusions For 50% stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.5 s should be selected.For 60% stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.6 s should be selected.For 70% or 80% stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.7 s should be selected.As stenosis of the cerebral arteries increases,the pressure duration should be prolonged.This study provides a theoretical reference for the EECP treatment strategy for patients with ischemic stroke with different stenoses.

关 键 词：增强型体外反搏 血流动力学 数值模拟 壁面切应力 缺血性脑卒中 

分 类 号：R318.01[医药卫生—生物医学工程]