多層密網(wǎng)支架的血流動(dòng)力學(xué)及動(dòng)物實(shí)驗(yàn)研究
發(fā)布時(shí)間：2018-08-03 16:26
【摘要】：主動(dòng)脈瘤的發(fā)病率呈逐年上升的趨勢,且死亡率較高、預(yù)后較差。主動(dòng)脈腔內(nèi)修復(fù)術(shù)利用覆膜支架將瘤體隔絕,創(chuàng)傷小、療效好,但其使用常受到主動(dòng)脈分支的限制。近年來在國外出現(xiàn)了一種新型的支架,即多層密網(wǎng)支架,其既可以減小瘤體壁血管的壓力,誘導(dǎo)瘤腔內(nèi)形成血栓,以機(jī)化縮小瘤體并降低其發(fā)生破裂的風(fēng)險(xiǎn),達(dá)到傳統(tǒng)覆膜支架治療主動(dòng)脈瘤的效果,又可以不堵塞血管瘤上的分支血管,并引導(dǎo)血液流入分支。但國外文獻(xiàn)對(duì)于該型支架的臨床應(yīng)用報(bào)道以及術(shù)后隨訪資料均較少,而國內(nèi)在此領(lǐng)域的研究也處于起步階段,尚有待深入研究其治療機(jī)理。因此,本研究擬通過流體力學(xué)數(shù)值模擬和實(shí)驗(yàn),探討分析多層密網(wǎng)支架對(duì)于瘤體及分支血管的血流動(dòng)力學(xué)影響,得到了有益的結(jié)果。本文主要研究內(nèi)容包括:⑴建立人體主動(dòng)脈瘤數(shù)字模型,模擬置入多層密網(wǎng)支架,在理論上分析瘤體和分支血管的壓力、速度流場等血流動(dòng)力學(xué)參數(shù)的變化情況;⑵根據(jù)醫(yī)學(xué)數(shù)據(jù)制作主動(dòng)脈瘤模型,應(yīng)用定常流動(dòng)實(shí)驗(yàn)測定瘤體內(nèi)壓力,并分析其變化情況;⑶對(duì)多層密網(wǎng)支架進(jìn)行壓力驗(yàn)證實(shí)驗(yàn)以及流體流場實(shí)驗(yàn),以研究主動(dòng)脈瘤模型內(nèi)的血流動(dòng)力學(xué)變化情況;⑷對(duì)多層密網(wǎng)支架進(jìn)行動(dòng)物體內(nèi)實(shí)驗(yàn),分析研究其在體內(nèi)血管相容性、維持分支血管通暢性的有效性以及血流動(dòng)力學(xué)變化情況。⑸根據(jù)上述血流動(dòng)力學(xué)實(shí)驗(yàn)、動(dòng)物實(shí)驗(yàn)的結(jié)果和研究結(jié)論,對(duì)多層密網(wǎng)支架既降低瘤體內(nèi)血流對(duì)瘤體的沖擊、改變血流流場狀況、誘導(dǎo)血栓形成,又同時(shí)能夠保證分支血管暢通的機(jī)理進(jìn)行流體力學(xué)方面的初步分析。得到結(jié)果如下:⑴多層密網(wǎng)支架置入后,可一定程度上降低瘤體內(nèi)血流對(duì)瘤體壁的壓力,減小了血流對(duì)瘤體壁的沖擊力,瘤體進(jìn)一步擴(kuò)張和發(fā)生破裂的風(fēng)險(xiǎn)因此而降低;⑵在數(shù)值模擬實(shí)驗(yàn)中,多層密網(wǎng)支架的置入可在一定程度上降低瘤體內(nèi)血流流速、瘤腔內(nèi)壓力以及瘤體的壁面切應(yīng)力;⑶多層密網(wǎng)支架置入后,改變了瘤腔內(nèi)的各種血流動(dòng)力學(xué)因素,其中瘤腔內(nèi)的血流流態(tài)由大量渦流變?yōu)閷恿?⑷在主動(dòng)脈瘤模型中,多層密網(wǎng)支架的置入對(duì)于分支血管的供血影響較小,能夠在一定程度上保證分支血管的暢通。⑸動(dòng)物實(shí)驗(yàn)表明,多層密網(wǎng)支架可在一定時(shí)間內(nèi)能夠保持腹主動(dòng)脈及分支血管的通暢性,且與密網(wǎng)支架的層數(shù)無關(guān),同時(shí)該支架可以在腹主動(dòng)脈內(nèi)緊密貼附固定,不會(huì)發(fā)生移位、彎曲、打折,此外支架的鎳鈦合金材料具有良好的生物相容性,植入生物體內(nèi)安全可靠。上述一系列實(shí)驗(yàn)均證明了多層密網(wǎng)支架可以在短期內(nèi)降低主動(dòng)脈瘤瘤腔內(nèi)的血流流速、血流對(duì)瘤體的壓力和壁面剪切力,減小了瘤體破裂的可能性;此外該支架還可以改變瘤腔內(nèi)的血流流態(tài),有利于瘤體內(nèi)形成血栓,使后者機(jī)化以縮小瘤體并防止其發(fā)生擴(kuò)張和破裂;更重要的是,其能夠保證瘤體上分支血管的暢通,維持相應(yīng)臟器的血供,且其生物相容性較好。因此,多層密網(wǎng)支架具有在一段時(shí)間內(nèi)治療主動(dòng)脈瘤的理論可行性,但其長期效果和臨床表現(xiàn)需后續(xù)的臨床試驗(yàn)來進(jìn)行分析研究。
[Abstract]:The incidence of aortic aneurysm is increasing year by year, and the mortality is higher and the prognosis is poor. Aortic endovascular repair using covered stent to isolate the tumor, small trauma, and good curative effect, but its use is often limited by the branch of the aorta. In recent years, a new type of stent, that is, multi-layer dense network stent, can reduce the tumor. The pressure of the vascular wall of the body induces a thrombus in the lumen of the tumor to narrow the tumor and reduce the risk of rupture. It can achieve the effect of the traditional covered stent in the treatment of aortic aneurysm. It can also not clog the branch vessels on the hemangioma and guide the blood flow into the branch. There are few follow-up data, and the domestic research in this field is in the initial stage, and the mechanism of treatment is still to be studied. Therefore, this study intends to analyze the hemodynamic effects of multi-layer dense network stent on the tumor and branch vessels through numerical simulation and experiment of fluid mechanics. The volume includes: (1) establishing the digital model of human aortic aneurysm, simulating the multi-layer dense network stent, analyzing the changes of the hemodynamic parameters, such as the pressure of the tumor body and the branch vessel, the velocity field and so on. (2) making the aortic aneurysm model according to the medical data, using constant flow experiment to measure the pressure in the tumor, and analyze the change of the tumor. In order to study the hemodynamic changes in the aortic aneurysm model, the pressure verification experiment and fluid field experiment were carried out to study the hemodynamic changes in the model of the aortic aneurysm. 4. In vivo, the vascular compatibility in the body, the effectiveness of maintaining the patency of the branch vessel and the hemodynamic changes were analyzed. According to the above hemodynamic experiments and the results of animal experiments, the results of the multi-layer dense network stent not only reduce the impact of blood flow on the tumor in the tumor body, change the flow field, induce thrombus formation, but also guarantee the mechanism of the smooth branch of the branch to carry out a preliminary analysis of the fluid mechanics. The results are as follows: (1) the multilayer density The stent implantation can reduce the pressure of blood flow to the wall of the tumor in a certain degree, reduce the impact force of the blood flow on the wall of the tumor, and reduce the risk of further expansion and rupture of the tumor. 2. In the numerical simulation experiment, the placement of multi-layer dense mesh scaffold can reduce the flow velocity in the tumor in a certain degree and pressure in the tumor. Force and the wall shear stress of the tumor; 3. After the stent implantation, various hemodynamic factors in the lumen of the tumor are changed, in which the flow flow in the tumor is transformed from a large number of swirl into laminar flow. 4. In the aortic aneurysm model, the placement of multi-layer dense mesh scaffold has little influence on the blood supply of the branch vessel, and can be guaranteed to a certain extent. The animal experiments show that the multi-layer dense network stent can maintain the patency of the abdominal aorta and the branch vessels for a certain time, and has nothing to do with the number of the dense network stent. At the same time, the stent can be tightly attached to the abdominal aorta, without displacement, bending, and discounts. In addition, the nickel titanium alloy material of the scaffold has a good effect. A series of experiments demonstrate that the flow velocity of the aneurysm in the aneurysm can be reduced in a short period of time. The pressure and wall shear force of the blood flow to the tumor can reduce the possibility of the rupture of the tumor, and the stent can also change the flow flow in the lumen of the tumor. It is beneficial to the formation of thrombus in the tumor, which makes the latter machine to narrow the tumor and prevent its expansion and rupture, and more importantly, it can ensure the smooth flow of the branch vessels on the tumor and maintain the blood supply of the corresponding organs, and its biocompatibility is good. Therefore, the multi-layer dense network stent has the theoretical feasibility for the treatment of the aortic aneurysm for a period of time. However, its long-term effects and clinical manifestations need further clinical trials.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R543.16
[Abstract]:The incidence of aortic aneurysm is increasing year by year, and the mortality is higher and the prognosis is poor. Aortic endovascular repair using covered stent to isolate the tumor, small trauma, and good curative effect, but its use is often limited by the branch of the aorta. In recent years, a new type of stent, that is, multi-layer dense network stent, can reduce the tumor. The pressure of the vascular wall of the body induces a thrombus in the lumen of the tumor to narrow the tumor and reduce the risk of rupture. It can achieve the effect of the traditional covered stent in the treatment of aortic aneurysm. It can also not clog the branch vessels on the hemangioma and guide the blood flow into the branch. There are few follow-up data, and the domestic research in this field is in the initial stage, and the mechanism of treatment is still to be studied. Therefore, this study intends to analyze the hemodynamic effects of multi-layer dense network stent on the tumor and branch vessels through numerical simulation and experiment of fluid mechanics. The volume includes: (1) establishing the digital model of human aortic aneurysm, simulating the multi-layer dense network stent, analyzing the changes of the hemodynamic parameters, such as the pressure of the tumor body and the branch vessel, the velocity field and so on. (2) making the aortic aneurysm model according to the medical data, using constant flow experiment to measure the pressure in the tumor, and analyze the change of the tumor. In order to study the hemodynamic changes in the aortic aneurysm model, the pressure verification experiment and fluid field experiment were carried out to study the hemodynamic changes in the model of the aortic aneurysm. 4. In vivo, the vascular compatibility in the body, the effectiveness of maintaining the patency of the branch vessel and the hemodynamic changes were analyzed. According to the above hemodynamic experiments and the results of animal experiments, the results of the multi-layer dense network stent not only reduce the impact of blood flow on the tumor in the tumor body, change the flow field, induce thrombus formation, but also guarantee the mechanism of the smooth branch of the branch to carry out a preliminary analysis of the fluid mechanics. The results are as follows: (1) the multilayer density The stent implantation can reduce the pressure of blood flow to the wall of the tumor in a certain degree, reduce the impact force of the blood flow on the wall of the tumor, and reduce the risk of further expansion and rupture of the tumor. 2. In the numerical simulation experiment, the placement of multi-layer dense mesh scaffold can reduce the flow velocity in the tumor in a certain degree and pressure in the tumor. Force and the wall shear stress of the tumor; 3. After the stent implantation, various hemodynamic factors in the lumen of the tumor are changed, in which the flow flow in the tumor is transformed from a large number of swirl into laminar flow. 4. In the aortic aneurysm model, the placement of multi-layer dense mesh scaffold has little influence on the blood supply of the branch vessel, and can be guaranteed to a certain extent. The animal experiments show that the multi-layer dense network stent can maintain the patency of the abdominal aorta and the branch vessels for a certain time, and has nothing to do with the number of the dense network stent. At the same time, the stent can be tightly attached to the abdominal aorta, without displacement, bending, and discounts. In addition, the nickel titanium alloy material of the scaffold has a good effect. A series of experiments demonstrate that the flow velocity of the aneurysm in the aneurysm can be reduced in a short period of time. The pressure and wall shear force of the blood flow to the tumor can reduce the possibility of the rupture of the tumor, and the stent can also change the flow flow in the lumen of the tumor. It is beneficial to the formation of thrombus in the tumor, which makes the latter machine to narrow the tumor and prevent its expansion and rupture, and more importantly, it can ensure the smooth flow of the branch vessels on the tumor and maintain the blood supply of the corresponding organs, and its biocompatibility is good. Therefore, the multi-layer dense network stent has the theoretical feasibility for the treatment of the aortic aneurysm for a period of time. However, its long-term effects and clinical manifestations need further clinical trials.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R543.16
【相似文獻(xiàn)】
相關(guān)期刊論文 前10條
1 周棟,黃維坤,高百順;組織工程心臟瓣膜支架材料的應(yīng)用進(jìn)展[J];中國臨床康復(fù);2002年18期
2 孫紅;真皮支架材料的研究進(jìn)展[J];中國美容醫(yī)學(xué);2004年01期
3 崔福齋,孟波,張金山;介入治療中支架材料的研究進(jìn)展[J];中國介入影像與治療學(xué);2004年01期
4 吳燕,成國祥;可注射可吸收凝膠支架材料的研究進(jìn)展[J];生物醫(yī)學(xué)工程學(xué)雜志;2005年01期
5 丁敏;;廈大研制出可將組織器官“種”在體外的醫(yī)用支架材料[J];功能材料信息;2006年04期
6 陳思;董念國;史嘉瑋;;組織工程心臟瓣膜支架材料進(jìn)展[J];心血管病學(xué)進(jìn)展;2008年06期
7 王雪力;侯理;譚競;湯克勤;夏和生;劉霆;;生物相容性聚氨酯支架材料的研究[J];高分子材料科學(xué)與工程;2008年02期
8 鄒明暉;董念國;;組織工程心臟瓣膜支架材料的研究與進(jìn)展[J];中國組織工程研究與臨床康復(fù);2010年29期
9 哈里木·克里木;王磊;齊海;;組織工程心臟瓣膜支架材料的選擇與應(yīng)用[J];中國組織工程研究與臨床康復(fù);2011年34期
10 郭各樸;馬青玉;王f ;趙波;章東;;聚乳酸微孔支架材料熱分解動(dòng)力學(xué)特性[J];科學(xué)通報(bào);2011年34期
相關(guān)會(huì)議論文 前10條
1 張亞;王曉東;;細(xì)胞復(fù)合型絲素支架材料修復(fù)兔橈骨骨缺損[A];蘇州市自然科學(xué)優(yōu)秀學(xué)術(shù)論文匯編(2008-2009)[C];2010年
2 楊光輝;王英杰;張世昌;劉濤;;聚氨酯支架材料內(nèi)肝細(xì)胞培養(yǎng)的初步研究[A];第一屆全國疑難重型肝病大會(huì)、第四屆全國人工肝及血液凈化學(xué)術(shù)年會(huì)論文集[C];2008年
3 趙斌;馬信龍;孫曉雷;李秀蘭;馬劍雄;徐康;張楊;郭躍;;低滲聯(lián)合凍干改良制備脫細(xì)胞神經(jīng)支架材料的研究[A];第十九屆全國中西醫(yī)結(jié)合骨傷科學(xué)術(shù)研討會(huì)論文匯編[C];2012年
4 儕y，
本文編號(hào)：2162313
本文鏈接：http://sikaile.net/shoufeilunwen/yxlbs/2162313.html
最近更新
教材專著
