本文選題：心力衰竭 + 心血管系統(tǒng)��； 參考：《北京工業(yè)大學》2012年碩士論文

【摘要】：心力衰竭已日益成為威脅人類健康的因素之一。晚期心衰主要采取心臟移植和心室輔助兩種治療手段，由于心臟供體不足，使得心室輔助得到廣泛關注和大力發(fā)展。心室輔助裝置是一種部分或全部替代心臟泵功能的設備，為血液循環(huán)系統(tǒng)提供動力。心血管系統(tǒng)是一個多參數(shù)強耦合的系統(tǒng)，其生理調節(jié)機制可以反映人體生理參數(shù)間相互關系。而心衰患者處于失代償狀態(tài)，該狀態(tài)下心血管系統(tǒng)的調節(jié)機制發(fā)生改變，這種變化迄今尚未明確。此外，左心室輔助治療心衰會改變心血管系統(tǒng)的血流動力學特性，其輔助方式以及控制策略對器官灌注與心功能恢復的血流動力學機理研究未見明確結論。 本文針對上述心衰患者生理調節(jié)機制與左心室輔助對心血管血流動力學影響這兩個問題，通過構建心肌收縮力、外周阻力和血管順應性等生理參數(shù)模型研究心衰生理調節(jié)機制；通過構建心血管-血泵耦合模型研究血泵輔助后血流動力學變化。首先，對心血管系統(tǒng)進行了模型研究，包括依據(jù)臨床數(shù)據(jù)建立的心肌收縮力模型、用于研究調節(jié)機制的外周阻力與血管順應性模型、研究心血管與血泵相互作用的心血管-血泵耦合模型。其次，對心血管與血泵相互作用進行了數(shù)值研究。開發(fā)了心血管模擬系統(tǒng)，利用該系統(tǒng)研究了由心尖到主動脈的并聯(lián)方式與由主動脈根到主動脈弓的串聯(lián)方式對器官灌注與心功能恢復的影響，以及恒流、恒速與恒壓差三種不同的控制策略對串聯(lián)輔助下心室卸載與血管的影響。最后，本論文進行了左心室輔助對心血管系統(tǒng)影響的動物實驗研究。開發(fā)了具有生理參數(shù)采集與血泵控制等功能的動物實驗系統(tǒng)。利用此系統(tǒng)建立左心輔助動物模型，并將模擬數(shù)據(jù)與實驗數(shù)據(jù)進行了對比，并依據(jù)動物實驗數(shù)據(jù)，對左心室輔助下心室卸載、器官灌注與搏動性等血流動力學參數(shù)進行了研究。 研究結果表明，第一，本文建立的心衰模型可反映患者血流動力學特性。第二，動物實驗采集的左心室壓和主動脈壓與模擬結果趨勢一致，模型可反映心血管血流動力學特性。第三，串聯(lián)輔助下，恒壓差控制策略具有較優(yōu)的心室卸載與器官灌注效果，并能產(chǎn)生與心臟射血同步的搏動性血流；并聯(lián)輔助下，恒速控制策略產(chǎn)生的器官灌注效果最佳，恒流控制策略產(chǎn)生更好的心室卸載；隨著輔助指數(shù)的增大搏動指數(shù)逐漸降低。第四，動物實現(xiàn)表明，，隨著轉速的增加器官灌注與心室卸載增大，搏動性降低，此結果與數(shù)值研究結果一致�？傊�，本文對心室輔助下心血管系統(tǒng)血流動力學模型的研究為心衰的臨床治療提供了理論模型依據(jù)，并為長期心室輔助的輔助方式及其控制策略提出了幾點臨床指導意見。
[Abstract]:Heart failure has increasingly become one of the factors threatening human health. Late heart failure is mainly treated by heart transplantation and ventricular assistance. Due to the shortage of heart donors, ventricular assistance has been widely concerned and developed. Ventricular assist is a device that partially or wholly replaces the function of cardiac pump and provides power to the circulatory system. Cardiovascular system is a multi-parameter strong coupling system, its physiological regulation mechanism can reflect the relationship between human physiological parameters. However, patients with heart failure are in a state of decompensation under which the regulatory mechanism of the cardiovascular system has changed, which has not yet been clarified. In addition, left ventricular adjuvant treatment of heart failure will change the hemodynamic characteristics of cardiovascular system. There is no clear conclusion on the hemodynamic mechanism of organ perfusion and cardiac function recovery by its auxiliary mode and control strategy. In this paper, the physiological regulation mechanism of heart failure patients and the effects of left ventricular assist on cardiovascular hemodynamics were studied by constructing physiological parameter models of cardiac contractility, peripheral resistance and vascular compliance. The hemodynamic changes of blood pump assisted by blood pump were studied by establishing a cardiovascular-blood pump coupling model. First, the cardiovascular system model was studied, including the myocardial contractility model based on clinical data, which was used to study the peripheral resistance and vascular compliance model of regulatory mechanism. The coupling model of cardiovascular and blood pump was studied. Secondly, the interaction between cardiovascular and blood pump is studied numerically. A cardiovascular simulation system was developed to study the effects of a parallel approach from the apex to the aorta and a series from the root of the aorta to the aortic arch on organ perfusion and cardiac function recovery, as well as the constant-current. Effects of three different control strategies, constant velocity and constant pressure difference, on ventricular unloading and vascularization assisted in series. Finally, an experimental study on the effects of left ventricular assist on cardiovascular system was carried out. An animal experimental system with physiological parameter collection and blood pump control was developed. The left ventricular assisted animal model was established by this system, and the hemodynamic parameters such as left ventricular assisted ventricular unloading, organ perfusion and pulsatility were studied according to the experimental data. The results show that, first, the heart failure model can reflect the hemodynamic characteristics of patients. Second, the trends of left ventricular pressure and aortic pressure collected in animal experiments are consistent with the simulated results. The model can reflect the characteristics of cardiovascular hemodynamics. Third, the constant-pressure difference control strategy has better effects of ventricular unloading and organ perfusion, and can produce pulsatile blood flow synchronously with cardiac ejection, and the organ perfusion effect of constant-velocity control strategy is the best with parallel assistance. Constant flow control strategy produces better ventricular unloading, and pulsatile index decreases with the increase of auxiliary index. Fourth, animal realization showed that organ perfusion and ventricular unloading increased with the increase of rotational speed, and pulsatility decreased, which was consistent with the numerical results. In conclusion, the study of the cardiovascular system hemodynamic model under ventricular assistance provides a theoretical model basis for the clinical treatment of heart failure, and provides some clinical guidance for the long-term ventricular assistant mode and its control strategy.
【學位授予單位】：北京工業(yè)大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R312

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