發(fā)布時間：2019-04-01 20:01

【摘要】：目的:顱內(nèi)動脈瘤的發(fā)生、發(fā)展、穩(wěn)定或者破裂與血流動力學(xué)密切相關(guān)。但以往的血流動力學(xué)研究都是基于破裂和未破裂動脈瘤,而忽略破裂事件可能對動脈瘤形態(tài)的影響而導(dǎo)致血流動力學(xué)參數(shù)的改變。本研究主要應(yīng)用計算機數(shù)值模擬技術(shù)探討伴隨動眼神經(jīng)麻痹后交通動脈瘤的血流動力學(xué)特征。方法:連續(xù)選擇2015年1月至12月在皖南醫(yī)學(xué)院弋磯山醫(yī)院神經(jīng)外科血管組接受腦血管造影并診斷為伴隨動眼神經(jīng)麻痹的后交通動脈瘤14枚,以及破裂后交通動脈瘤30枚。重建三維腦血管造影圖像獲得合格特異性動脈瘤模型,并應(yīng)用計算流體力學(xué)(computational fluid dynamics CFD)的數(shù)值模擬的方法分析伴隨動眼神經(jīng)麻痹后交通動脈瘤的血流動力學(xué)特征。結(jié)果:18例破裂后交通動脈的血流流動模式Ⅲ,12例是Ⅳ,而伴動眼神經(jīng)麻痹的后交通動脈瘤有8例屬于Ⅲ,6例屬于Ⅳ。兩者都屬于不穩(wěn)定的流動模式。平均壁面切應(yīng)力(wall shear stress WSS)伴隨動眼神經(jīng)麻痹組明顯低于破裂后交通動脈瘤組(7.96±3.03 vs 13.78±1.17,P=0.01)。破裂組低壁面切應(yīng)力面積百分數(shù)(LSA%)明顯低于動眼神經(jīng)麻痹組[3.23(2.32,3.24)%vs 9.17(8.35,12.05)%,P0.01]。然而,兩組間的剪切振蕩系數(shù)(oscillatory shear index OSI)(0.04±0.338vs 0.018±0.004,P=0.48),歸一化的WSS(normalized wall shear stress NWSS)(0.53±0.26 vs 0.86±0.34,p=0.15)都沒有明顯差異。年齡(p=0.12)、性別(p=0.75)、高血壓(p=0.46)、糖尿病(P=0.82)、吸煙(p=0.87)等臨床特征在兩組之間也無明顯差異。結(jié)論:伴隨動眼神經(jīng)麻痹的后交通動脈瘤有很高的破裂風(fēng)險,研究此種類型的動脈瘤對臨床血流動力學(xué)的研究具有極其重要的意義。高LSA%以及低WSS可能是最終導(dǎo)致伴隨動眼神經(jīng)麻痹的后交通動脈瘤的破裂的原因。年齡、性別、高血壓、糖尿病、吸煙等臨床特征并不影響動眼神經(jīng)麻痹后交通動脈瘤的破裂風(fēng)險。基于影像學(xué)的計算機流體力學(xué)在評估顱內(nèi)動脈瘤破裂風(fēng)險方面具有重要意義�，F(xiàn)在的研究表明無論是高或者低的WSS都能導(dǎo)致動脈瘤的生長和破裂。這些不同結(jié)果的產(chǎn)生有可能源自于不同參數(shù)的定義,研究樣本量過小,或者是顱內(nèi)動脈瘤生長和破裂內(nèi)在的復(fù)雜性。但Meng等提出了統(tǒng)一的假設(shè):高或者低的WSS分別通過壁細胞介導(dǎo)和炎癥細胞介導(dǎo)的破壞性重建通路促進動脈瘤的生長和破裂。我們也回顧性分析了各個文獻中不同WSS參數(shù)的定義和近期計算機流體力學(xué)的研究。未來,我們期待更大的數(shù)據(jù)、更好的數(shù)據(jù)分析方法、以及更全面血液動力學(xué)生物機制的理解。這些都能有助于提供更準確顱內(nèi)動脈瘤風(fēng)險評估預(yù)測模型。
[Abstract]:Objective: the occurrence, development, stability or rupture of intracranial aneurysms is closely related to hemodynamics. However, previous hemodynamic studies were based on ruptured and unruptured aneurysms and ignored the effects of ruptured events on the morphology of aneurysms, which resulted in changes in hemodynamic parameters. In this study, the hemodynamic characteristics of communicating aneurysms associated with oculomotor nerve paralysis were studied by computer numerical simulation. Methods: 14 posterior communicating artery aneurysms with oculomotor paralysis and 30 ruptured posterior communicating aneurysms were selected from January to December 2015 in the neurosurgical vessel group of Yijishan Hospital of Southern Anhui Medical College and diagnosed as posterior communicating aneurysms with oculomotor paralysis. Three-dimensional cerebral angiography images were reconstructed to obtain a qualified and specific aneurysm model. The hemodynamic characteristics of communicating aneurysms associated with oculomotor nerve paralysis were analyzed by numerical simulation of computational fluid dynamics (computational fluid dynamics CFD). Results: of the 18 cases of ruptured posterior communicating artery, 12 cases were 鈪，

本文編號：2451859