本文選題：心功能恢復(fù)　切入點(diǎn)：人工心臟泵　出處：《北京工業(yè)大學(xué)》2013年博士論文

【摘要】：心力衰竭（心衰）是一種嚴(yán)重威脅人類健康的疾病。晚期心衰最有效的治療方法是心臟移植與人工心臟輔助。由于移植心臟數(shù)量不足，人工心臟得到快速發(fā)展。隨著人工心臟使用量的增加，由其引發(fā)的心臟功能恢復(fù)現(xiàn)象引起了極大的關(guān)注。然而目前尚未建立以促進(jìn)心臟功能恢復(fù)為目的的人工心臟控制策略。 人工心臟泵是由北京工業(yè)大學(xué)研制的新一代人工心臟。本文的研究目標(biāo)是通過控制人工心臟泵與人體的相互作用，促進(jìn)心臟功能的恢復(fù)。為此，本文建立面向心功能恢復(fù)的人工心臟泵分層控制策略以解決人工心臟泵治療心衰中面臨的三方面問題：如何確定人工心臟泵的最佳輔助水平；如何滿足循環(huán)系統(tǒng)的血液灌注與心臟卸載需求；以及如何維持人工心臟泵系統(tǒng)的控制穩(wěn)定性。針對(duì)上述問題，論文開展三方面研究。 第一，建立循環(huán)系統(tǒng)與人工心臟泵壀合模型，為人工心臟泵控制策略研究提供被控對(duì)象。首先，建立循環(huán)系統(tǒng)集中參數(shù)模型以研究循環(huán)系統(tǒng)血流動(dòng)力學(xué)機(jī)理。其次，建立壓力反射系統(tǒng)（Baroreflex System）數(shù)學(xué)模型以研究壓力反射系統(tǒng)對(duì)心率的調(diào)節(jié)機(jī)制。再次，建立人工心臟泵流體力學(xué)模型以研究人工心臟泵的流體特性。最后，建立循環(huán)系統(tǒng)與人工心臟泵壀合模型將循環(huán)系統(tǒng)集中參數(shù)模型、壓力反射系統(tǒng)數(shù)學(xué)模型以及人工心臟泵流體力學(xué)模型進(jìn)行壀合，并采用數(shù)值方法研究壀合模型的有效性。 第二，設(shè)計(jì)人工心臟泵分層控制策略，解決人工心臟泵促進(jìn)心臟功能恢復(fù)中面臨的三個(gè)問題。首先，設(shè)計(jì)外層控制策略確定循環(huán)系統(tǒng)的最佳輔助水平。其次，設(shè)計(jì)中層控制策略以滿足循環(huán)系統(tǒng)血液灌注與心臟卸載的需求。控制策略采用心率來反映循環(huán)系統(tǒng)血液灌注需求的變化；設(shè)計(jì)血流輔助指數(shù)（BAI)反映心臟卸載水平的變化。再次，設(shè)計(jì)內(nèi)層控制策略維持人工心臟泵系統(tǒng)的控制穩(wěn)定性。最終，根據(jù)這三個(gè)問題的研究結(jié)論建立人工心臟泵分層控制策略，并利用數(shù)值方法，體外實(shí)驗(yàn)方法與動(dòng)物實(shí)驗(yàn)方法研究分層控制策略的輔助效果。 第三，研究人工心臟泵輔助引起的血液搏動(dòng)性改變及其輔助模式對(duì)循環(huán)系統(tǒng)的血流動(dòng)力學(xué)影響。首先，設(shè)計(jì)人工心臟泵搏動(dòng)控制策略補(bǔ)償人工心臟泵輔助引起血液搏動(dòng)性的變化。其次，設(shè)計(jì)恒速輔助模式、同步輔助模式與反搏輔助模式等三種人工心臟泵輔助模式，采用數(shù)值方法研究三種輔助模式對(duì)循環(huán)系統(tǒng)產(chǎn)生的血流動(dòng)力學(xué)影響。 論文的研究工作共獲得三個(gè)主要結(jié)論。 第一，循環(huán)系統(tǒng)與人工心臟泵壀合模型能夠準(zhǔn)確地反映人工心臟對(duì)循環(huán)系統(tǒng)的血流動(dòng)力學(xué)影響。一方面能夠準(zhǔn)確地模擬心衰狀態(tài)下循環(huán)系統(tǒng)血流動(dòng)力學(xué)特性；另一方面壀合模型能夠準(zhǔn)確地模擬人工心臟泵對(duì)循環(huán)系統(tǒng)血流動(dòng)力學(xué)的影響。 第二，本文建立的外層控制策略能夠確定循環(huán)系統(tǒng)的最佳輔助水平，調(diào)整時(shí)間小于5s;中層控制策略能夠滿足循環(huán)系統(tǒng)血液灌注與心臟卸載的需求；內(nèi)層控制策略能夠減小系統(tǒng)的內(nèi)部不確定性與外部擾動(dòng)對(duì)人工心臟泵系統(tǒng)控制穩(wěn)定性的影響，最大誤差為O.lL/min;分層控制策略在一個(gè)控制策略中有效地解決上述三方面問題，并且系統(tǒng)調(diào)整時(shí)間小于5s，最大誤差為O.lL/min。動(dòng)物實(shí)驗(yàn)研究表明分層控制策略能夠準(zhǔn)確地確定實(shí)驗(yàn)動(dòng)物的最佳輔助水平，，并且能夠獲得血液灌注需求與心臟卸載水平之間的最優(yōu)組合。 第三，人工心臟泵輔助能夠直接影響循環(huán)系統(tǒng)的血流動(dòng)力學(xué)特性。一方面，本文設(shè)計(jì)的人工心臟泵搏動(dòng)控制策略能夠補(bǔ)償輔助過程中循環(huán)系統(tǒng)的血液搏動(dòng)性的變化，使人工心臟泵輔助下循環(huán)系統(tǒng)的血液搏動(dòng)性恢復(fù)正常。另一方面，同步輔助模式與反搏輔助模式能夠更好地實(shí)現(xiàn)心臟卸載，其中同步輔助模式在實(shí)現(xiàn)最好的心臟壓力卸載的同時(shí)能夠產(chǎn)生最大的血液搏動(dòng)性；而反搏輔助模式在實(shí)現(xiàn)心臟容積卸載的同時(shí)能夠獲得最小的心臟等效后負(fù)荷。 論文的工作具有三方面創(chuàng)新性。1、論文首次提出了通過分層控制已達(dá)到優(yōu)化人工心臟泵輔助水平和促進(jìn)心臟功能恢復(fù)的方法。2、論文建立了外層控制策略確定心臟的最佳輔助水平，并作為優(yōu)化人工心臟泵輸出的控制變量；首次提出了血流輔助指數(shù)用于檢測(cè)和控制心臟卸載水平；建立的中層控制策略能夠平衡血液灌注與心臟卸載的需求；建立的內(nèi)層控制策略能夠維持人工心臟泵系統(tǒng)的控制穩(wěn)定性。3、體外模擬實(shí)驗(yàn)、動(dòng)物實(shí)驗(yàn)與臨床應(yīng)用驗(yàn)證該控制系統(tǒng)能夠滿足心臟輔助水平、血液灌注與心臟卸載以及人工心臟泵系統(tǒng)控制穩(wěn)定性等三方面需求，確保了實(shí)驗(yàn)研究中動(dòng)物和人體血液循環(huán)系統(tǒng)的正常運(yùn)轉(zhuǎn)。使用該控制系統(tǒng)的人工心臟已經(jīng)成功應(yīng)用于臨床病例與多例動(dòng)物實(shí)驗(yàn)中。
[Abstract]:Heart failure (HF) is a serious threat to human health. The most effective treatment for advanced heart failure is a heart transplant and auxiliary artificial heart. Due to insufficient number of heart transplantation, artificial heart gets rapid development. With the increase of the amount of use of the artificial heart, cardiac function caused by recovery phenomenon has aroused great attention however. Has not yet been established to promote the recovery of cardiac function as artificial heart control policy.
Artificial heart pump is a new generation of artificial heart developed by Beijing University of Technology. The goal of this paper is through the interaction of control artificial heart pump and human body, promote the recovery of heart function. Therefore, the establishment of artificial heart pump hierarchical control strategy based on the recovery of cardiac function in order to solve the three problems facing artificial heart pump in the treatment of heart failure. How to determine the best level of auxiliary artificial heart pump; how to meet the circulatory system of blood perfusion and cardiac unloading needs; and how to maintain the stability of the control system of the artificial heart pump. In view of the above questions, three aspects of research papers.
First, the establishment of the circulatory system and artificial heart pump Pi models for artificial heart pump controlled object control strategy. Firstly, establish the circulation system of the lumped parameter model to study hemodynamic mechanism of the circulatory system. Secondly, the establishment of baroreflex system (Baroreflex System) mathematical model to study the baroreflex system on heart rate regulation again. In order to study the characteristics of fluid, artificial heart pump establish artificial heart pump fluid mechanics model. Finally, the establishment of the circulatory system and artificial heart pump Pi combined cycle system model lumped parameter model, baroreflex system mathematical model and artificial heart pump fluid mechanics model Pi, and the effectiveness was studied by numerical simulation method Pi model.
Second, the design of artificial heart pump hierarchical control strategy, promote the recovery of cardiac function in the three to solve the problem of artificial heart pump. Firstly, the design of outer control strategy to determine the best auxiliary horizontal circulation system. Secondly, the design of control strategy to meet the needs of middle circulating blood perfusion and cardiac unloading needs. Control strategy is adopted to reflect the change of heart rate needs blood perfusion of the circulatory system; blood flow index (BAI) aided design to reflect changes in heart unloading. Again, the inner control strategy to maintain stability control design of artificial heart pump system. In the end, according to the conclusion of the three problems of artificial heart pump hierarchical control strategy, and the use of numerical methods, auxiliary effect in vitro method and animal experiment method to study the hierarchical control strategy.
Third. The hemodynamic effects of pulsatile blood change of artificial heart pump caused by the auxiliary and auxiliary model of circulation system. Firstly, the design of artificial heart pump pulse compensation control strategy of artificial heart pump caused by changes of blood pulsation. Secondly, the design of constant speed auxiliary mode, synchronous mode and auxiliary counterpulsation mode three artificial heart pump assisted mode, hemodynamic effects using numerical method to study three kinds of modes on the circulatory system.
Three main conclusions have been obtained in the research work of this paper.
First, the circulatory system and artificial heart pump Pi model can accurately reflect the hemodynamic effects of artificial heart on the circulatory system. On the one hand can accurately simulate the hemodynamic characteristics of circulatory system in heart failure; on the other hand Pi model can accurately simulate the heart pump on the hemodynamics of the circulatory system of workers.
Second, the outer control strategy can determine the optimal level of assisted circulation system, the adjustment time is less than 5S; the middle control strategy can meet the circulating blood perfusion and cardiac unloading needs; the inner control strategy can reduce the uncertainty of internal system and external disturbance effects on stability control of artificial heart pump system, the maximum error is O.lL/min; hierarchical control strategy effectively solves the above three problems in a control strategy, and the system adjustment time is less than 5S, the maximum error is O.lL/min. on the animal experiments show that the hierarchical control strategy can accurately determine the optimal level of experimental animal assisted, and can get the optimal combination between blood perfusion and cardiac unloading demand levels.
Third, the auxiliary artificial heart pump can directly affect the hemodynamic characteristics of the circulatory system. On the one hand, can the circulatory system in the process of compensation assisted blood pulsatile changes the design of artificial heart pump pulsatile blood control, pulsatile artificial heart pump assisted circulation system back to normal. On the other hand, synchronous auxiliary mode and counterpulsation mode can achieve better cardiac unloading, the synchronous auxiliary mode can produce blood while achieving maximum pulsatile heart pressure unloading best; and counterpulsation mode can obtain the minimum at the same time to achieve the equivalent of heart heart volume unloading after load.
The work of this paper has three aspects of innovation of.1, this paper put forward the hierarchical control has reached the optimal artificial heart pump auxiliary level and method of promoting the recovery of cardiac function of.2, the control strategy is established to determine the optimal level of outer auxiliary heart, and as a control variable optimization artificial heart pump; auxiliary flow is put forward for the first time the index for the detection and control of cardiac unloading; middle control strategy can be established to balance the blood perfusion and cardiac unloading needs;.3 control the stability of inner control strategy established to maintain the artificial heart pump system, in vitro experiments, animal experiments and clinical application of the control system can meet the level of cardiac assist, blood perfusion and heart unloading and artificial heart pump control system stability in three aspects of demand, to ensure that the animal and human blood in experimental study The normal operation of the circulatory system. The artificial heart, which uses the control system, has been successfully applied to clinical cases and multiple animal experiments.

【學(xué)位授予單位】：北京工業(yè)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R318.11

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