本文選題：心臟移植　切入點：器官保護技術(shù)　出處：《北京工業(yè)大學》2015年碩士論文

【摘要】：心臟移植是終末期心力衰竭最有效的治療手段。供體心臟的數(shù)量是心臟移植的最大制約因素,高質(zhì)量的心臟保存是提高移植手術(shù)成功率和遠期生存率的重要環(huán)節(jié)。目前,常溫氧合血不停跳器官保護技術(shù)較之于常用的低溫冷藏保存法,能大幅度延長心臟體外存活時間,減少對心臟的損傷,但最優(yōu)的灌注參數(shù)與心臟功能的評價指標尚不明確。本論文基于器官保護技術(shù),結(jié)合集中參數(shù)模型理論,研究離體心臟最優(yōu)的灌注參數(shù),探討評價心功能的指標,最后設計離體心臟保存室。首先,建立離體心臟保護模式下的集中參數(shù)模型,實現(xiàn)對心臟冠脈系統(tǒng)的灌注,通過改變集中參數(shù)變量,確定最優(yōu)的灌注流量與灌注壓力。其次,建立心功能評估模式下的集中參數(shù)模型,評估左心功能,探討主動脈壓力、左心室容積以及收縮力/容積函數(shù)在心功能中的作用。最后,根據(jù)數(shù)值研究的基礎,綜合考慮心臟的生理特點與體外保護時的實際情況,設計了離體心臟保存室,用以保存、運輸離體心臟。研究結(jié)果表明,第一,建立了離體心臟保護模式的集中參數(shù)模型,此模型實現(xiàn)的是對冠脈系統(tǒng)的灌注,最優(yōu)的灌注壓力為45 mm Hg,灌注流量110 ml/min;第二,建立了心功能評估模式的集中參數(shù)模型,評估左心的功能,模擬結(jié)果顯示,當加大后負荷時,主動脈壓力升高,左心室的容積變大,收縮力/容積函數(shù)降低,均表明了左心的收縮力更大,儲血量更高。第三,通過理論研究的基礎,設計了離體心臟保存室,其能夠提供循環(huán)可再利用的血液,保證心臟在水平方向上的平衡,接口的設計可減少對心臟自身血管和瓣膜的損傷。總之,本文為體外保存離體心臟提供灌注保存的場所,并仿真了保護模式下的最優(yōu)灌注參數(shù)以及心功能評估模式下的指標,為衡量體外保護離體心臟的效果提供了有力的參考,為臨床上提供更適合、更完善的心臟和移植手術(shù)的成功提供有利的保障。
[Abstract]:Heart transplantation is the most effective treatment for end-stage heart failure. The number of donor hearts is the biggest constraint factor for heart transplantation. High quality heart preservation is an important link to improve the success rate and long-term survival rate of transplantation. Compared with the conventional cryopreservation method, oxygenated blood at room temperature can significantly prolong the survival time of the heart in vitro and reduce the damage to the heart. However, the optimal perfusion parameters and the evaluation indexes of cardiac function are not clear. Based on the organ protection technology and the theory of centralized parameter model, the optimal perfusion parameters of isolated heart were studied in this paper, and the evaluation indexes of cardiac function were discussed. At last, the isolated heart preservation chamber is designed. Firstly, the centralized parameter model is established in the isolated heart protection mode to realize the perfusion of the coronary artery system. The optimal perfusion flow rate and perfusion pressure are determined by changing the centralized parameter variables. A centralized parameter model was established to evaluate the left ventricular function, and to investigate the role of aortic pressure, left ventricular volume and contractile force / volume function in cardiac function. Considering the physiological characteristics of the heart and the actual situation of in vitro protection, an isolated heart preservation chamber was designed to preserve and transport the isolated heart. The results show that, first, a centralized parameter model of the isolated heart protection model is established. The optimal perfusion pressure is 45 mm Hgand the perfusion flow rate is 110 ml / min. Secondly, the centralized parameter model of cardiac function evaluation model is established to evaluate the function of the left heart, and the simulation results show that when the afterload is increased, With the increase of aortic pressure, the volume of left ventricle becomes larger, and the contractile force / volume function decreases, which indicates that the left heart has greater contractility and higher blood storage. Thirdly, based on the theoretical research, an isolated heart preservation chamber is designed. It can provide circulating and reused blood, ensure the balance of the heart in the horizontal direction, and the design of the interface can reduce the damage to the heart's own blood vessels and valves. The optimal perfusion parameters in protective mode and the indexes in cardiac function evaluation mode were simulated, which provided a powerful reference for evaluating the effect of protecting isolated heart in vitro and more suitable for clinical application. A better heart and a successful transplant provide a good guarantee.
【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】：2015
【分類號】：R654.2

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本文編號：1665651