【摘要】：Glenn手術(shù)是單心室缺陷綜合征姑息性手術(shù)Fontan手術(shù)的第二步。Glenn手術(shù)是將上腔靜脈與肺動(dòng)脈進(jìn)行端側(cè)吻合,上腔靜脈血直接流入左右肺動(dòng)脈進(jìn)入肺部,進(jìn)行血氧交換,而不與肺靜脈的動(dòng)脈血混合,從而減輕紫紺癥狀。血流動(dòng)力學(xué)因素是影響心血管疾病手術(shù)后恢復(fù)的重要因素。單心室病人常伴隨有血管發(fā)育不良等并發(fā)癥,其中最常見的是肺動(dòng)脈狹窄。不同的肺動(dòng)脈狹窄程度會(huì)造成不同的血流情況,影響病人術(shù)后左右肺的分流量和能量損耗等血管發(fā)育的生理需求,增加單心室負(fù)荷,在血流動(dòng)力學(xué)角度上也會(huì)造成不良的血流動(dòng)力學(xué)因素,可能會(huì)影響手術(shù)成功率及手術(shù)長期有效性。目前臨床上實(shí)施手術(shù)主要依據(jù)二維醫(yī)學(xué)圖像和臨床醫(yī)生的手術(shù)經(jīng)驗(yàn),缺乏手術(shù)前血流動(dòng)力學(xué)理論指導(dǎo)。而基于血流動(dòng)力學(xué)理論,運(yùn)用幾何多尺度方法實(shí)現(xiàn)手術(shù)規(guī)劃,可得到臨床上關(guān)心的血流動(dòng)力學(xué)參數(shù)及指標(biāo),給臨床提供一定的參考。本研究研究內(nèi)容包括:1、基于單心室病人的二維CT圖像,重建單心室病人血管圖像,并通過虛擬手術(shù),構(gòu)建肺動(dòng)脈不同狹窄的Glenn手術(shù)三維模型,以分析比較不同的肺動(dòng)脈狹窄對(duì)Glenn術(shù)后血流動(dòng)力學(xué)的影響;2、建立單心室病人血液循環(huán)系統(tǒng)的集中參數(shù)模型,通過不斷調(diào)試和試驗(yàn),確定集中參數(shù)模型各個(gè)元件的參數(shù);3、將上述三維模型代替到集中參數(shù)模型相應(yīng)的部分,進(jìn)行幾何多尺度的耦合,通過對(duì)四種不同肺動(dòng)脈狹窄程度的Glenn術(shù)后模型進(jìn)行仿真,從血流動(dòng)力學(xué)角度對(duì)比不同狹窄程度對(duì)病人術(shù)后發(fā)展的影響;4、制作Glenn手術(shù)透明模型,在數(shù)值模擬基礎(chǔ)上初步進(jìn)行幾組穩(wěn)態(tài)PIV試驗(yàn)。研究結(jié)果表明:病人不同的血管發(fā)育情況對(duì)單心室病人Glenn手術(shù)后的血管恢復(fù)有重要的影響。對(duì)于伴隨單邊肺動(dòng)脈狹窄的單心室病人,隨著狹窄程度的增加,研究結(jié)果呈現(xiàn)了左肺動(dòng)脈逐漸減小的分流率和逐漸增高的能量損耗,并當(dāng)狹窄為75%或高于75%時(shí),左肺動(dòng)脈的分流急劇下降,能量損耗也遠(yuǎn)遠(yuǎn)高于狹窄程度較小的模型,且分布較大面積的高OSI區(qū)域。這些血流動(dòng)力學(xué)參數(shù)均表明在同一Glenn手術(shù)方式下,左肺動(dòng)脈狹窄程度為75%或高于75%時(shí),狹窄對(duì)血管壁將產(chǎn)生不良的血流動(dòng)力學(xué)影響。本研究對(duì)單心室病人在單邊肺動(dòng)脈不同程度狹窄的情況下進(jìn)行虛擬Glenn手術(shù),數(shù)值模擬中所用幾何多尺度方法能夠準(zhǔn)確為三維模型的數(shù)值計(jì)算提供近生理的邊界條件,在血流動(dòng)力學(xué)角度上研究肺動(dòng)脈不同狹窄對(duì)Glenn手術(shù)術(shù)后恢復(fù)的影響,并運(yùn)用粒子圖像測速(Particle Image Velocimetry,PIV)技術(shù)對(duì)Glenn手術(shù)進(jìn)行數(shù)值模擬研究的驗(yàn)證。
[Abstract]:Glenn operation is the second step of Fontan operation in patients with single ventricular defect syndrome. Glenn procedure is to anastomose the superior vena cava with the pulmonary artery end-to-side, the blood of the superior vena cava flows directly into the left and right pulmonary arteries to enter the lung for blood oxygen exchange. And does not mix with the arterial blood of pulmonary vein, thereby alleviate cyanosis symptom. Hemodynamic factors play an important role in postoperative recovery of cardiovascular diseases. Single ventricle patients often have complications such as vascular dysplasia, the most common of which is pulmonary artery stenosis. Different degree of pulmonary artery stenosis will cause different blood flow, which will affect the physiological requirements of left and right lung flow and energy loss, and increase the single ventricular load. Hemodynamic factors may affect the success rate and long-term effectiveness of the operation. At present, the clinical practice of surgery is mainly based on two-dimensional medical images and clinicians' operation experience, lack of theoretical guidance of hemodynamics before surgery. Based on the theory of hemodynamics and the geometric multi-scale method, the parameters and indexes of hemodynamics concerned in clinic can be obtained, which can provide a certain reference for clinical practice. The main contents of this study are as follows: 1. Based on two-dimensional CT images of patients with single ventricle, the vascular images of patients with single ventricle were reconstructed, and a three-dimensional model of Glenn operation with different stenosis of pulmonary artery was constructed by virtual surgery. To compare the effect of pulmonary artery stenosis on hemodynamics after Glenn. (2) to establish the centralized parameter model of blood circulation system of single ventricular patients, and to determine the parameters of each component of the centralized parameter model through continuous debugging and testing. 3. The above 3D model is replaced by the corresponding part of the lumped parameter model, and the geometric multi-scale coupling is carried out. Four kinds of Glenn postoperative models with different degree of pulmonary artery stenosis are simulated. The effects of different degree of stenosis on postoperative development were compared from hemodynamic point of view. 4. The transparent model of Glenn operation was made and several steady state PIV tests were carried out on the basis of numerical simulation. The results show that different vascular development in patients with single ventricle plays an important role in the recovery of blood vessels after Glenn surgery. For patients with unilateral pulmonary artery stenosis, the results of the study showed a decreasing shunt rate and increasing energy loss of the left pulmonary artery as the degree of stenosis increased, and when the stenosis was 75% or higher, The shunt of the left pulmonary artery decreased sharply and the energy loss was much higher than that of the model with less stenosis and the large area of high OSI was also found. These hemodynamic parameters indicated that when the stenosis degree of left pulmonary artery was 75% or higher than 75% in the same Glenn procedure, the stenosis would have a bad hemodynamic effect on the vascular wall. In this study, virtual Glenn surgery was performed on single-ventricular patients with unilateral pulmonary artery stenosis of varying degrees. The geometric multi-scale method used in the numerical simulation can provide the near physiological boundary conditions for the numerical calculation of the three-dimensional model. The effect of different stenosis of pulmonary artery on postoperative recovery of Glenn was studied in terms of hemodynamics. The particle image velocimetry (Particle Image Velocimetry,PIV) technique was used to verify the numerical simulation of Glenn operation.
【學(xué)位授予單位】：北京工業(yè)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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