多層密網(wǎng)支架的血流動力學及動物實驗研究
發(fā)布時間：2018-08-03 16:26
【摘要】：主動脈瘤的發(fā)病率呈逐年上升的趨勢,且死亡率較高、預后較差。主動脈腔內修復術利用覆膜支架將瘤體隔絕,創(chuàng)傷小、療效好,但其使用常受到主動脈分支的限制。近年來在國外出現(xiàn)了一種新型的支架,即多層密網(wǎng)支架,其既可以減小瘤體壁血管的壓力,誘導瘤腔內形成血栓,以機化縮小瘤體并降低其發(fā)生破裂的風險,達到傳統(tǒng)覆膜支架治療主動脈瘤的效果,又可以不堵塞血管瘤上的分支血管,并引導血液流入分支。但國外文獻對于該型支架的臨床應用報道以及術后隨訪資料均較少,而國內在此領域的研究也處于起步階段,尚有待深入研究其治療機理。因此,本研究擬通過流體力學數(shù)值模擬和實驗,探討分析多層密網(wǎng)支架對于瘤體及分支血管的血流動力學影響,得到了有益的結果。本文主要研究內容包括:⑴建立人體主動脈瘤數(shù)字模型,模擬置入多層密網(wǎng)支架,在理論上分析瘤體和分支血管的壓力、速度流場等血流動力學參數(shù)的變化情況;⑵根據(jù)醫(yī)學數(shù)據(jù)制作主動脈瘤模型,應用定常流動實驗測定瘤體內壓力,并分析其變化情況;⑶對多層密網(wǎng)支架進行壓力驗證實驗以及流體流場實驗,以研究主動脈瘤模型內的血流動力學變化情況;⑷對多層密網(wǎng)支架進行動物體內實驗,分析研究其在體內血管相容性、維持分支血管通暢性的有效性以及血流動力學變化情況。⑸根據(jù)上述血流動力學實驗、動物實驗的結果和研究結論,對多層密網(wǎng)支架既降低瘤體內血流對瘤體的沖擊、改變血流流場狀況、誘導血栓形成,又同時能夠保證分支血管暢通的機理進行流體力學方面的初步分析。得到結果如下:⑴多層密網(wǎng)支架置入后,可一定程度上降低瘤體內血流對瘤體壁的壓力,減小了血流對瘤體壁的沖擊力,瘤體進一步擴張和發(fā)生破裂的風險因此而降低;⑵在數(shù)值模擬實驗中,多層密網(wǎng)支架的置入可在一定程度上降低瘤體內血流流速、瘤腔內壓力以及瘤體的壁面切應力;⑶多層密網(wǎng)支架置入后,改變了瘤腔內的各種血流動力學因素,其中瘤腔內的血流流態(tài)由大量渦流變?yōu)閷恿?⑷在主動脈瘤模型中,多層密網(wǎng)支架的置入對于分支血管的供血影響較小,能夠在一定程度上保證分支血管的暢通。⑸動物實驗表明,多層密網(wǎng)支架可在一定時間內能夠保持腹主動脈及分支血管的通暢性,且與密網(wǎng)支架的層數(shù)無關,同時該支架可以在腹主動脈內緊密貼附固定,不會發(fā)生移位、彎曲、打折,此外支架的鎳鈦合金材料具有良好的生物相容性,植入生物體內安全可靠。上述一系列實驗均證明了多層密網(wǎng)支架可以在短期內降低主動脈瘤瘤腔內的血流流速、血流對瘤體的壓力和壁面剪切力,減小了瘤體破裂的可能性;此外該支架還可以改變瘤腔內的血流流態(tài),有利于瘤體內形成血栓,使后者機化以縮小瘤體并防止其發(fā)生擴張和破裂;更重要的是,其能夠保證瘤體上分支血管的暢通,維持相應臟器的血供,且其生物相容性較好。因此,多層密網(wǎng)支架具有在一段時間內治療主動脈瘤的理論可行性,但其長期效果和臨床表現(xiàn)需后續(xù)的臨床試驗來進行分析研究。
[Abstract]:The incidence of aortic aneurysm is increasing year by year, and the mortality is higher and the prognosis is poor. Aortic endovascular repair using covered stent to isolate the tumor, small trauma, and good curative effect, but its use is often limited by the branch of the aorta. In recent years, a new type of stent, that is, multi-layer dense network stent, can reduce the tumor. The pressure of the vascular wall of the body induces a thrombus in the lumen of the tumor to narrow the tumor and reduce the risk of rupture. It can achieve the effect of the traditional covered stent in the treatment of aortic aneurysm. It can also not clog the branch vessels on the hemangioma and guide the blood flow into the branch. There are few follow-up data, and the domestic research in this field is in the initial stage, and the mechanism of treatment is still to be studied. Therefore, this study intends to analyze the hemodynamic effects of multi-layer dense network stent on the tumor and branch vessels through numerical simulation and experiment of fluid mechanics. The volume includes: (1) establishing the digital model of human aortic aneurysm, simulating the multi-layer dense network stent, analyzing the changes of the hemodynamic parameters, such as the pressure of the tumor body and the branch vessel, the velocity field and so on. (2) making the aortic aneurysm model according to the medical data, using constant flow experiment to measure the pressure in the tumor, and analyze the change of the tumor. In order to study the hemodynamic changes in the aortic aneurysm model, the pressure verification experiment and fluid field experiment were carried out to study the hemodynamic changes in the model of the aortic aneurysm. 4. In vivo, the vascular compatibility in the body, the effectiveness of maintaining the patency of the branch vessel and the hemodynamic changes were analyzed. According to the above hemodynamic experiments and the results of animal experiments, the results of the multi-layer dense network stent not only reduce the impact of blood flow on the tumor in the tumor body, change the flow field, induce thrombus formation, but also guarantee the mechanism of the smooth branch of the branch to carry out a preliminary analysis of the fluid mechanics. The results are as follows: (1) the multilayer density The stent implantation can reduce the pressure of blood flow to the wall of the tumor in a certain degree, reduce the impact force of the blood flow on the wall of the tumor, and reduce the risk of further expansion and rupture of the tumor. 2. In the numerical simulation experiment, the placement of multi-layer dense mesh scaffold can reduce the flow velocity in the tumor in a certain degree and pressure in the tumor. Force and the wall shear stress of the tumor; 3. After the stent implantation, various hemodynamic factors in the lumen of the tumor are changed, in which the flow flow in the tumor is transformed from a large number of swirl into laminar flow. 4. In the aortic aneurysm model, the placement of multi-layer dense mesh scaffold has little influence on the blood supply of the branch vessel, and can be guaranteed to a certain extent. The animal experiments show that the multi-layer dense network stent can maintain the patency of the abdominal aorta and the branch vessels for a certain time, and has nothing to do with the number of the dense network stent. At the same time, the stent can be tightly attached to the abdominal aorta, without displacement, bending, and discounts. In addition, the nickel titanium alloy material of the scaffold has a good effect. A series of experiments demonstrate that the flow velocity of the aneurysm in the aneurysm can be reduced in a short period of time. The pressure and wall shear force of the blood flow to the tumor can reduce the possibility of the rupture of the tumor, and the stent can also change the flow flow in the lumen of the tumor. It is beneficial to the formation of thrombus in the tumor, which makes the latter machine to narrow the tumor and prevent its expansion and rupture, and more importantly, it can ensure the smooth flow of the branch vessels on the tumor and maintain the blood supply of the corresponding organs, and its biocompatibility is good. Therefore, the multi-layer dense network stent has the theoretical feasibility for the treatment of the aortic aneurysm for a period of time. However, its long-term effects and clinical manifestations need further clinical trials.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R543.16
[Abstract]:The incidence of aortic aneurysm is increasing year by year, and the mortality is higher and the prognosis is poor. Aortic endovascular repair using covered stent to isolate the tumor, small trauma, and good curative effect, but its use is often limited by the branch of the aorta. In recent years, a new type of stent, that is, multi-layer dense network stent, can reduce the tumor. The pressure of the vascular wall of the body induces a thrombus in the lumen of the tumor to narrow the tumor and reduce the risk of rupture. It can achieve the effect of the traditional covered stent in the treatment of aortic aneurysm. It can also not clog the branch vessels on the hemangioma and guide the blood flow into the branch. There are few follow-up data, and the domestic research in this field is in the initial stage, and the mechanism of treatment is still to be studied. Therefore, this study intends to analyze the hemodynamic effects of multi-layer dense network stent on the tumor and branch vessels through numerical simulation and experiment of fluid mechanics. The volume includes: (1) establishing the digital model of human aortic aneurysm, simulating the multi-layer dense network stent, analyzing the changes of the hemodynamic parameters, such as the pressure of the tumor body and the branch vessel, the velocity field and so on. (2) making the aortic aneurysm model according to the medical data, using constant flow experiment to measure the pressure in the tumor, and analyze the change of the tumor. In order to study the hemodynamic changes in the aortic aneurysm model, the pressure verification experiment and fluid field experiment were carried out to study the hemodynamic changes in the model of the aortic aneurysm. 4. In vivo, the vascular compatibility in the body, the effectiveness of maintaining the patency of the branch vessel and the hemodynamic changes were analyzed. According to the above hemodynamic experiments and the results of animal experiments, the results of the multi-layer dense network stent not only reduce the impact of blood flow on the tumor in the tumor body, change the flow field, induce thrombus formation, but also guarantee the mechanism of the smooth branch of the branch to carry out a preliminary analysis of the fluid mechanics. The results are as follows: (1) the multilayer density The stent implantation can reduce the pressure of blood flow to the wall of the tumor in a certain degree, reduce the impact force of the blood flow on the wall of the tumor, and reduce the risk of further expansion and rupture of the tumor. 2. In the numerical simulation experiment, the placement of multi-layer dense mesh scaffold can reduce the flow velocity in the tumor in a certain degree and pressure in the tumor. Force and the wall shear stress of the tumor; 3. After the stent implantation, various hemodynamic factors in the lumen of the tumor are changed, in which the flow flow in the tumor is transformed from a large number of swirl into laminar flow. 4. In the aortic aneurysm model, the placement of multi-layer dense mesh scaffold has little influence on the blood supply of the branch vessel, and can be guaranteed to a certain extent. The animal experiments show that the multi-layer dense network stent can maintain the patency of the abdominal aorta and the branch vessels for a certain time, and has nothing to do with the number of the dense network stent. At the same time, the stent can be tightly attached to the abdominal aorta, without displacement, bending, and discounts. In addition, the nickel titanium alloy material of the scaffold has a good effect. A series of experiments demonstrate that the flow velocity of the aneurysm in the aneurysm can be reduced in a short period of time. The pressure and wall shear force of the blood flow to the tumor can reduce the possibility of the rupture of the tumor, and the stent can also change the flow flow in the lumen of the tumor. It is beneficial to the formation of thrombus in the tumor, which makes the latter machine to narrow the tumor and prevent its expansion and rupture, and more importantly, it can ensure the smooth flow of the branch vessels on the tumor and maintain the blood supply of the corresponding organs, and its biocompatibility is good. Therefore, the multi-layer dense network stent has the theoretical feasibility for the treatment of the aortic aneurysm for a period of time. However, its long-term effects and clinical manifestations need further clinical trials.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R543.16
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