【摘要】：Glenn手術是單心室缺陷綜合征姑息性手術Fontan手術的第二步。Glenn手術是將上腔靜脈與肺動脈進行端側吻合,上腔靜脈血直接流入左右肺動脈進入肺部,進行血氧交換,而不與肺靜脈的動脈血混合,從而減輕紫紺癥狀。血流動力學因素是影響心血管疾病手術后恢復的重要因素。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脈狹窄。不同的肺動脈狹窄程度會造成不同的血流情況,影響病人術后左右肺的分流量和能量損耗等血管發(fā)育的生理需求,增加單心室負荷,在血流動力學角度上也會造成不良的血流動力學因素,可能會影響手術成功率及手術長期有效性。目前臨床上實施手術主要依據(jù)二維醫(yī)學圖像和臨床醫(yī)生的手術經(jīng)驗,缺乏手術前血流動力學理論指導。而基于血流動力學理論,運用幾何多尺度方法實現(xiàn)手術規(guī)劃,可得到臨床上關心的血流動力學參數(shù)及指標,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,構建肺動脈不同狹窄的Glenn手術三維模型,以分析比較不同的肺動脈狹窄對Glenn術后血流動力學的影響;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,確定集中參數(shù)模型各個元件的參數(shù);3、將上述三維模型代替到集中參數(shù)模型相應的部分,進行幾何多尺度的耦合,通過對四種不同肺動脈狹窄程度的Glenn術后模型進行仿真,從血流動力學角度對比不同狹窄程度對病人術后發(fā)展的影響;4、制作Glenn手術透明模型,在數(shù)值模擬基礎上初步進行幾組穩(wěn)態(tài)PIV試驗。研究結果表明:病人不同的血管發(fā)育情況對單心室病人Glenn手術后的血管恢復有重要的影響。對于伴隨單邊肺動脈狹窄的單心室病人,隨著狹窄程度的增加,研究結果呈現(xiàn)了左肺動脈逐漸減小的分流率和逐漸增高的能量損耗,并當狹窄為75%或高于75%時,左肺動脈的分流急劇下降,能量損耗也遠遠高于狹窄程度較小的模型,且分布較大面積的高OSI區(qū)域。這些血流動力學參數(shù)均表明在同一Glenn手術方式下,左肺動脈狹窄程度為75%或高于75%時,狹窄對血管壁將產(chǎn)生不良的血流動力學影響。本研究對單心室病人在單邊肺動脈不同程度狹窄的情況下進行虛擬Glenn手術,數(shù)值模擬中所用幾何多尺度方法能夠準確為三維模型的數(shù)值計算提供近生理的邊界條件,在血流動力學角度上研究肺動脈不同狹窄對Glenn手術術后恢復的影響,并運用粒子圖像測速(Particle Image Velocimetry,PIV)技術對Glenn手術進行數(shù)值模擬研究的驗證。
[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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