本文選題：冠心病 + 個體化　； 參考：《首都醫(yī)科大學》2016年碩士論文

【摘要】：冠心病是指冠狀動脈粥樣硬化使管腔發(fā)生堵塞以及冠狀動脈功能性的改變,導致心肌缺血、缺氧而引起的心臟病,亦稱為缺血性心臟病。冠心病嚴重威脅著人類的健康,其預防、診斷和治療一直是臨床研究中一項迫切需要解決的重大課題。支架植入術是治療冠心病的一種有效手段,近年來得到了廣泛應用。其過程是將壓握在球囊導管的支架輸送到血管病變部位,通過施壓膨脹球囊使支架擴張變形以達到支撐血管的目的。目前,支架植入手術方案如支架尺寸、置入方案的選取等主要依靠造影二維顯像和臨床經(jīng)驗,缺乏必要的理論依據(jù),也無法直接獲取支架后冠脈的管腔幾何形變及內(nèi)部鋼梁分布與貼壁情況,預估病人的治療效果。而且人體存在個體差異性,不合理的支架手術方案可能引發(fā)術后并發(fā)癥如支架后再狹窄等。本論文立足于當前冠脈支架植入手術治療冠心病的現(xiàn)狀,期望建立一種基于個體化冠脈的球囊-支架系統(tǒng)模型,能夠更加真實的反映臨床中支架在狹窄冠脈段擴張及回彈服役的過程,從而更直觀地了解支架植入引起的管腔幾何形變、支架與血管的應力應變情況以及支架鋼梁的分布與貼壁情況等,為個性化的支架植入手術方案和療效預測提供一定的指導。論文的主要工作包括:針對球囊-支架系統(tǒng)擴張和回彈模擬中的球囊選擇,我們研究了不同球囊褶皺模型對支架擴張和回彈過程的影響。結(jié)合制造商提供的壓力-直徑順應性曲線驗證模擬的合理性,并引入“狗骨頭”率(DB)、軸向縮短率(LR)及徑向回彈率(RR)評估球囊-支架系統(tǒng)模擬結(jié)果的優(yōu)劣。結(jié)果表明,球囊的褶皺形態(tài)影響著支架的擴張和回彈,無褶球囊-支架系統(tǒng)的模擬效果最差,六褶錐形末端球囊-支架系統(tǒng)的模擬結(jié)果最符合制造商的數(shù)據(jù),支架擴張更加均勻,且DB、LR和RR都較低。因此,在有限元模擬中,為了更真實的模擬支架的擴張和回彈,球囊的褶皺和錐形末端的幾何特征不可忽略。在論文的第二大部分(第三章),我們根據(jù)患者的CT血管造影(CTA)影像重建右冠狀動脈模型,采用第一部分討論的六褶錐形末端球囊,進行基于個體化冠脈的球囊-支架系統(tǒng)共同擴張和回彈的耦合模擬,對有限元模擬的準靜態(tài)條件及臨床一致性進行了評估,并分析了管腔幾何支架前后的形變及支架擴張最大時刻和回彈服役時刻血管和支架的應力應變分布,最后對支架的定位情況進行了研究。評估結(jié)果發(fā)現(xiàn),計算模擬結(jié)果與臨床造影顯像具有良好的一致性。支架的植入使血管發(fā)生了一定程度的抻直形變,同時也很大程度上改變了血管的管腔直徑和管腔面積。血管的最大主應力分布主要集中在斑塊區(qū)域,在支架最大擴張程度下的應力值達到了血管的極限應力,可能有破裂的風險。支架受到的Mises應力最值出現(xiàn)在支撐體的拐彎處以及花冠間的連接處。在服役的最終時刻,我們還發(fā)現(xiàn)支架近端附近出現(xiàn)了接觸不良現(xiàn)象,這可能與回彈不完全和彎曲的幾何構(gòu)造相關。
[Abstract]:Coronary artery disease is a kind of coronary atherosclerosis that causes the obstruction of the cavity and the function of coronary artery, which leads to myocardial ischemia and hypoxia. It is also called ischemic heart disease. Coronary heart disease is a serious threat to human health. The prevention, diagnosis and treatment of coronary artery disease is an important lesson in clinical research. Stent implantation is an effective method for the treatment of coronary heart disease. It has been widely used in recent years. The process is to carry the stent in the balloon catheter to the site of vascular lesion, and to expand the stent by pressure expansion balloon to achieve the purpose of supporting the blood vessel. The selection is mainly dependent on the two-dimensional imaging and clinical experience, lack of the necessary theoretical basis, and can not directly obtain the geometric deformation of the cavities of the stent and the distribution of the internal steel beam and the adherence of the internal steel, and predict the treatment effect of the patients. Moreover, there are individual differences in the human body. The unreasonable stent operation may lead to postoperative complications. This paper, based on the current status of coronary stent implantation in the treatment of coronary heart disease, expects to establish a balloon stent system based on individualized coronary artery, which can more truly reflect the process of stent expansion and resilience in narrow coronary segments, thus more intuitively understanding of stent implantation. The geometric deformation of the cavity, the stress and strain of the stent and blood vessel, the distribution and the attachment of the support steel beam provide some guidance for the individualized stent implantation and the prediction of the effect. The main work of this paper includes: We studied the different spheres for the balloon stent system expansion and the selection of the balloon in the rebound simulation. The effect of the capsule fold model on the expansion and springback of the scaffold. Combined with the pressure diameter compliance curve provided by the manufacturer to verify the rationality of the simulation, and the introduction of the "dog bone" rate (DB), the axial shortening rate (LR) and radial rebound rate (RR) to evaluate the simulation results of the balloon stent system. The results show that the fold shape of the balloon affects the support. The expansion and rebound of the frame, the least simulated effect of the folds of the balloon stent system, the simulation results of the six fold tapered end balloon stent system most conform to the manufacturer's data, the stent expansion is more uniform, and the DB, LR and RR are lower. Therefore, in the finite element simulation, the folds and cones of the balloon are in the form of more real simulation of the expansion and rebound of the scaffold. The geometric features of the end can not be ignored. In the second part of the paper (third chapter), we reconstruct the right coronary artery model based on the CT angiography (CTA) image of the patient, and use the six fold tapered terminal balloon discussed in the first part to simulate the joint expansion and rebound of the balloon support system based on the individual coronary artery, and to the finite element. The quasi static condition and clinical consistency of the simulation were evaluated. The deformation of the stent, the maximum time of stent expansion and the stress and strain distribution of the stent were analyzed. Finally, the position of the stent was studied. The results were presented, and the results of calculation and clinical imaging were calculated. Good consistency. The implantation of the stent causes a certain degree of straightening of the blood vessel, and it also greatly changes the diameter of the lumen and the cavity area of the vessel. The distribution of the maximum principal stress in the blood vessel is mainly concentrated in the patch area. The stress value under the maximum expansion of the stent has reached the ultimate stress of the blood vessel, and may have broken down. Risk. The Mises stress of the scaffold is most valued at the bend of the support and the junction between the corolla. At the end of the service, we also found that there was a bad contact near the proximal end of the support, which may be related to the incomplete and curved geometry of the springback.

【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R541.4

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