北京生物醫(yī)學(xué)工程

V-A ECMO 的不同血流量對主動脈血流分布的數(shù)值研究

Numerical analysis of aortic blood flow distribution with different V-A ECMO blood flow

作者：藺暄淇谷凱云管志遠劉有軍

單位：北京工業(yè)大學(xué)生命科學(xué)與生物工程學(xué)院(北京100124) 北京大學(xué)第三醫(yī)院(北京 100191)

關(guān)鍵詞：血流動力學(xué); 心衰; 主動脈; 動靜脈體外膜肺氧合; 流固耦合

分類號：R318.01

出版年·卷·期（頁碼）：2020·39·4（350-356）

摘要：

目的不同血流量的動靜脈體外膜肺氧合 ( veno-arterial extracorporeal membrane oxygenation, V-A ECMO)對心臟、腦、腎臟和下肢血流灌注的血流動力學(xué)影響尚存在爭議。本文采用數(shù)值模擬的方法研究 V-A ECMO 不同血流量對主動脈血流分布的影響。方法基于患者 CT 圖像數(shù)據(jù),采用 MIMICS 軟件重建主動脈和 ECMO 插管模型,隨后進行網(wǎng)格劃分和邊界條件設(shè)定,通過 Adina 軟件進行流固耦合計算,分析心衰(heart failure,HF)。ECMO 輔助 1.0 L、1.5 L、2.0 L、2.5 L、3.0 L 的血流動力學(xué)變化,研究體外膜肺氧合的效果? 結(jié)果 ECMO 輔助后,增加了腦部?腎臟和下肢血流? 隨著 ECMO 血流量增加,血液交匯面向主動脈弓移動? 與其他輔助情況相比較,ECMO 3?? 0 L 時頭臂干血流量減少(HF vs. ECMO 1. 0 L vs. ECMO 1. 5 L vs. ECMO 2. 0 L vs. ECMO 2. 5 L vs. ECMO 3. 0 L:1 339. 3 mL / min Vs. 1 851. 49 mL / min vs. 2 027. 26 mL / min vs. 2 332. 07 mL / min vs. 2 611. 04 mL / min vs. 1 792. 64mL / min)。 ECMO 插管側(cè)即右側(cè)股動脈血流明顯減小,且隨 ECMO 血流量增大整體呈現(xiàn)先減小后增加的趨勢,而左側(cè)股動脈血流量隨 ECMO 血流量增加呈平緩增大的趨勢,兩側(cè)股動脈血流量最大相差 5.9倍(ECMO 2. 0 L:186.90 mL / min vs. 1 102.59 mL / min)。 ECMO 輔助后,降低了主動脈弓血流速度? 高血管壁應(yīng)力集中在主動脈內(nèi)側(cè)和頭臂干根部。ECMO 輔助后血管壁應(yīng)力發(fā)生改變,在血流量最大時刻(1. 696 s),最大應(yīng)力逐漸增加(0.60 MPa vs. 0.61 MPa vs. 0.62 MPa vs. 0.63 MPa vs. 0.64 MPa)。結(jié)論V-A ECMO 增加血液灌注,但血液交匯面對于腦血流量的影響值得關(guān)注。

Objective The hemodynamic effects of Veno-arterial extracorporeal pulmonary oxygenation ( V-AECMO ) with different blood flow on heart, brain,kidney, and lower limb blood perfusion are controversial.In view of this problem, this paper uses numerical simulation to study the influence of V-A ECMO under different blood flow on the aortic blood flow distribution.

Methods A three-dimensional reconstruction by MIMICS according to the CT image data of the patient was used to establish a finite element model of the aorta and ECMO. Then, the boundary conditions were set, Adina software was used to calculate hemodynamic changes of heart failure and ECMO-assisted 1.0 L, 1.5 L, 2.0 L, 2.5 L, and 3.0 L through fluid?solid coupling method to study the effect of extracorporeal membrane Oxygenation. Results ECMO increased blood flow to the brain, kidneys and lower limbs. As ECMO blood flow increased, the blood confluence moved toward the aortic arch. Compared with other auxiliary cases, the blood flow of brachiocephalic trunk decreased obviously during ECMO 3.0 L (HF vs. ECMO 1.0 L vs. ECMO 1.5 L Vs. ECMO 2.0 L vs. ECMO 2.5 L vs.ECMO 3.0 L:1 339.3 mL / min vs.1 851.49 mL / min vs. 2 027.26 mL /min vs. 2 332.07 mL / min vs. 2 611.04 mL / min vs. 1 792.64 mL / min). On the side of ECMO intubation, the right femoral arterial blood flow was significantly reduced, and as the ECMO blood flow increased, it showed a trend of first decrease and then increase, while the left femoral arterial blood flow increased gradually with the ECMO blood flow increase trend, the maximum difference in femoral artery blood flow on both sides was 5.9 times (ECMO 2.0 L:186.90 mL / min vs. 1 102.59 mL / min). After the ECMO adjuvant therapy, blood flow velocity of aortic arch decreased and high blood vessel wall stress built up at the inside of the aorta and the roots of the brachiocephalic trunk. After ECMO assisted, the blood vessel wall stress changed. At the time of maximum blood flow (1.696 s), the maximum stress gradually increased (0.60 MPa vs. 0.61 MPa vs. 0.62 MPa vs. 0.63 MPa vs. 0.64 MPa). Conclusions V-A ECMO increases blood perfusion, yet the effect of blood junctions on cerebral blood flow is worthy of attention.

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