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人工心臟泵輔助對左心室血流動力學影響的數(shù)值研究

Numerical research of the artificial heart blood pump’s effect on left ventricular hemodynamics

作者: 陳佳  王得水  谷凱云  高斌  萬峰  常宇                         
單位:                                 北京工業(yè)大學生命科學與生物工程學院(北京100124)            
關鍵詞:                               心力衰竭;人工心臟泵輔助;計算流體力學;血流動力學             
分類號:
出版年·卷·期(頁碼):2015·34·4(331-339)
摘要:

目的 采用數(shù)值模擬方法研究人工心臟輔助裝置植入對左心室內(nèi)血流動力學的影響。方法 首先利用心血管集中參數(shù)模型獲取了健康狀態(tài)、心衰狀態(tài)以及人工心臟泵輔助狀態(tài)下收縮末期左心室三維幾何模型,其中選取超彈性材料Ogden為心肌材料,以左心房壓力,主動脈壓力以及通過左心室容積計算獲取的左心室壁面位移作為邊界條件,利用CFD方法對上述三種情況進行左心室的數(shù)值模擬。同時對比了健康時的模擬結果和生理狀態(tài)下的左心室壓力,以及心衰和人工心臟泵輔助兩種狀態(tài)下的血流動力學指標的差別。通過左心室壓力和流速等評價灌注和負荷的情況,通過壁面切應力和渦流,評價人工心臟泵輔助后的左心室血流動力學變化規(guī)律。結果 健康狀態(tài)下模擬的左心室壓力與生理指標相符合。在心衰和人工心臟泵輔助狀態(tài)下,收縮期內(nèi)左心室壓力與健康狀態(tài)比分別降低了1718Pa和8455Pa,輔助后左心室最大壓力下降速度高于心衰時。人工心臟泵輔助后,舒張期壁面切應力峰值由4.3Pa降低至3.8Pa,收縮期壁面切應力峰值由4.1Pa降低至1.3Pa,射血速度峰值由1.61m/s降低至0.68m/s,主動脈瓣開放時間由0.25s增加至0.65s,左室射血分數(shù)由43.6%增加至52.7%,心室底端漩渦持續(xù)時間由0.35s增加至0.51s,頂端漩渦出現(xiàn)血流分離。結論 左心室壓力對比表明本研究方法可以用來模擬左心室的行為。人工心臟泵輔助能夠快速降低心室內(nèi)壓力和心室負荷,增加灌注時間,提高器官灌注,降低左心室壁面切應力以及提高左心室內(nèi)血液流場的渦流強度,延長渦流持續(xù)時間。

Objective This work focused on the hemodynamic (velocity, pressure, wall shear stress, vortex) effect of artificial heart blood pump on the left ventricle by the means of numerical simulation. Methods The left atrial pressure, aortic pressure and the left ventricular volume of the 3 situations (healthy, heart failure, assisted) were derived from the lumped parameter cardiovascular model, which was used as the boundary conditions. Then we used the volume data to build 3D geometry models of the 3 situations at end-systole phase. In the work, the hyper-elastic material Ogden was chosen to stand for myocardium. We carried out the numerical simulation by the means of computational fluid dynamics (CFD), compared the left ventricular pressure (LVP) in simulation and physiology, and the hemodynamic index between the heart failure (HF) and artificial heart blood pump assisted situations. The LVP and the velocity were used to evaluate the perfusion and ventricular unloading, while the wall shear stress (WSS) and vortex were used to evaluate the flow pattern. Results The LVP of the simulation and the physiology in healthy situation were the same. The pressure dropped 1788Pa and 1455Pa respectively in heart failure and assisted situations during the systole and the pressure drop speed was much higher in assisted situation. The peak WSS were 4.3Pa and 3.8Pa during diastole, 4.1Pa and 1.3Pa during systole in HF and assisted situations. The peak velocities were 1.61m/s and 0.68m/s in HF and assisted situations during systole, yet the duration of ejecting were 0.25s and 0.65s. As a result, the left ventricular ejection fraction (LVEF) increased from 43.6% to 52.7%. The existence duration of lower vortex increased from 0.35s to 0.51s in HF and assisted situations, and the blood separated from the upper vortex in assisted situation. Conclusions The LVP in simulation and physiology were the same, demonstrating the simulation method available. The artificial heart blood pump assisted can help to decrease the LVP and the ventricular load, extend the ejecting duration and improve perfusion. What’s more, it can reduce the WSS, enhance the vortex and extend the duration of vortex existence.

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