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不同冠脈后負(fù)荷下競(jìng)爭(zhēng)流對(duì)左乳內(nèi)動(dòng)脈橋血流動(dòng)力學(xué)影響

Effect of competitive flow on hemodynamics of the left internal mammary artery grafting with different afterload

作者: 李蘭蘭  劉有軍  毛伯?  張慧霞 
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)
關(guān)鍵詞: 冠脈搭橋手術(shù);后負(fù)荷;競(jìng)爭(zhēng)流;遠(yuǎn)期通透性;血流動(dòng)力學(xué);計(jì)算流體力學(xué) 
分類號(hào):R318.04
出版年·卷·期(頁(yè)碼):2016·35·4(331-338)
摘要:

目的 研究冠狀動(dòng)脈在不同后負(fù)荷條件下,冠脈搭橋手術(shù)后競(jìng)爭(zhēng)流對(duì)左乳內(nèi)動(dòng)脈(left internal mammary artery, LIMA)血流動(dòng)力學(xué)影響。方法 模擬LIMA到前降支(left anterior descending, LAD)搭橋手術(shù)三維模型(three-dimensional, 3D),建立與冠脈模型相對(duì)應(yīng)的集中參數(shù)模型(lumped parameter model, LPM, 0D),為其提供1倍和1.2倍兩種不同后負(fù)荷的邊界條件,同時(shí)在LAD主干處設(shè)置了25%、40%、50%、60%、75%5種不同直徑狹窄程度,使用計(jì)算流體力學(xué)(computational fluid dynamics, CFD)耦合計(jì)算冠脈3D模型和0D模型,從血流動(dòng)力學(xué)角度分析不同后負(fù)荷時(shí)競(jìng)爭(zhēng)流對(duì)LIMA的影響。結(jié)果 1倍后負(fù)荷時(shí),LAD總流量約為80mL/min,隨狹窄率增加,RC/G從2.025減小到0.280,LIMA平均血流量從26.598mL/min增加到62.310mL/min,震蕩剪切指數(shù)(oscillatory shear index, OSI)從0.1557減小到0.0020,狹窄率小于50%時(shí), 時(shí)間平均壁面切應(yīng)力(time-average wall shear stress, TAWSS)低于1Pa;1.2倍后負(fù)荷模型中,LAD總流量為71mL/min,隨狹窄率增加,RC/G從2.222減小到0.289,LIMA平均血流量從22.188mL/min增加到54.810mL/min,OSI從0.1790降低到0.0024,狹窄率小于60%時(shí)TAWSS低于1Pa。后負(fù)荷改變時(shí),相同狹窄程度下橋血管在收縮期血流量變化很小,但舒張期流量隨后負(fù)荷增大而減小。結(jié)論 當(dāng)冠脈后負(fù)荷較大時(shí),競(jìng)爭(zhēng)流強(qiáng)度偏大。當(dāng)血管管徑和狹窄程度都相同時(shí),后負(fù)荷大的患者LIMA橋血管會(huì)因偏低的WSS和較高的OSI更容易引起“線性征”,降低橋血管遠(yuǎn)期通透性。

Objective To analyze the influence of competitive flow on hemodynamics of left internal mammary artery graft after coronary artery bypass grafting (CABG) with different afterload. Methods Three-dimensional (3D) models of left internal mammary artery (LIMA) to left anterior descending (LAD) grafting the were reconstructed, and 1 afterload and 1.2 afterload boundary conditions of these models were provided by the lumped parameter model (LPM, 0D) of cardiovascular circulatory system. Meanwhile, five different stenoses at the trunk of LAD were reconstructed, including 25%, 40%, 50%, 60%, 75%. Finally, 3D model and 0D model were coupled by computational fluid dynamics (CFD) to observe the influence of competitive flow with different afterload on LIMA. Results For 1 afterload, flow rate of LAD was 80mL/min, and with stenosis increasing, RC/G decreased from 2.025 to 0.280, mean flow rate of LIMA ranged from 26.598mL/min to 62.310mL/min, oscillatory shear index (OSI) decreased from 0.1557 to 0.0020, and time-average wall shear stress (TAWSS) was <1Pa when the stenosis was less than 50%. For 1.2 afterload, flow rate of LAD was 71mL/min, and with stenosis increasing, RC/G decreased from 2.222 to 0.289, mean flow rate of LIMA ranged from 22.188mL/min to 54.810mL/min, OSI decreased from 0.1790 to 0.0024, and TAWSS was <1Pa when the stenosis was less than 60%. When the afterload of coronary was different, flow rate in systole changed little with the same stenosis, however in diastole, flow rate of LIMA decreased with the afterload increasing. Conclusions When the afterload of coronary increases, intensity of competitive flow increases. If the vascular diameter and stenosis of coronary are all the same for different patients, “string phenomenon” may appear in LIMA graft with high afterload because of lower WSS and higher OSI, which may reduce the long-term patency of the graft.

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