远端侧-侧吻合冠脉搭桥术后血栓形成的数值模拟
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1.北京联合大学机器人学院;2.北京工业大学环境与生命学部

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Numerical Simulation of Thrombus Formation after Distal-End Side-to-Side Anastomosisfor Coronary Artery Bypass Grafting
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    摘要:

    目的 采用远端DESSA进行冠脉搭桥术时,桥血管远端将生成血栓,可能会造成不良事件。有的临床大夫对桥血管远端进行裁剪处理,有的保持桥血管远端形状不变。本文将对这两种不同处理方式对桥血管远端血栓生成情况进行数值模拟研究,以便对比两种术式的异同。方法 针对远端DESSA冠脉搭桥术,构建桥血管远端裁剪和不裁剪2种模型。使用生化反应的血液物质传输扩散模型,同时考虑血流动力学的切变率、流体滞留时间和血小板分布这几个参数,评估血栓形成的可能性,使用数值模拟方法探讨远端DESSA冠脉搭桥中血栓生长。结果 对于桥血管远端无裁剪处理的模型,血栓首先在桥血管远端内壁面上形成,随后向其内部生长, 直至血栓占满大部分桥血管远端区域,血栓进入稳定状态,体积不再变化,其值为15.051mm3。对于桥血管远端裁剪处理模型,生成血栓体积为7.352mm3,同远端无裁剪模型相比,生成血栓体积减小了51.2%。桥血管远端裁剪处理后,吻合口上方桥血管内壁上有血栓生成,壁厚约为0.16mm,其值为桥血管半径的10.65%。上述两种术式中,桥血管远端区域形成多个漩涡流(流速小于0.01m/s),促进桥血管远端血栓形成;计算结果和临床报道的血栓形成区域相一致。结论 临床远端DESSA的冠脉搭桥术时,对桥血管远端进行裁剪处理,减小了桥血管生成血栓体积,但吻合口上方桥血管壁面生成血栓对冠脉搭桥术后影响还需进一步研究。

    Abstract:

    Objective The use of distal-end side-to-side anastomosis for coronary artery bypass grafting, thrombus will be generated at the distal end of the graft, which may cause adverse events. Some clinical doctors cut the partial distal ends of the graft, and some keep the shape of the distal end of the graft unchanged. This article will study the difference in thrombus formation of the distal end of the graft with two different treatments for the distal end of graft. Methods For the distal-end side-to-side anastomosis coronary artery bypass grafting, two models were constructed. Distal end of the graft of one model was cut and the other wasn’t. Using hemodynamics combined with a blood substance transport and diffusion model that considers biochemical reactions, the parameters of shear rate, fluid residence time, and platelet distribution are used to evaluate the possibility of thrombus formation for a DESSA of coronary artery. Results For the model with no cutting treatment at the distal end of the graft, the thrombus is first formed on the inner wall of the distal end of the graft, and then grows inward until the thrombus occupies the most region of the graft. This means the formation of a stable thrombus, and the volume of the thrombus doesn’t change. Its volume is 15.05mm3. For the model with cutting treatment at the distal end of the graft, the final volume of the thrombus is 7.35mm3, which is 51.2% less than that of the model without distal end trimming of the graft. It is worth noting that thrombus is formed on the inner wall of the graft above the anastomosis for the model with distal end trimming of the graft, and the wall thickness is about 0.16 mm. Although 0.16mm is small, its value is 10.65% of the radius of the graft (1.50mm). In the above two procedures, multiple vortices (less than 0.01m/s) were formed in the distal region of the graft, which further promotes the thrombus formation in the distal end of the graft. The area of thrombus formation obtained from numerical simulation is consistent with the clinical investigation. Conclusion For clinical coronary artery bypass grafting with side-to-side anastomosis, the volume of the generated thrombus can be reduced for the model with the trimming of the distal end of the graft. However, the effect of thrombus formation on the inner wall of the graft above the anastomosis on coronary artery bypass graft needs further study.

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  • 收稿日期:2021-07-12
  • 最后修改日期:2021-09-02
  • 录用日期:2021-09-07
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