全身麻醉下个体化病人体温调节反应的计算机仿真
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Computer Simulation of Individualized Human Thermal Response during General Anesthesia
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    摘要:

    目的 通过构建计算机仿真模型分析全身麻醉引起的体温调节系统损伤和手术室低温环境对个体化病人围手术期体温调节的影响。方法 开发一个麻醉模型,通过降低基本代谢率、皮下血管收缩和骨骼肌颤抖的阈值来模拟麻醉效果,并耦合到作者建立的“皮肤-体核”二节点体温调节模型中。该模型可通过设置骨骼肌颤抖产热、出汗、及皮下血管舒缩能力的强弱模拟年龄衰老导致的热调节能力损伤,设置不同脂肪厚度模拟肥胖以及设置心血管模型参数模拟不同的心血管疾病,进而计算分析这些个体化特征对低温麻醉条件下体温调节的影响。结果 在低温环境下,与年轻人相比,老年人体核温度较低,体表温度较高。脂肪厚度增加或左心室功能衰竭加重,都有可能缓解低温环境中体核温度下降。风速或相对湿度增加会导致体核温度降低。当麻醉引起的血管收缩阈值降低0-5~3 ℃时,会引起体核温度显著降低。结论 通过对比模型预测与实验测量的结果,验证了该模型的可靠性。身体的个体化特征对低温环境下人体温度调节具有重要影响。个体体征与全身麻醉结合进一步复杂化了人体的体温调节,给临床医师带来巨大挑战。

    Abstract:

    Objective To analyze the effects of anesthesia-induced thermoregulatory system impairment and low temperature environment of the operating room on the perioperative thermoregulation of individualized patients by constructing a computer simulation model. Methods A simple anesthesia model was proposed and then incorporated into the self-developed individualized thermoregulatory model, in which human body was represented as a cylinder with two layers of the core and the skin. The integrated model could be used to assess the effects of individualized characteristics such as age, obesity, and cardiovascular diseases on thermoregulation by modifying different physiological parameters involving sweating, shivering and cutaneous vasomotion. Simulation of the general anesthesia effects on human thermoregulation could be achieved by reducing basal metabolic rate and thresholds for vasoconstriction and shivering. Results The elderly people showed lower core temperature but higher skin temperature, compared with the young people. In a low temperature environment, an increase in fat thickness or an increase in severity degree of the left ventricular failure (LVF) might alleviate the decrease in core temperature, while an increase in wind speed or relative humidity could result in a decrease in core temperature. When the threshold setting of vasoconstriction was reduced by 0-5-3 ℃, the core temperature showed a significant decrease. Conclusions By comparing model simulations with experimental measurements, the reliability and validity of the model in predicting human transient thermal responses during varying external thermal environment was verified. The individualized characteristics of human body had an important influence on human body temperature in a low temperature environment. Moreover, the combination of individualized characteristics of human body and general anesthesia further complicated the body′s thermoregulation and posed significant challenges for clinicians.

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俞快,张现成,刘浩.全身麻醉下个体化病人体温调节反应的计算机仿真[J].医用生物力学,2020,35(2):163-170

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  • 收稿日期:2019-01-21
  • 最后修改日期:2019-03-11
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  • 在线发布日期: 2020-04-27
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