左心室局部心肌缺血时采用压力控制间歇闭塞冠状穴的仿真研究

SIMULATION STUDY OF PRESSURE CONTROLLED INTERMITTENT CORONARY SINUS OCCLUSION WHEN LEFT VENTRICLE SUFFERED REGIONAL ISCHEMIA

为了研究左心室局部心肌缺血时采用压力控制间歇闭塞冠状穴（ＰｒｅｓｓｕｒｅＣｏｎｔｒｏｌｅｄＩｎｔｅｒ－ｍｉｔｅｎｔＣｏｒｏｎａｒｙＳｉｎｕｓＯｃｃｌｕｓｉｏｎ，简称ＰＩＣＳＯ）对心血管系统一些重要血液动力学参量的影响以及对缺血心肌的挽救作用，我们建立了一个详细的冠脉循环模型和左心室局部心肌缺血时的组分式模型，并将它们纳入我们原有的心血管循环系统模型中。在计算机仿真实验中，我们考察了缺血心肌的弹性对ＰＩＣＳＯ辅助效果的影响以及ＰＩＣＳＯ的最佳闭塞／释放时间。仿真结果指出：缺血心肌损伤越严重，弹性越小，冠状穴闭塞（ＣＳＯ）期间缺血区域的毛细血管与静脉之间的前、后向血流就越小，ＰＩＣＳＯ的辅助效果也越小；ＣＳＯ不改变心肌的耗氧量，但ＣＳＯ期间的逆向血流能给心肌增加部分供氧量；ＰＩＣＳＯ的最佳闭塞／释放时间是一组使冠状动脉血流以及毛细血管与静脉之间的前、后向血都相对最大时的折中值。

Adetailed model of the regionally ischemic left ventricle and the coronary circulation with special regard to coronary sinus occlusion were established to investigate the effects of PICSO (Pressure Controlled Intermittent Coronary sinus occlusion) on some important hemodynamic variables of cardiovascular system and on salvaging ischemic myocardium when left ventricle suffered regional ischemia. In computer simulations, the effects of contractility of the ischemic myocardium on the efficacy of PICSO and the optimal occlusion/release time of PICSO were studied. The results indicated that: the lower the contractility of the ischemic myocardium was the smaller the forward and retrograde blood flow between capillary and veins were during CSO; oxygen consumption of the myocardium wouldn't be affected during CSO, however, the retrograde blood flow during CSO could enhance oxygen availarbility of the myocardium; the optimal occlusion/release time of PICSO is a compromise value at which the coronary arterial flow and the forward and retrograde flow between capillary and veins all get their relative maximal value.