體外循環中人工血管端對邊縫合於股動脈時夾角之探討

The Research of Included Angle on Artificial Vascular Graft End-to-Side Sutured to Femoral Artery for Extracorporeal Circulation

楊仲宇(Chung-Yu Yang)

指導教授 ： 張炎林

中原大學/工學院/生物醫學工程研究所/碩士(2014年)

https://doi.org/10.6840/CYCU.2014.00020

摘要

在已開發國家人口老化迅速，愈來愈多的老年患者需要執行心血管手術。此手術需要心肺繞道 (CPB)，而利用人工血管縫合在股動脈，當作體外循環(ECC)中的動脈插管，已成為現今主動脈手術及其他難以在升主動脈插管手術的方法之一 ; 此法可將充氧血從人工血管灌流入股動脈，然後再向上流入右頸總動脈及右椎動脈而提供符合生理的腦部保護。然而，究竟能對腦部分配多少血流量及分配至近端與遠端的灌注，一直是外科醫師最為關心的議題。我們假設人工血管與股動脈間的縫合夾角大小，是影響灌注流量分配至近端及遠端的主要因素。本研究首先選取一個健康人的電腦斷層影像，轉換成只保留從總頸動脈分岔位置至股動脈的三維影像，而製作成主動脈的假體，也包括將人工血管以不同夾角縫合在股動脈。實驗時，從人工血管灌注，以不同的縫合夾角(0°，15°，30°，45°，60°，75°與90°)進行試驗，應用非侵入式超音波流量計和侵入式壓敏電阻，分析在各分支出口測量的血液流量與壓力之分佈。得到當插管角度為15°時，2、3、4、5點往頭部的流量偏差加總為+0%，以確保腦部足夠血流，全身流量偏差與正常生理比較為42.5%，偏差最小，右/左下肢偏差為(-6.7%/+11.7%)，偏差最小，避免過度灌注和下肢缺血，為較理想的角度。當插管角度大於60°時，往頭部的偏差變大(-3.6%)，且右/左下肢流量分佈也越不平均(-10%/+26.7%)，而角度0°直接插管會使整體流量與壓力分配非常不平均。結論為當插管角度為15°時，是較理想的角度，此結果將有助於臨床上執行主動脈手術包含人工血管縫合角度之參考，以提升體外循環之安全性。

關鍵字

縫合角度 ； 總頸動脈分岔位置至股動脈假體 ； 血液流量分佈 ； 心肺繞道 ； 體外循環

並列摘要

Abstract
Because of the ratio of aged population is increasing in developed countries, more and more aged patients are undergoing cardiac surgery. Femoral artery cannulation by using a vascular graft sutured to the femoral artery as an arterial conduit for extracorporeal circulation (ECC) has become an alternative way of cardiopulmonary bypass (CPB)setup, especially for aortic surgery and for surgery that cannot establish arterial access from the ascending aorta. During CPB, physiological brain protection can be provided by selective brain perfusion via sending the oxygenated blood through the vascular graft to the femoral artery, and then upward into the right common carotid artery and the right vertebral artery. However, the fraction of blood flow distribution to the brain via this graft- femoral artery perfusion has been of major concern to the cardiovascular surgeons and perfusionists. In this study, a mock from common carotid artery to femoral artery model (made of expoxy resin) is reconstructed from an adult who did not have cardiovascular disease. A vascular graft with an anastomotic angle of θ is sutured to the femoral artery. Using this in vitro model, we analyze how different anastomotic angles of θ(0°,15°,30°,45°,60°,75° and 90°)affect the blood flow distribution during CPB. Also, transonic flowmeter (HT110) and arterial pressure monitor (HP) analysis is used to validate the flow and pressure distribution. When the cannula is angle of 15°, 2,3,4,5 points flow plus to the deviation of the head of the total flow is + 0%. In order to ensure adequate cerebral blood flow; systemic physiological comparison with the normal flow deviation of 42.5%, minimum deviation, right / left lower limb deviation (-6.7% / +11.7%) also the smallest deviation, to avoid hyperperfusion and ischemia of lower limb, is more satisfactory angle. When the cannula is greater than the angle of 60 °, to the deviation of the head becomes large (-3.6%), and the right / left lower limbs flow distribution are more uneven distribution (-10% / +26.7%), the angle of 0 ° direct cannulation make the overall flow and pressure distribution is very uneven distribution. In summary, when cannula angle of 15 °, the angle is more satisfactory. This results may be helpful to be used in aortic surgery including minimally invasive cardiac surgery, re-do cardiac operation and surgeries that calcified ascending aorta were encountered, and to increase the safety of ECC during CPB.

並列關鍵字

cardiopulmonary bypass ； blood flow distribution ； Anastomotic angle ； extracorporeal circulation ； mock from common carotid artery to femoral artery model

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