摘要
目的探讨标准颈动脉内膜切除术(CEA)术后血管几何形态特征对血管内血流动力学状态的影响。方法回顾性收集2016年5月至2020年12月在海南省人民医院神经外科及血管外科行CEA的患者50例,所有患者均在术后一周内进行颈动脉CTA检查,测量并记录血管几何形态特征数据。利用Mimics、Geomagic等软件对患者术后CTA影像学资料进行颈动脉建模,采用Ansys Fluent进行计算流体力学(CFD)分析,定量测定颈动脉窦部外侧壁壁面剪切力(WSS)数据,定性判断血管内有无湍流现象的发生。比较Bulb/CCA管径比值≤1和>1两组患者在血管内是否形成湍流,对血管几何形态特征数据与颈动脉窦部外侧壁WSS数据进行Spearman相关性分析,将存在显著相关性的血管几何形态数据纳入多元线性回归分析;采用多重二元Logistic回归分析管腔内形成湍流的血管几何形态的独立危险因素。结果Bulb/CCA管径比值≤1和>1两组患者经χ2检验显示Bulb/CCA管径比值>1组的患者CEA术后血管腔内更容易产生湍流,差异具有统计学意义(P<0.05);经Spearman相关性分析结果显示:颈动脉窦部管径(r=-0.463,P<0.05)、颈动脉窦部与颈总动脉远段管径比值(r=-0.554,P<0.05)、颈内动脉和颈外动脉分叉角度(r=-0.361,P<0.05)与观测点WSS数值呈负相关;多元线性回归分析结果显示,颈动脉窦部管径(B=-0.161,P<0.05)与观测点WSS数值存在线性相关关系;多重二元Logistic回归分析结果显示,颈动脉窦管径和颈总动脉远段管径是CEA术后颈动脉管腔内产生湍流的独立危险因素(P<0.05)。结论CEA术后颈动脉血管几何形态影响血管内血流动力学状态,颈动脉窦管径、颈总动脉远段管径以及两者的比值对CEA术后管腔内的血流动力学状态有显著影响。
Objective To investigate the influence of vascular geometry on intravascular hemodynamics after standard carotid endarterectomy(CEA).Methods In this study,50 patients who underwent CEA in the Department of Neurosurgery and Department of Vascular Surgery,Hainan General Hospital from May 2016 to December 2020 were retrospectively collected.All patients underwent carotid artery CTA examination within one week after surgery to measure and record the geometric morphological characteristics of vessels.Based on the CTA imaging data,modeling was conducted on the carotid artery using Mimics,Geomagic,and other software,and then computational fluid dynamics(CFD)was performed using Ansys Fluent to quantitatively measure the WSS data of the external wall of the carotid sinus and qualitatively determine whether there was turbulence in the blood vessels.The Chi-square test was used to determine whether the difference of endovascular turbulence in subgroups of Bulb/CCA diameter ratio≤1 and>1 was significant.Spearman correlation analysis was performed on the vascular geometry characteristics data and the external wall WSS data of carotid sinus,and the vascular geometry data with significant correlation were included in multiple linear regression analysis.Multiple binary logistic regression was used to analyze the independent risk factors affecting the vascular geometry of turbulent flow.Results The Chi-square test of Bulb/CCA ratio≤1 and>1 showed that patients in Bulb/CCA ratio>1 group were more prone to endovascular turbulence after CEA,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that carotid sinus diameter(r=-0.463,P<0.05),carotid sinus diameter ratio to distal carotid artery diameter(r=-0.554,P<0.05),internal carotid artery and external carotid artery branching angle(r=-0.361,P<0.05)were negatively correlated with WSS values at the observation points.Multiple linear regression analysis showed that there was a linear correlation between carotid sinus diameter(B=-0.161,P<0.05
作者
安思龙
陈健龙
蔡仁端
符策锐
王振平
宋智勇
刘朝晖
AN Si-long;CHEN Jian-long;CAI Ren-duan;FU Ce-rui;WANG Zhen-ping;SONG Zhi-yong;LIU Zhao-hui(Hainan Medical University,Haikou 570311,Hainan,CHINA;Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,Hainan,CHINA;University of Science and Technology Beijing,Beijing 100083,CHINA)
出处
《海南医学》
CAS
2023年第15期2145-2149,共5页
Hainan Medical Journal
基金
海南省卫生健康行业科研项目(编号:20A200219)。
