中国医学前沿杂志（电子版）2025，Vol.17Issue(11)：64-72,9.DOI:10.12037/YXQY.2025.11-09
体外循环动脉置管策略对颈动脉灌注影响的计算流体力学分析
Computational fluid dynamics analysis of the effect of arterial cannulation strategy on carotid artery perfusion during cardiopulmonary bypass
摘要
Abstract
Objective Arterial cannulation strategies during cardiopulmonary bypass(CPB)critically influence end-organ perfusion efficacy.This study aimed to compare the effects of ascending aortic cannulation(AscAoC),femoral artery cannulation(FAC),and right axillary artery cannulation(rAxAC)on carotid artery(CarA)perfusion using computational fluid dynamics(CFD)simulations.Methods Three-dimensional aortic models were reconstructed from computed tomography(CT)imaging data of 62 cardiac surgery patients admitted to the 989 Hospital of the Joint Logistic Support Force from March 2021 to December 2024.Hemodynamic simulations were performed using the Ansys Fluent module.Consistency between CFD results and transcranial Doppler(TCD)clinical measurements was validated via Spearman correlation analysis(r=0.78,P=0.002).Kruskal-Wallis H tests was used to compare CarA perfusion characteristics across cannulation strategies,while multivariate logistic regression analyzed correlations between anatomical parameters(∠SC/∠SI angle ratio and cross-sectional area at the origin of the right subclavian artery,CSA-rSCA)and right CarA steal phenomenon in the rAxAC group.Results CFD simulations demonstrated that in the AscAoC group,the total bilateral CarA perfusion was(1 016.1±197.1)ml/min[left CarA(550.9±172.0)ml/min,right CarA(465.7±127.1)ml/min].Comparing the left and right sides,the perfusion volume on the left side was superior to that on the right side(P=0.002 3).In the FAC group,the total bilateral CarA perfusion volume was(1 562.2±340.1)ml/min[left CarA(795.7±198.6)ml/min,right CarA(766.6±195.4)ml/min].Comparison between the left and right sides showed no statistically significant difference(P=0.416 1).Comparing the total volumes between the two groups,the FAC group was higher than the AscAoC group(P<0.01).In the rAxAC group,the total bilateral CarA perfusion was(912.5±566.1)ml/min[left CarA(513.3±242.3)ml/min,right CarA 326.4(91.2,652.8)ml/min].Comparing the left and right sides,the perfusion volume on the left side was superior to that on the right side(P=0.005 8).Within this group,11 cases exhibited reverse blood flow in the right CarA perfusion.Multivariate analysis identified ∠SC/∠SI ratio as an independent predictor of right CarA steal(odds ratio OR=1.38×10-10,P<0.001).No retrograde blood flow were observed in either AscAoC or FAC groups.Conclusions AscAoC achieves near-physiological cerebral perfusion distribution,FAC delivers stable,bilaterally balanced flow less influenced by anatomy,but its higher total flow may carry hyper-perfusion risk.rAxAC perfusion instability is significantly influenced by local vascular anatomy.关键词
体外循环/颈动脉灌注/计算流体力学Key words
Cardiopulmonary bypass/Carotid perfusion/Computational fluid dynamics引用本文复制引用
卢圣勋,邢亚闯,刘杰,李景华,周胜凯,魏晋清,罗俊辉..体外循环动脉置管策略对颈动脉灌注影响的计算流体力学分析[J].中国医学前沿杂志（电子版）,2025,17(11):64-72,9.基金项目
河南省医学科技计划项目(LHGJ20250816) （LHGJ20250816）
洛阳市科技发展计划项目(医疗卫生)(2022002Y) （医疗卫生）
联勤保障部队第九八九医院院内课题项目(9892023YNKT-05B) Henan Provincial Medical Science and Technology Research Project(LHGJ20250816) （9892023YNKT-05B）
Luoyang Science and Technology Development Plan Project(Healthcare)(2022002Y) （Healthcare）
The 989 Hospital of the Joint Logistic Support Force(9892023YNKT-05B) （9892023YNKT-05B）
