离心泵的研制及体外循环的初步应用探讨

离心泵已被用于辅助循环及体外循环。本文报告自行设计的离心泵并初步应用于体外循环。本离心泵分泵头及驱动装置两个部分,二者之间是以磁性体相互吸附连接带动,血液由泵头中央进入离心室,随叶片的高速旋转而产生离心力将血液推出泵周出口。泵头是根据国内材料及加工工艺设计,叶轮采用6个叶片和2个碟片胶合而成,转速为0～3 600r/min,出口压力为0～79.98kPa(0～600mmHg),最大流量为81/min,预充量为34ml,泵接头直径为9.5mm(3/8吋)。 离体血细胞破坏试验是摸拟体外循环条件,流量在21/min以上时离心泵比滚柱泵对血细胞破坏明显减少。动物实验结果离心泵转流180分钟后游离血红蛋白平均上升6.04％(土6.06％),滚柱泵转流相同时间则上升为32.24％(士32.25％),证明离心泵比滚柱泵对血细胞破坏明显减少。临床初步应用,对10例15～20kg体重患儿进行体外循环下室缺修补术,流量为1.8～2.5l/min,泵出压为17.3～20kPa(130～150mmHg),灌注压为3.07～4.67kPa(23～35mmHg),转流时间为30～50分钟,转速为2 000～2 500r/min,结果均自动复跳,无血色素尿;术后4小时拔除气管插管,无其它并发症,说明本离心泵具备用于体外循环的条件。     

人工心脏圆盘泵的流动特性研究

人工心脏（血泵）一直存在泵体对血细胞剪切力过大和流速过快容易引起溶血的问题。为了研究人体正常血压情况下,血泵内部剪切力和速度场的分布情况,选择圆盘泵叶轮代替传统离心泵叶轮,对两种模型进行数值计算,分析不同叶轮内部剪切力和速度场的分布规律。研究表明传统离心泵内部流速高,叶片表面剪切力大,对血细胞的伤害大。圆盘泵相比传统离心泵,剪切力更小,流场速度分布均匀,流速更小。和传统离心泵相比,不同转速下圆盘泵能降低溶血的发生率。圆盘泵叶片数为6片时,抗溶血性能更好。研究结果为血泵的优化提供理论依据。     

旋转血泵产生低溶血搏动流的方法

为减少心室辅助装置中叶轮泵输出搏动流对血液成分的破坏作用,我们将泵的入口和叶轮外形轮廓设计成锥形,研制出博动流轴流泵;并设计出扭曲形叶片的叶轮,周期性的改变叶轮的转速,研制出搏动流离心泵。理论分析和实验表明这两种类型的装置均无明显附加紊流产生,也没有对血液成分产生破坏,具有较强实用性。     

基于粒子图像测速技术的血泵内流场研究

自制外触发同步系统,应用二维粒子图像测速技术技术(PIV)实现了流线型叶轮血泵和直叶片叶轮血泵的内流场的测量,并分析叶轮设计和运行条件对血泵内流场和血液相容性的影响.实验结果表明:基于外触发同步的PIV系统实现了对血泵同一流道的流速信息的连续采样;血泵内的绝对速度和相对速度分布随着叶轮设计、流量和进出口压差而改变.在设计工况(4 L/min,100 mmHg)下,流线型叶轮血泵流道内的流动模式较为规则,而直叶片血泵的流动模式则出现了明显的旋涡、回流和流动分离等现象.根据血液动力学理论,在设计工况下,流线型叶轮血泵具有较好的血液相容性.     

XZ-Ⅱ型轴流血泵的流场分析

血液破坏是目前影响国产心室辅助装置(ventricular assist device,VAD)不能临床应用的主要障碍.方法本文中采用计算机辅助设计(computer-aided design,CAD)工具设计XZ-Ⅱ型轴流血泵,并用计算流体力学(computationalfluid dynamics,CFD)方法进行泵内流场分析对VAD进行血液相容性研究.结果①血泵的压力流量输出可以满足心室辅助的要求;②流场中的最大剪切率出现在叶轮入口的地方,在整个叶轮端面保持了较高的剪切率,而且随着转速升高,剪切率增大,流量增加,剪切率也增大;③在叶轮相对径向流速以较高速度旋转时,在入口附近,流场保持层流状态,接近转子时,出现周向剪切速度,转子和泵壁之间的流场出现了不对称性,中下壁面出现较大波动,在叶轮附近,流场发生剧烈的变化,在靠近轮毂的地方会出现湍流,叶片之间出现较大的分离涡流,在出口导流叶片与叶轮的相接区域,流动出现局部回流,在狭窄的交接区域,出现流动滞止,流体进入导流叶片时,流动方向在此急剧变化会引起流动分离,从而影响了出口流速和流动的稳定性;④叶轮与出口导叶片接触端面压力变化剧烈.结论叶轮内部、叶轮与导叶片连接部分、出口导叶片内部流场不稳定容易形成涡流和流动停滞,容易形成血栓;叶轮与出口导叶片连接端面以及叶轮内部剪切力较高,容易产生溶血.     

具有分流和悬臂叶片尾导的轴流血泵设计分析

根据中国终末期心衰患者对左心辅助泵辅助人体血液循环的要求,设计以3 L/min流量、100 mm Hg压升为设计点,流量范围为2～7 L/min的微型可植入轴流血泵。该血泵采用纺锤形的转子叶轮结构以及带分流叶片、悬臂叶片的尾导结构,以使血泵在较宽的压力流量范围内具有良好的溶血和抗血栓特性。本文用数值模拟及粒子成像测速(PIV)的方法分析血泵的水力学特性、流场及溶血特性。结果表明:血泵转速为7 000～11 000 r/min时,在2～7 L/min的流量范围内可提供60.0～151.3 mm Hg的压升;分流叶片抑制了尾导的尾缘吸力面处的流动分离;悬臂式叶片结构将转子叶片的叶尖间隙变为尾导叶片的叶根间隙,间隙的切线速度由6.2 m/s降至4.3～1.1 m/s;血泵的最大标量剪切应力值为897.3 Pa,平均剪切应力值为37.7 Pa;采用Heuser溶血模型得到的溶血指数为0.168%;PIV试验所得泵内尾导区域的流场速度分布与数值计算得到的流场特征吻合良好。本研究所设计的轴流血泵的尾导具有分流叶片和悬臂叶片,流道内血流无较大分离流动,降低了剪切力对血液的破坏,溶血性能良好,压力流量性能满足临床需要。     

叶片倒角对FDA标准血泵流场和溶血预测的影响

目的采用计算流体力学(computational fluid dynamics, CFD)方法研究FDA标准离心血泵叶片倒角对流场和溶血的影响。方法针对FDA标准离心泵,模拟3个工况下水力学性能、流场形态、溶血指数等血泵关键性能,并进一步比较叶片结构有、无倒角时对前述模拟结果造成的影响。结果血泵叶轮倒角对血泵压头(无倒角特征与有倒角特征压头计算值最大百分比差异为57.38%)、流场等均有影响,从而导致溶血预测值也有显著差别(两者最大误差超过1个数量级)。结论对叶轮进行有倒角处理有助于优化血泵的性能。研究结果对更好使用CFD辅助血泵的血液相容性设计具有重要意义。     

自体血逆预充技术在儿童体外循环中的血液保护作用

目的在使用目前儿童体外循环管路基础上,探讨自体血逆预充技术用于儿童体外循环对血液保护作用。方法选取60例体重在20～40kg之间体外循环下行择期心脏手术先心病患儿,分为自体血逆预充组（Rap组,n=30）和标准预充组（SP组,n=30）。自体Rap组在转机前进行Rap操作,对照组常规预充转机。记录所有患儿的一般临床资料、手术情况、术后监护室情况、不同时刻患儿红细胞压积（hematocrit,Hct）和围术期用血量。结果两组患儿一般资料和手术情况差异无统计学意义（P〉0.05）;Rap组预充液量明显减少（P〈0.05）;阻断升主动脉后10min时RAP组患儿Hct高于对照组（P〈0.05）;Rap组术中用血量和输血率均少于SP组,但差异无统计学意义（P〉0.05）,两组患儿术后恢复情况相比较差异无统计学意义（P〉0.05）。结论Rap技术用于儿童体外循环可以减少预充量,保持转机过程中较高的Hct。但对血液保护作用不明显,目前用于临床的儿童体外循环管路有待于进一步改进。     

深静脉取栓器流体动力碎栓数值模拟

目的采用数值模拟方法分析叶轮结构参数和使用参数对流场的影响,并藉此优化取栓器的设计及使用。方法首先利用血液静置冷藏获取血栓;然后通过水击实验获取不同冲击角度下血栓破碎的临界速度及速度梯度;最后采用计算流体力学方法对旋切式取栓器流场进行数值模拟,分析叶轮转速及叶片升角对流场的影响。结果不同水击角度下血栓破碎的临界速度均在5 m/s左右,临界速度梯度均为1 m/s;流场中有效速度(大于临界速度)所占比重与叶轮转速成正相关,与叶片升角成负相关,且速度梯度与叶轮转速成正相关。结论为了优化取栓器的设计,可在保证安全的前提下采用较大的叶轮转速及较小的叶片升角。     

植入式叶轮全人工心脏的原型设计

此装置具有一个两端均有输出轴的直流电机,左、右叶轮直接固定于输出轴上。有两个介于电机壳和泵壳之间的密封盒,每个密封盒内部都有磁铁——磁性流体结构,提供转子的非摩擦密封。由于不同的压力与流量比率,开式叶轮分别为混流型(左)和轴流型(右),两者都用新的三元理论的解析方法来设计,其扭曲的叶片形状由轴向螺旋线和径向对数螺旋线组合而成,以便减小血细胞的速度变化,降低泵中的雷诺切应力。随着电机周期性地改变转速,左泵和右泵同步地射血,产生符合生理条件的脉动流。泵输出通过改变电机平均电压来调节。两个泵的流量平衡是由叶轮泵的自动调节特性来实现的。根据叶轮辅助心脏的离体和在体试验结果,可知叶轮全人工心脏的溶血指标是可以接受的。     

基于CFD的液悬浮人工心脏泵叶轮入口优化分析

目的应用计算流体动力学方法(computational fluid dynamics,CFD)对离心式双向液力悬浮人工心脏血泵流场进行仿真分析,通过改进叶轮入口结构来改善血液在血泵的流动状态,从而提升其抗溶血性能。方法从影响血泵溶血性能的角度考虑,基于N-S方程和k-ε标准双方程湍流模型,应用软件FLUENT6.3对离心式人工心脏血泵流场进行数值模拟,分析在设计工况下,叶轮入口处的结构变化对泵内流场的影响,以及流场中最大速度与溶血水平之间的关系,并根据流场分析结果对血泵叶轮入口进行优化。结果经过优化,血泵内流场紊乱现象得到改善,影响溶血值的切应力和曝光时间均有所降低,溶血性能得到改善。同时,对于离心式双向液力悬浮血泵,在设计工况下,其流场中最大速度有作为流场优化过程中的直观指标参数的潜力。结论该研究的仿真分析可为离心式双向液力悬浮人工心脏的设计积累一定经验。     

Axial flow pump treatment during myocardial depression in calves: an invasive hemodynamic and echocardiographic tissue Doppler study

The aim of this study was to investigate flow characteristics and myocardial function after implantation of an axial pump left ventricular assist device while varying afterload and during progressive myocardial depression. Ten calves were included, seven of which fulfilled the protocol. Invasive hemodynamic monitoring and echocardiography with color-coded systolic tissue Doppler velocity (TD velocity) were used during prepump conditions, at three different pump speeds, during modification of the systemic vascular resistance (SVR), and during increasing degrees of beta-blockade. The TD velocity decreased with the myocardial function whereas left ventricular size, fractional shortening, and pump speed did not correlate significantly with the TD velocity. The TD velocity correlated significantly with native stroke volume, heart rate, SVR and cardiac output but none of these alone could explain more than 20% of the changes in TD velocity. The axial flow pump studied is effective in unloading the severely depressed heart and has a high capacity for maintaining an adequate cardiac output, regardless of differing hemodynamic conditions, pump speed or decreasing LV function. Echocardiography with volumetric rendering and TD velocity imaging are valuable tools for monitoring and quantifying residual myocardial function during pump treatment.     

Feasibility of a miniature centrifugal rotary blood pump for low-flow circulation in children and infants

In this study, a seal-less, tiny centrifugal rotary blood pump was designed for low-flow circulatory support in children and infants. The design was targeted to yield a compact and priming volume of 5 ml with a flow rate of 0.5-4 l/min against a head pressure of 40-100 mm Hg. To meet the design requirements, the first prototype had an impeller diameter of 30 mm with six straight vanes. The impeller was supported with a needle-type hydrodynamic bearing and was driven with a six-pole radial magnetic driver. The external pump dimensions included a pump head height of 20 mm, diameter of 49 mm, and priming volume of 5 ml. The weight was 150 g, including the motor driver. In the mock circulatory loop, using fresh porcine blood, the pump yielded a flow of 0.5-4.0 l/min against a head pressure of 40-100 mm Hg at a rotational speed of 1800-4000 rpm using 1/4" inflow and outflow conduits. The maximum flow and head pressure of 5.25 l/min and 244 mm Hg, respectively, were obtained at a rotational speed of 4400 rpm. The maximum electrical-to-hydraulic efficiency occurred at a flow rate of 1.5-3.5 l/min and at a rotational speed of 2000-4400 rpm. The normalized index of hemolysis, which was evaluated using fresh porcine blood, was 0.0076 g/100 l with the impeller in the down-mode and a bearing clearance of 0.1 mm. Further refinement in the bearing and magnetic coupler are required to improve the hemolytic performance of the pump. The durability of the needle-type hydrodynamic bearing and antithrombotic performance of the pump will be performed before clinical applications. The tiny centrifugal blood pump meets the flow requirements necessary to support the circulation of pediatric patients.     

A novel counterpulse drive mode of continuous-flow left ventricular assist devices can minimize intracircuit backward flow during pump weaning

Bridge to recovery has become a major goal after left-ventricular-assist-device (LVAD) implantation thanks to recent development in adjunctive therapies. Precise assessment of native heart function under minimum LVAD support is the key for successful LVAD explantation. However, weaning of centrifugal LVADs normally generates diastolic intracircuit backward flow. This retrograde flow may become excessive load for the native heart during off-pump test. The flow itself is an inevitable characteristic of centrifugal pumps. Therefore, evaluating this retrograde flow in vitro is of considerable significance, even if its amount is different from that in clinical settings. The purpose of this study was to assess diastolic backflow of continuous-flow centrifugal LVADs in a mock circulation model. A centrifugal LVAD (EVAHEART, Sun Medical Technology) was installed in a mock circulation model by the left ventricle uptake and the ascending aortic return. Pump flow was measured at the pump rotational speed of 1000, 1500, 2000, and 2500 rpm, and pulse rate of the virtual native heart was varied to 60, 90, and 120 beats/min. After data collection, pump flow was integrated, and forward and backward intracircuit flow were calculated. As a result, nonphysiological reverse flow of approximately 2.0 L/min exists at the rotational speed, providing 0 L/min mean pump flow. An ideal off-test trial condition should be realizing both ±0 L/min pump flow and no intracircuit backward flow at the same time. We are developing a novel EVAHEART drive mode that can change its rotational speed in synchronization with cardiac cycle with the aim of controlling this retrograde flow with the new drive mode and creating an ideal off-test condition.     

The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation

Aortic valve regurgitation (AR) is a serious complication under left ventricular assist device (LVAD) support. AR causes LVAD-left ventricular (LV) recirculation, which makes it difficult to continue LVAD support. However, the hemodynamics and myocardial oxygen metabolism of LVAD support with AR have not been clarified, especially, how pump rotation speed influences them. An animal model of LVAD with AR was newly developed, and how pump rotation speed influences hemodynamics and myocardial oxygen metabolism was examined in acute animal experiments. Five goats (55 ± 9.3 kg) underwent centrifugal type LVAD, EVAHEART implantation. The AR model was established by placing a vena cava filter in the aortic valve. Hemodynamic values and the myocardial oxygen consumption, delivery, and oxygen extraction ratio (O₂ER) were evaluated with changing pump rotation speeds with or without AR (AR+, AR?). AR+ was defined as Sellers classification 3 or greater. AR was successfully induced in five goats. Diastolic aortic pressure was significantly lower in AR+ than AR? (p = 0.026). Central venous pressure, mean left atrial pressure, and diastolic left ventricular pressure were significantly higher in AR+ than AR? (p = 0.010, 0.047, and 0.0083, respectively). Although systemic flow did not improve with increasing pump rotation speed, LVAD pump flow increased over systemic flow in AR+, which meant increasing pump rotation speed increased LVAD-LV recirculation and did not contribute to effective systemic circulation. O₂ER in AR? decreased with increasing pump rotation speed, but O₂ER in AR+ was hard to decrease. The O₂ER in AR+ correlated positively with the flow rate of LVAD-LV recirculation (p = 0.012). AR caused LVAD-LV recirculation that interfered with the cardiac assistance of LVAD support and made it ineffective to manage with high pump rotation speed.     

基于CFD技术的Sarns离心式血泵流动特性分析

目的应用专业计算流体动力学（computational fluid dynamics,CFD）分析软件FLUENT,对一种具有长短叶片的Sarns离心式血泵的内部流场进行三维数值模拟。方法利用Solidworks软件对Sams型血泵进行三维建模,然后对所建模型网格处理,通过选取标准,κ-ε湍流模型和SIMPLE算法,具体分析了内部流动状态、压力分布、壁面剪切力等流场特性。结果结果表明,该离心泵内部流场分布较不匀,叶片及血泵出口处有回流和旋涡现象,剪切力大小基本处于致红细胞破碎的临界状态之下,高转速下剪切力最大,主要分布在叶轮区域,但暴露时间极短,基本满足血液生理要求。结论该研究为Sarns血泵的进一步优化提供了理论基础。     

How to produce a pulsatile flow with low haemolysis?

It is evident that a pulsatile flow is important for blood circulation because the flow pulsatility can reduce the resistance of peripheral vessels. It is difficult, however, to produce a pulsatile flow with an impeller pump, since blood damage will occur when a pulsatile flow is produced. Further investigation has revealed that the main factor for blood damage is turbulence shear, which tears the membranes of red blood cells, resulting in free release of haemoglobin into the plasma, and consequently leads to haemolysis. Therefore, the question for developing a pulsatile impeller blood pump is: how to produce a pulsatile flow with low haemolysis? The authors have successively developed a pulsatile axial pump and a pulsatile centrifugal pump. In the pulsatile axial pump, the impeller reciprocates axially and rotates simultaneously. The reciprocation is driven by a pneumatic device and the rotation by a dc motor. For a pressure of 40 mm Hg pulsatility, about 50 mm axial reciprocating amplitude of the impeller is desirable. In order to reduce the axial amplitude, the pump inlet and the impeller both have cone-shaped heads, and the gap between the impeller and the inlet pipe changes by only 2 mm, that is the impeller reciprocates up to 2 mm and a pressure pulsatility of 40 mm Hg can be produced. As the impeller rotates with a constant speed, low turbulence in the pump may be expected. In the centrifugal pulsatile pump, the impeller changes its rotating speed periodically; the turbulence is reduced by designing an impeller with twisted vanes which enable the blood flow to change its direction rather than its magnitude during the periodic change of the rotating speed. In this way, a pulsatile flow is produced and the turbulence is minimized. Compared to the axial pulsatile pump, the centrifugal pulsatile pump needs only one driver and thus has more application possibilities. The centrifugal pulsatile pump has been used in animal experiments. The pump assisted the circulation of calves for several months without harm to the blood elements and the organ functions of the experimental animal. The experiments demonstrated that the pulsatile impeller pump is the most efficient pump for assisting heart recovery, because it can produce a pulsatile flow like a diaphragm pump and has no back flow as occurs in a non-pulsatile rotary pump; the former reduces the circulatory resistance and the latter increases the diastole pressure in aorta and thus increases the perfusion of coronary arteries of the natural heart.     

可植入旋转式心室辅助泵的现状及展望

可植入旋转式血泵主要包括离心泵及轴流泵;前利用离心力驱动血流时,泵转速2000～6000r／min,以非搏动血流为主,少数为搏动血流。动物实验最长存活23周。轴流泵利用高速旋转叶轮驱动血液。叶轮转速6000～20000r／min,以非搏动血流为主,最长动物实验存活6个月,近期可能应用于临床研究。同时介绍了血管内搏动性轴流泵一动力性主动脉瓣。另外还介绍了其它类型的旋转泵。并对可植入式旋转泵的研制提出了一些看法。     

基于fluent离心式血泵内流场仿真与结构优化

提高溶血性能,降低溶血率作为血泵性能优化的一个重要指标,对血泵的结构优化具有重要的指导意义。本文基于一款离心式血泵通过使用计算流体力学（CFD）技术,采用非结构化网格、N-S方程和标准K-ε湍流模型在fluent中模拟分析出不同工况下血泵流场内部的剪切力场、压力场等重要参数并根据叶轮流场数据分析,提出了4种不同的结构优化方案;并基于三维快速溶血预估模型计算出不同流量、不同叶轮结构下血泵的溶血性能。仿真结果显示:当叶片与叶轮径向夹角为45°,流量达到5 L/min、转速为2 100 r/min时,扬程为115 mmHg,溶血率达到0.022 1 g/100 L,优化后模型较原模型溶血率提升40.9%,满足人体泵血生理需求。实验结果显示:选用优化后结构进行实验分析,得到扬程的实验数据与仿真数据相互验证,进一步证实了该仿真结果的准确性。