体外反搏对典型冠状动脉疾病作用效果的集中参数建模仿真

目的 研究增强型体外反搏（enhanced external counter pulsation，EECP）疗法对典型冠脉血管病及微血管心绞痛的血流动力学影响。方法 使用集中参数建模方法，建立包含导管动脉与心肌微循环的右优势型冠脉生理模型。分别仿真单支狭窄、三支狭窄及微血管心绞痛等病理情况。建立EECP干预模型，结合上述病理模型，仿真EECP对病理模型的血流动力学作用。结果 建立的冠脉生理模型、病理模型及EECP干预模型仿真结果与相关文献中的实验数据相符合。EECP对3种病理情况都有改善冠脉血流的效果。对单支狭窄，EECP在左主干冠脉狭窄程度达到80%~85%之后便无法使血流恢复正常水平。对三支狭窄，若3条分支狭窄程度有1支超过90%，则无法使用EECP治疗。对微血管心绞痛，EECP有效的临界情况是充血心肌血流量>1.03 mL/（min·g）、冠状动脉血流储备>1.64。结论 建立的EECP干预冠脉血管病模型符合预期，所获仿真数据对EECP的临床操作具有一定参考价值。

Effects of External Counterpulsation on Typical Coronary Artery Diseases: A Lumped Parameter Model Study

Objective To study the hemodynamic effects of enhanced external counter pulsation (EECP) on typical coronary artery disease and microcirculation angina. Methods A physiological model of the right dominant coronary artery, including the coronary conduit arteries and coronary microcirculation, was established using lumped parameter models. Pathological conditions, such as one-vessel lesions, three-vessel lesions, and microcirculation angina, were simulated. EECP intervention models were established, and the hemodynamic effects of EECP on pathological models was simulated. Results The simulation results of the coronary physiological model, pathological models, and EECP intervention model established in this study were consistent with experimental data in related literature. EECP improved coronary blood flow in all three pathological conditions. For one-vessel lesions, EECP could not recover the blood flow of left main coronary artery to a normal level after the stenosis rate reached 80–85%. For three-vessel lesions, EECP treatment could not be used if the stenosis rate in one of the three vessels exceeded 90%. For microcirculation angina, EECP was effective when critical condition myocardial blood flow was >1.03 mL/min·g and coronary flow reserve was >1.64. Conclusions The model of coronary disease under EECP interference established in this study meets expectations, and the obtained simulation data have certain reference values for the clinical application of EECP.