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Article(id=1244321220599066815, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, articleNumber=null, orderNo=null, doi=10.16156/j.1004-7220.2025.05.020, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734624000000, receivedDateStr=2024-12-20, revisedDate=1740412800000, revisedDateStr=2025-02-25, acceptedDate=null, acceptedDateStr=null, onlineDate=1774598897361, onlineDateStr=2026-03-27, pubDate=1759248000000, pubDateStr=2025-10-01, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1774598897361, onlineIssueDateStr=2026-03-27, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1774598897361, creator=13701087609, updateTime=1774598897361, updator=13701087609, issue=Issue{id=1244321215637209904, tenantId=1146029695717560320, journalId=1244284848500682798, year='2025', volume='40', issue='5', pageStart='1079', pageEnd='1366', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1774598896178, creator=13701087609, updateTime=1774599509568, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1244323788452639476, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1244323788452639477, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1230, endPage=1238, ext={EN=ArticleExt(id=1244321221735723210, articleId=1244321220599066815, tenantId=1146029695717560320, journalId=1244284848500682798, language=EN, title=Hemodynamic Comparison of Different Cannulation Methods in Extracorporeal Membrane Oxygenation System, columnId=1244321216404767539, journalTitle=Journal of Medical Biomechanics, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effects and differences of two veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation methods and subsequent left ventricular unloading on cardiac function and hemodynamics.

Methods

The lumped parameter model (LPM) of VA-ECMO integrated with the cardiovascular system in the MATLAB/Simulink environment was extended to simulate and analyze the changes in ventricular function and blood flow in the heart failure patient model under central VA-ECMO or peripheral VA-ECMO support. The effects of using arterial vasodilators or a left atrial drainage cannula on left ventricular function under central VA-ECMO support at a pump flow rate of 3 L/min were compared.

Results

Under central VA-ECMO or peripheral VA-ECMO support, left ventricular pressure and volume increased, and stroke volume and ventricular work decreased. Both arterial vasodilators and the left atrial drainage cannula could reduce left ventricular pressure and volume. Arterial vasodilators additionally increased stroke volume and improved left ventricular ejection fraction from 11.6% to 19.5%.

Conclusions

Both VA-ECMO cannulation methods provide effective circulatory support in the heart failure patient model, with similar effects on ventricular function. Under central VA-ECMO support, arterial vasodilators can improve left ventricular function more effectively than the left atrial drainage cannula.

, correspAuthors=Dongsheng ZHANG, Lu HAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Yajing ZHANG, Dongsheng ZHANG, Lu HAN), CN=ArticleExt(id=1244321231260988083, articleId=1244321220599066815, tenantId=1146029695717560320, journalId=1244284848500682798, language=CN, title=体外膜肺氧合系统不同插管方式的血流动力学对比, columnId=1244321216576734006, journalTitle=医用生物力学, columnName=论著, runingTitle=null, highlight=null, articleAbstract=
目的

分析两种静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）插管方式及后续进行的左心室减压对心室功能和血流动力学的影响及差异。

方法

在MATLAB/Simulink环境中扩建VA-ECMO与心血管系统结合的集总参数模型，模拟分析心衰患者模型在中心VA-ECMO或外周VA-ECMO支持下的心室功能及血流变化。比较在泵流量为3 L/min的中心VA-ECMO支持下，使用动脉血管扩张药物或在左心房放置减压管对左心室功能的影响。

结果

在中心VA-ECMO或外周VA-ECMO支持下，左心室压力和容积均增大，每搏输出量和心室做功减少。动脉血管扩张药物和左心房减压管均能降低左心室压力和容积，其中动脉血管扩张药物可增加左心室每搏输出量，并将射血分数由11.6%提升至19.5%。

结论

两种VA-ECMO插管方式均能为心衰患者模型提供有效的循环支持，且对心室功能影响相似。中心VA-ECMO支持下，动脉血管扩张药物比左心房减压管更能改善左心室功能。

, correspAuthors=张东升, 韩露, authorNote=null, correspAuthorsNote=
张东升，教授，博士生导师，E-mail：；
韩露，助理研究员，E-mail：

*

为共同通信作者
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作者贡献声明：

张雅晶负责数值模拟、数据分析和论文初稿撰写；韩露负责论文研究设计、结果分析和论文指导；张东升负责论文审阅和论文指导。

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J Am Coll Cardiol, 2015, 66(23): 2663-2674., articleTitle=Hemodynamics of mechanical circulatory support, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1244321231542006481, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, xref=1., ext=[AuthorCompanyExt(id=1244321231550395091, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, companyId=1244321231542006481, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.Shanghai Key Laboratory of Mechanics in Energy Engineering, Shanghai Institute of Applied Mathematics and Mechanics, School of Mechanics and Engineering Science, Shanghai University, Shanghai 200444, China), AuthorCompanyExt(id=1244321231558783700, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, companyId=1244321231542006481, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.上海大学　力学与工程科学学院，上海应用数学与力学研究所，上海市能源工程力学重点实验室，上海　200444)]), AuthorCompany(id=1244321231672029922, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, xref=2., ext=[AuthorCompanyExt(id=1244321231684612834, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, companyId=1244321231672029922, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China), AuthorCompanyExt(id=1244321231693001443, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, companyId=1244321231672029922, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.上海交通大学医学院附属上海儿童医学中心　心胸外科，上海　200127)])], figs=[ArticleFig(id=1244321235782447110, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 1, caption=LPM of cardiovascular circulatory system model, figureFileSmall=NYxBaL1xb32WJuBnCokP6Q==, figureFileBig=16BaP2msPUCcSrtFE47vLg==, tableContent=null), ArticleFig(id=1244321235904081934, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图1, caption=心血管循环系统集总参数模型

注：R为电阻，L为电感，C为电容；MV、AV、TV、PV分别为二尖瓣、主动脉瓣、三尖瓣、肺动脉瓣；LA、LV、RA、RV分别为左心房、左心室、右心房、右心室；ao、da、sa、sv、lfv、rfv、sup、inf分别为上行主动脉、降主动脉、体循环动脉、体循环静脉、左股静脉、右股静脉、上腔静脉和下腔静脉；po、ap和vp分别为肺动脉、肺小动脉和肺静脉。

, figureFileSmall=NYxBaL1xb32WJuBnCokP6Q==, figureFileBig=16BaP2msPUCcSrtFE47vLg==, tableContent=null), ArticleFig(id=1244321236201877550, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 2, caption=Left ventricular PVLOOP in healthy and heart failure models and comparison of left ventricular energy parameters in different states　(a) Left ventricular PVLOOP of the healthy adult model and the heart failure patient model, (b) Comparison of ventricular pressure-volume area, potential energy and stroke work, figureFileSmall=or272cGviFshjx1QTCVZdQ==, figureFileBig=2M3pVy/AN/skPjhbLOGMXg==, tableContent=null), ArticleFig(id=1244321236315123767, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图2, caption=健康和心衰模型左心室压力-容积环及不同状态下左心室能量参数对比, figureFileSmall=or272cGviFshjx1QTCVZdQ==, figureFileBig=2M3pVy/AN/skPjhbLOGMXg==, tableContent=null), ArticleFig(id=1244321236403204161, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 3, caption=Ventricular PVLOOPs with central VA-ECMO support or peripheral VA-ECMO support　(a) Central VA-ECMO, (b) Peripheral VA-ECMO, figureFileSmall=H8OWxOb5uXYEIbaMXtPvOg==, figureFileBig=VR/2nxDq/9Iu2RyxYbI4VQ==, tableContent=null), ArticleFig(id=1244321236537421904, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图3, caption=使用中心VA-ECMO支持或外周VA-ECMO支持的心室压力-容积环, figureFileSmall=H8OWxOb5uXYEIbaMXtPvOg==, figureFileBig=VR/2nxDq/9Iu2RyxYbI4VQ==, tableContent=null), ArticleFig(id=1244321237703438428, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 4, caption=Changes in flow rates of left heart and systemic circulation for different models　(a) Healthy model, (b) Heart failure model, (c) Central VA-ECMO with 3 L/min pump flow, (d) Peripheral VA-ECMO with 3 L/min pump flow, figureFileSmall=0UQgkUqlqOQ3dS9HE+VVQQ==, figureFileBig=CtcEOCVSbvVE/vbNSghhsw==, tableContent=null), ArticleFig(id=1244321237812490343, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图4, caption=不同模型中左心和部分体循环模块流量变化, figureFileSmall=0UQgkUqlqOQ3dS9HE+VVQQ==, figureFileBig=CtcEOCVSbvVE/vbNSghhsw==, tableContent=null), ArticleFig(id=1244321237938319473, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 5, caption=Left ventricular PVLOOPs in heart failure patient under central VA-ECMO support with different unloading methods　(a) Use of arterial vasodilators, (b) Placement of the left atrial drainage cannula, figureFileSmall=ZxFpPcmRNA/VVFiK9bMFuQ==, figureFileBig=Y8PB3YZ7nBK9u1E+csM7YQ==, tableContent=null), ArticleFig(id=1244321238038982778, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图5, caption=心衰患者在中心VA-ECMO支持下使用不同减压方式的左心室压力-容积环, figureFileSmall=ZxFpPcmRNA/VVFiK9bMFuQ==, figureFileBig=Y8PB3YZ7nBK9u1E+csM7YQ==, tableContent=null), ArticleFig(id=1244321238122868865, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Fig. 6, caption=Pressure and flow changes with different left ventricular unloading methods during central VA-ECMO support at pump flow rate of 3 L/min　(a) Use of arterial vasodilators, (b) Placement of the left atrial drainage cannula, figureFileSmall=JvDC4mNr/xDS2aPq7rbZLA==, figureFileBig=W66sTGxNkz3TRjU0KakWdA==, tableContent=null), ArticleFig(id=1244321238278058128, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=图6, caption=在泵流量为3 L/m in中心VA-ECMO支持下使用不同左心减压方式后的压力和流量变化, figureFileSmall=JvDC4mNr/xDS2aPq7rbZLA==, figureFileBig=W66sTGxNkz3TRjU0KakWdA==, tableContent=null), ArticleFig(id=1244321238399692954, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Tab. 1, caption=

Parameters of healthy (heart failure) heart model

, figureFileSmall=null, figureFileBig=null, tableContent=
参数左心室右心室左心房右心房
l/cm885.55.5
K1.15（0.95）1.751.21.2
V0/mL15（25）4055
Ees/（mmHg·mL-1）2.8（0.6）1——
A1（0.65）1——
B0.020.02——
Emax/（mmHg·mL-1）——0.30.3
Emin/（mmHg·mL-1）——0.20.2
T1/s0.33T0.33T——
T2/s0.45T0.45T——
Ta/s——0.8T0.8T
T/s0.80.80.80.8
D/s——0.040.04
), ArticleFig(id=1244321238529716390, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=表1, caption=

健康（心衰）心脏模型参数

, figureFileSmall=null, figureFileBig=null, tableContent=
参数左心室右心室左心房右心房
l/cm885.55.5
K1.15（0.95）1.751.21.2
V0/mL15（25）4055
Ees/（mmHg·mL-1）2.8（0.6）1——
A1（0.65）1——
B0.020.02——
Emax/（mmHg·mL-1）——0.30.3
Emin/（mmHg·mL-1）——0.20.2
T1/s0.33T0.33T——
T2/s0.45T0.45T——
Ta/s——0.8T0.8T
T/s0.80.80.80.8
D/s——0.040.04
), ArticleFig(id=1244321238651351212, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Tab. 2, caption=

Parameters of systemic and pulmonary circulation model

, figureFileSmall=null, figureFileBig=null, tableContent=
部位 R/[（mmHg·s）·mL-1] C/（mL·mmHg-1） L/[（mmHg·s2）·mL-1]
上行主动脉0.0100.080.000 1
降主动脉0.0200.050.000 1
体循环动脉0.9501.500.000 1
体循环静脉0.10020.00—
上腔静脉0.0088.00—
下腔静脉0.0088.00—
左股静脉0.0043.00—
右股静脉0.0043.00—
肺动脉0.0105.000.000 1
肺小动脉0.1500.200.000 1
肺静脉0.05020.00—
二尖瓣0.002——
主动脉瓣0.002——
三尖瓣0.001——
肺动脉瓣0.001——
), ArticleFig(id=1244321238777180342, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=表2, caption=

体循环和肺循环模型参数

, figureFileSmall=null, figureFileBig=null, tableContent=
部位 R/[（mmHg·s）·mL-1] C/（mL·mmHg-1） L/[（mmHg·s2）·mL-1]
上行主动脉0.0100.080.000 1
降主动脉0.0200.050.000 1
体循环动脉0.9501.500.000 1
体循环静脉0.10020.00—
上腔静脉0.0088.00—
下腔静脉0.0088.00—
左股静脉0.0043.00—
右股静脉0.0043.00—
肺动脉0.0105.000.000 1
肺小动脉0.1500.200.000 1
肺静脉0.05020.00—
二尖瓣0.002——
主动脉瓣0.002——
三尖瓣0.001——
肺动脉瓣0.001——
), ArticleFig(id=1244321238882037948, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Tab. 3, caption=

Comparison of model parameters and physiological parameters in healthy model

, figureFileSmall=null, figureFileBig=null, tableContent=
指标模型模拟参数生理参数
左心室收缩末期压力11690~140
左心室舒张末期压力44~12
上行动脉收缩压11590~140
平均动脉压9870~105
中心静脉压110~14
右心室舒张末期压力2915~28
右心室收缩末期压力70~8
肺动脉收缩压2815~28
), ArticleFig(id=1244321239041421517, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=表3, caption=

健康成人模型输出参数与生理参数对比

, figureFileSmall=null, figureFileBig=null, tableContent=
指标模型模拟参数生理参数
左心室收缩末期压力11690~140
左心室舒张末期压力44~12
上行动脉收缩压11590~140
平均动脉压9870~105
中心静脉压110~14
右心室舒张末期压力2915~28
右心室收缩末期压力70~8
肺动脉收缩压2815~28
), ArticleFig(id=1244321239175639251, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=EN, label=Tab. 4, caption=

Comparison of model output data and clinical data in heart failure patient

, figureFileSmall=null, figureFileBig=null, tableContent=
参数模型模拟数据临床数据
上行动脉压/mmHg78~5486~61
中心静脉压/mmHg88
左心室舒张末期直径/mm6764
左心室收缩末期直径/mm58.656
左心室射血分数/%23.726
), ArticleFig(id=1244321239276302559, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321220599066815, language=CN, label=表4, caption=

心衰患者模型输出数据与临床数据对比

, figureFileSmall=null, figureFileBig=null, tableContent=
参数模型模拟数据临床数据
上行动脉压/mmHg78~5486~61
中心静脉压/mmHg88
左心室舒张末期直径/mm6764
左心室收缩末期直径/mm58.656
左心室射血分数/%23.726
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体外膜肺氧合系统不同插管方式的血流动力学对比
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张雅晶 1 , 张东升 1, * , 韩露 2, *
医用生物力学 | 论著 2025,40(5): 1230-1238
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医用生物力学 | 论著 2025, 40(5): 1230-1238
体外膜肺氧合系统不同插管方式的血流动力学对比
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张雅晶1, 张东升1, * , 韩露2, *
作者信息
  • 1.上海大学　力学与工程科学学院，上海应用数学与力学研究所，上海市能源工程力学重点实验室，上海　200444
  • 2.上海交通大学医学院附属上海儿童医学中心　心胸外科，上海　200127

通讯作者:

张东升，教授，博士生导师，E-mail：；
韩露，助理研究员，E-mail：

*

为共同通信作者
Hemodynamic Comparison of Different Cannulation Methods in Extracorporeal Membrane Oxygenation System
Yajing ZHANG1, Dongsheng ZHANG1 , Lu HAN2
Affiliations
  • 1.Shanghai Key Laboratory of Mechanics in Energy Engineering, Shanghai Institute of Applied Mathematics and Mechanics, School of Mechanics and Engineering Science, Shanghai University, Shanghai 200444, China
  • 2.Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
出版时间: 2025-10-01 doi: 10.16156/j.1004-7220.2025.05.020
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摘要
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目的

分析两种静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）插管方式及后续进行的左心室减压对心室功能和血流动力学的影响及差异。

方法

在MATLAB/Simulink环境中扩建VA-ECMO与心血管系统结合的集总参数模型，模拟分析心衰患者模型在中心VA-ECMO或外周VA-ECMO支持下的心室功能及血流变化。比较在泵流量为3 L/min的中心VA-ECMO支持下，使用动脉血管扩张药物或在左心房放置减压管对左心室功能的影响。

结果

在中心VA-ECMO或外周VA-ECMO支持下，左心室压力和容积均增大，每搏输出量和心室做功减少。动脉血管扩张药物和左心房减压管均能降低左心室压力和容积，其中动脉血管扩张药物可增加左心室每搏输出量，并将射血分数由11.6%提升至19.5%。

结论

两种VA-ECMO插管方式均能为心衰患者模型提供有效的循环支持，且对心室功能影响相似。中心VA-ECMO支持下，动脉血管扩张药物比左心房减压管更能改善左心室功能。

静脉-动脉体外膜肺氧合  /  集总参数模型  /  心血管循环  /  左心减压  /  血流动力学
Objective

To analyze the effects and differences of two veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation methods and subsequent left ventricular unloading on cardiac function and hemodynamics.

Methods

The lumped parameter model (LPM) of VA-ECMO integrated with the cardiovascular system in the MATLAB/Simulink environment was extended to simulate and analyze the changes in ventricular function and blood flow in the heart failure patient model under central VA-ECMO or peripheral VA-ECMO support. The effects of using arterial vasodilators or a left atrial drainage cannula on left ventricular function under central VA-ECMO support at a pump flow rate of 3 L/min were compared.

Results

Under central VA-ECMO or peripheral VA-ECMO support, left ventricular pressure and volume increased, and stroke volume and ventricular work decreased. Both arterial vasodilators and the left atrial drainage cannula could reduce left ventricular pressure and volume. Arterial vasodilators additionally increased stroke volume and improved left ventricular ejection fraction from 11.6% to 19.5%.

Conclusions

Both VA-ECMO cannulation methods provide effective circulatory support in the heart failure patient model, with similar effects on ventricular function. Under central VA-ECMO support, arterial vasodilators can improve left ventricular function more effectively than the left atrial drainage cannula.

veno-arterial extracorporeal membrane oxygenation  /  lumped parameter model  /  cardiovascular circulatory system  /  left ventricular unloading  /  hemodynamics
张雅晶, 张东升, 韩露. 体外膜肺氧合系统不同插管方式的血流动力学对比. 医用生物力学, 2025 , 40 (5) : 1230 -1238 . DOI: 10.16156/j.1004-7220.2025.05.020
Yajing ZHANG, Dongsheng ZHANG, Lu HAN. Hemodynamic Comparison of Different Cannulation Methods in Extracorporeal Membrane Oxygenation System[J]. Journal of Medical Biomechanics, 2025 , 40 (5) : 1230 -1238 . DOI: 10.16156/j.1004-7220.2025.05.020
正文
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静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）治疗心衰的临床效果已获得广泛认可。当心脏泵血功能丧失或严重衰竭时，VA-ECMO可以暂时为心衰患者提供心血管循环支持[1]。VA-ECMO的主要目的是代替自身心脏做功，让心脏得到休息，所以在心功能恢复前需要较高的VA-ECMO流量支持，以满足全身各脏器的灌注[2-3]。在VA-ECMO中，前向的主动脉血流由离心泵的驱动血流量和自身腔室血液输出共同组成。
心衰患者在接受VA-ECMO临床治疗时，血流模式的变化会引起体内血流动力学的显著改变，导致心血管循环系统与VA-ECMO之间产生复杂的相互作用。由于临床中肺动脉导管等介入操作的复杂性，且目前尚未对肺动脉导管数据的系统使用达成共识，这在一定程度上限制了相关数据的获取和利用。而基于3D结构的流体仿真由于无法获得整个循环系统的建模，往往不能全面反映整个循环系统的血流动力学效能。集总参数模型（lumped parameter model，LPM）能够清晰呈现循环系统各部分的血流动力学变化，并且可以快速调整模型模拟预测病人体内不同状况下的血液循环。同时，LPM仿真方法不仅弥补了人体试验中的伦理限制，也有效降低了体外循环模拟装置的成本问题。一些血流动力学研究已经利用LPM取得了通用性的研究进展[4-6]。随着Windkessel模型的不断完善，LPM可以更加准确模拟不同的生理现象[7-10]。其中，心脏时变弹性模型被广泛应用于模拟LPM中的心脏功能[11]。
VA-ECMO支持期间，血液逆行进入主动脉，可能会导致血压升高、充盈压增大和肺水肿等，造成心衰加剧[12]，此时需要进行左心减压。关于心源性休克患者在使用外周VA-ECMO支持期间的左心室卸载过程，也有了一定的进展[13]。在VA-ECMO引起急性肺水肿的情况下，可以使用动脉血管扩张药物快速降低血压，减轻心脏的后负荷，迅速缓解心衰。当药物效果不理想或是心脏无法有效排空血液时，可以放置左心房减压管改善肺循环，进而达到左心减压的效果。本文通过降低左心室后负荷（体循环动脉血管阻力和顺应性）模拟使用动脉血管扩张药物的临床效果，通过增加LPM中左心房引流的通路模拟放置左心房减压管的效果。
尽管心血管循环系统的研究已取得显著进展，但利用LPM模拟VA-ECMO在不同插管方式下对心血管循环血流动力学变化的影响仍需进一步探讨。本文在文献[14]模型基础上进行扩展，结合临床数据，模拟心衰患者模型心血管循环与VA-ECMO支持的相互作用。此外，模拟了中心VA-ECMO支持下使用动脉血管扩张药物或放置左心房减压管对患者左心减压的血流动力学影响。
1　模型和方法
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1.1　心血管数值模型
将人体血液循环分为3个部分：心脏、体循环和肺循环。体循环包括上行主动脉（升主动脉和主动脉弓）、降主动脉、体循环动脉、上腔静脉、下腔静脉、左右股静脉和其他体循环静脉；肺循环包括肺动脉、肺小动脉和肺静脉。人体心血管循环系统LPM如图1所示。利用等效阻抗分流的方式模拟从体循环静脉分流到上腔静脉和左、右股静脉，以及左、右股静脉的血流并行进入下腔静脉的过程。
心脏4个腔室的几何结构可以简化为不同类型的截短椭球体形状，根据其半径和压力之间的功能关系对心房和心室进行建模[14]。在LPM中基于质量守恒和动量守恒，描述心脏4个腔室内的体积变化与流量之间的关系为：
式中：V为心腔体积；Q为流量，下标j代表左心房、左心室、右心房和右心室。
心室收缩活动期间为主动收缩，其压力与体积之间的关系遵循Voigt黏弹性模型的时变弹性方程：
式中：Ees为心室的收缩弹性；Vv（t）为心室收缩的瞬时体积；V0为无压力时心室的体积；fact,v（t）为心室的激活功能；t为在心动周期中的瞬时时刻，T1、T2和T分别对应心室收缩期结束、心室舒张期结束和整个心动周期持续的时间。
心室舒张活动期间为被动收缩，其收缩压力与容积的关系表示为：
式中：A、B为用来调节心室被动收缩压的系数。
心房压力可以表示为：
式中：Emax和Emin分别为心房收缩末期弹性和舒张末期弹性；Va（t）是心房的瞬时体积；Ea（t）为心房随时间变化的弹性函数，可以用激活函数fact,a（t）表示：
以1名体重为67 kg的心衰成年患者为例，体内血流量总体积为5 300 mL，在无应激条件下为3 835 mL。根据临床超声获得心衰患者左心室的收缩弹性（Ees），通过测压管监测上行主动脉、降主动脉、上腔静脉、下腔静脉、左股静脉和右股静脉的瞬时阻力和顺应性，对于某些无法直接测量的血管参数，如体循环、肺循环的动脉和静脉，则根据临床经验和文献[14-17]数据进行调整。除心衰模型的左心室收缩弹性外，健康心脏和心衰心脏参数参考文献[14]心脏模型，具体模型参数如表1、2所示。根据文献选取心室和心房在心动周期内的时间（T1、T2、Ta、T和D）[18]，将模型的心动周期设定为0.8 s。
1.2　VA-ECMO模型
VA-ECMO由氧合器和离心泵组成，本文仅考虑离心泵的作用。VA-ECMO流入管路的压力和流量关系为[19]：
式中：pin为流入管路连接模块的压力；Qin为流入管路内的流量；Rin、Cin和Lin分别为流入管路的阻力、顺应性和有效惯性。
流出管路的压力和流量关系为：
式中：pout为流出管路连接模块的压力；Qout为流出管路的流量；Qopump为从VA-ECMO流入到流出管路连接模块的总流量；Rout、Cout和Lout分别为流出管路的阻力、顺应性和有效惯性。
由于离心泵本身不存储血液，可以忽略流入管路和流出管路的顺应性，可得到VA-ECMO模块的压力和流量的总方程为：
为了比较相同流量下的压力-容积环（pressure-volume loop，PVLOOP）变化情况，泵的初始流量设定为固定值（1、2、3 L/min）。VA-ECMO模型中泵流量的计算采用Euler方法进行迭代。
1.3　VA-ECMO模型和心血管模型的耦合
VA-ECMO根据插管位置的不同，可以分为中心VA-ECMO和外周VA-ECMO。
中心VA-ECMO：VA-ECMO流入管路连接到右心房，流出管路连接到上行主动脉，血液从右心房泵入上行主动脉。此时，右心房流量与体积变化的关系为：
上行主动脉的压力和流量关系为：
外周VA-ECMO：VA-ECMO流入管路连接到左股静脉，流出管路连接到降主动脉。此时下腔静脉内的压力和流量关系为：
降主动脉的压力和流量关系为：
中心VA-ECMO支持下使用动脉血管扩张药物：中心VA-ECMO插管位置不变，仅通过临床实时血流动力学监测和药物剂量调整，使体循环动脉的阻值由0.95 mmHg·s/mL减少至0.4 mmHg·s/mL，体循环动脉顺应性由1.5 mL/mmHg增大至4.0 mL/mmHg。
中心VA-ECMO支持下使用左心房引流管：VA-ECMO有两条流入管路，分别连接到右心房和左心房，流出管路连接到上行主动脉，此时左心房流量与体积的变化关系为：
右心房流量与体积的变化关系为：
式中：α为从左心房抽取的血液在VA-ECMO回流至循环系统的血液中所占的比例。
1.4　模拟方法与验证
本文模型是利用MATLAB/Simulink软件使用一阶常微分方程来描述心血管循环中不同血管压力和流量的0-D血流动力学模型。模型选用的相对误差为1×10-5，采用可变步长，并使模型运行足够长的时间以确保模型收敛，即各个模块中的生理信号达到稳态平衡状态。达到收敛后，可以在整个心动周期中观察到来自每个模块的生理信号。表3、4分别列出了健康成人和临床心衰患者的生理参考数据。结合数据可以看出，所有模拟数据结果均在生理参考数据范围之内，说明该模型在描述血流动力学特征方面具有准确性和可靠性。
2　结果
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2.1　中心VA-ECMO或外周VA-ECMO支持下的心腔变化
对比健康成人模型与心衰患者模型左心室PVLOOP发现，心衰患者使用两种VA-ECMO均可增加左心室压力-容积面积并减少每搏功。随着泵流量的增加，两种VA-ECMO的压力-容积面积、机械能和每搏功呈现出相似的变化趋势。但是外周VA-ECMO的压力-容积面积和机械能大于中心VA-ECMO，每博功小于中心VA-ECMO（见图2）。
本文发现，心衰患者模型在中心VA-ECMO或外周VA-ECMO支持下，随着泵流量的增加，心室PVLOOP表现出相似的变化：左心室PVLOOP向右上方移动且环内面积逐渐减小，右心室PVLOOP向左下方移动且环内面积减小。使用VA-ECMO支持后，随着泵流量的增大，左心室压力不断升高，收缩末期和舒张末期容积增大，每搏输出量减少，左心室的射血期逐渐缩短，左心室逐渐休息，VA-ECMO代替心室进行泵血功能。左心功能降低导致右心室后负荷增加，舒张期压力升高，但离心泵又从右心房抽取血液到主动脉，降低了右心室的前负荷，导致右心室舒张末期和收缩末期压力均减小。同时由于减少了流向右心室的血流，右心室收缩末期容积减少。在相同泵流量下，与外周VA-ECMO相比，接受中心VA-ECMO的患者左心室具有较小的舒张末期容积、更高的左心室射血分数和更长的等容收缩期；右心室则具有相同的舒张末期容积，较大的收缩末期容积、较低的舒张末期压力、更高的右心室射血分数和更短的等容收缩期（见图3）。
由1个心动周期内左心、上行主动脉、体循环动脉和上腔静脉流量变化曲线可见，4种模型中，二尖瓣处的流量存在两个波峰，而主动脉瓣和上行主动脉的流量仅有1个波峰，体循环动脉流量相对平缓。心衰患者模型通过左心的血流量约为健康模型的50%，左心房流出的最大血流量约为健康模型的2/3。在VA-ECMO支持下，通过二尖瓣、主动脉瓣和上行主动脉的流量波峰均降低，而体循环动脉的流量有微小的上升，且通过主动脉瓣的流量与通过上行主动脉的流量图像出现分层现象。中心VA-ECMO中主动脉瓣的流量峰值为198.9 mL/s，约为上行主动脉流量峰值的83%。而外周VA-ECMO中主动脉瓣处的流量峰值为154.9 mL/s，约为上行主动脉流量峰值的1.1倍（见图4）。
2.2　在中心VA-ECMO支持下的左心减压
由于模拟的心衰模型在中心VA-ECMO或外周VA-ECMO支持下的心室压力体积以及各模块流量的变化相似，因此只选择在合适泵流量（3 L/min）的中心VA-ECMO中使用动脉血管扩张药物和左心房引流管两种减压方式。在临床上，左心房引流管流量受到管径和回心血量的影响，通常约占总流量的30%，故选取α=30%，以模拟临床中左心减压管的效果，旨在减少左心室血液淤积，防止血栓形成和心功能进一步恶化。
结果表明，两种减压方式均可降低使用中心VA-ECMO后的左心室压力和容积，但使用动脉血管扩张药物会增加左心室的每搏输出量，左心室射血分数由11.6%增大到19.5%；在左心房放置引流管会减小左心室的每搏输出量，左心室射血分数减小到9.8%。在中心VA-ECMO支持下，心衰患者使用动脉血管扩张药物后左心室的舒张末期和收缩末期的压力和容积均低于使用左心房引流管的情况（见图5）。
本文发现，1个心动周期内，心衰患者在中心VA-ECMO支持下使用动脉血管扩张药物后的左心室压力、上行主动脉压力、左心房压力和体循环动脉压力会更小，而二尖瓣、主动脉瓣和上行主动脉处流量的峰值会更高（见图6）。
3　讨论
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本文利用LPM对比了中心VA-ECMO和外周VA-ECMO两种插管位置对心衰患者的心脏功能和全身不同部位血管的血流动力学变化，并对比两种减压措施对血流动力学的影响。结果表明，中心VA-ECMO与外周VA-ECMO插管部位对心衰患者的左心室压力和容积变化几乎无显著差异，两者展现出相似的变化趋势。同时，两种VA-ECMO对全身血流速度的影响也表现出相似性，尽管在血流速度峰值上有微小差异，但这也表明两种插管方式在维持心血管系统内血流速度方面的作用较为一致，都能有效为心衰患者提供血流支持，保持全身血液循环的稳定。
在VA-ECMO支持期间，左心室的卸载程度主要取决于左心室的绝对流量和其可扩张性舒张储备。在临床没有肺水肿的情况下，维持一定水平的左心室射血是非常理想的。左心减压技术使得左心室在负荷减少的情况下继续射血，并降低舒张末期和收缩末期容积，减少了心室扩张的可能性。对于本研究中的心衰患者模型，在中心VA-ECMO支持下，使用动脉血管扩张药物比左心房引流管效果更加明显，能够显著降低左心室的压力和容积，改善心室功能。除了本研究讨论的这两种简单的左心减压操作，主动脉内球囊泵等也是VA-ECMO期间常见的辅助手段[20-22]。
本文及其他研究均指出，随着VA-ECMO流量的增加，PVLOOP向右上方移动，且越来越“窄”[23-24]。但在临床实践中，当心衰患者使用VA-ECMO的瞬间，左心室压力和体积会相对减小，推测原因是在LPM模拟过程中，为了保证模型的质量守恒和惯性力守恒，将外周阻力和左心室收缩力设为恒定值，并模拟持续的体外血流。这种设置可能导致左心室后负荷增加，而左心室克服后负荷增加的唯一途径是通过弗兰克-斯塔林（Frank-Starling）机制，此时血液会在左心室聚集，左心室压力会增高以及射血分数降低。
本研究建立的模型能够根据个体患者的临床数据调整模型参数，通过调节心脏收缩性和血管参数来适应不同的生理状态。由于模型仅基于单例心衰患者数据进行模拟，其结果无法充分代表所有心衰患者的血流动力学变化。因此，未来的研究计划纳入更多的患者模型，并考虑结合计算流体力学或机器学习等方法，对模型参数的变异范围进行统计分析，以增强模型的泛化能力。
4　结论
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本文利用LPM将两种不同的VA-ECMO插管方式与人体心血管系统相结合，并考虑后续的左心减压操作。结果发现，中心VA-ECMO和外周VA-ECMO对左心室压力、容积变化以及全身血流速度的影响相似。同时，在该特定患者模型状态下，使用动脉血管扩张药物的降压效果优于置入左心房引流管。此外，该模型具备灵活调节的能力，能够根据不同患者的具体情况模拟和预测治疗效果，为优化临床治疗方案提供支持。
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doi: 10.16156/j.1004-7220.2025.05.020
  • 接收时间：2024-12-20
  • 首发时间：2026-03-27
  • 出版时间：2025-10-01
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  • 收稿日期：2024-12-20
  • 修回日期：2025-02-25
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    1.上海大学　力学与工程科学学院，上海应用数学与力学研究所，上海市能源工程力学重点实验室，上海　200444
    2.上海交通大学医学院附属上海儿童医学中心　心胸外科，上海　200127

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张东升，教授，博士生导师，E-mail：；
韩露，助理研究员，E-mail：

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