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研究生:廖秀梅
研究生(外文):Hsiu-Mei Liao
論文名稱:氣管支氣管支架置放前後氣流變化的數值模擬
論文名稱(外文):Numerical Simulation of Airflow Change in Central Airways for Tracheobronchial Stent Placement
指導教授:黃志揚黃志揚引用關係
指導教授(外文):Chih-Yang Huang
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:基礎醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:67
中文關鍵詞:壓力流量氣管支氣管支架計算流體力學影像醫學
外文關鍵詞:PressureAirflowTracheobronchial stentComputational Fluid DynamicsImage biomedical medicine
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中央氣管阻塞會造成病患喘,咳嗽及清痰困難。有許多原因會造成氣管阻塞,如肺癌、食道癌、甲狀腺癌及肺結核。氣管支架的置放是臨床上改善呼吸道狹窄的一種治療方法,病人在術後肺功能檢查及臨床的症狀上都有顯著改善,但是當病人因疾病上的限制無法進行肺功能檢查時,氣管支架置放的效益便沒有了客觀的評估工具。本研究結合影像醫學和計算流體力學(Computational Fluid Dynamic, CFD)軟體來模擬氣管或支氣管支架置放前及後氣流和壓力的改變。我們共收集7位正常人、7位接受氣管支架置放前和後、7位接受支氣管支架置放前和後的電腦斷層影像的DICOM檔,進行呼吸道三維幾何重建,再利用計算流體力學軟體來模擬呼吸道內部氣流,數值模擬結果顯示,當入口流量設為100 ml/s,出口壓力設為0 Pa時,氣管支架置放後的壓差顯著小於置放前(1.4411 Pa v.s 6.4636 Pa,P = 0.016),氣管支架置放後的壓差比上正常人的壓差為1.4411 Pa:0.6353 Pa,P = 0.073,可見氣管支架的置放能改善呼吸道阻力。支氣管支架置放前的壓差比上置放後的壓差為0.8916 Pa:0.8324 Pa,P = 0.938。在面積方面,氣管支架置放前支架中間的面積顯著大於置放後的面積(1.679 cm2 v.s 0.649 cm2,P=0.016),而支氣管支架置放前後的面積比為0.6473 cm2 v.s 0.9555 cm2,P=0.688。在氣流分布上,氣管或支氣管支架置放後,右側與左側主支氣管流量的比值更接近正常人的56.58%:43.42%,且原本因狹窄而產生的逆流,在支架置放後亦有改善。本研究提供臨床醫師另一種評估支架置放前後氣流、壓力及面積變化的工具。
中文摘要..................................................................................................ii
英文摘要..................................................................................................iv
誌謝.........................................................................................................vii
目錄..........................................................................................................ix
圖目錄.....................................................................................................xiii
表目錄......................................................................................................xv

第一章 前言..............................................................................................1
1.1 研究背景......................................................................................1
1.2 研究目的......................................................................................2
第二章 文獻探討.....................................................................................3
2.1 氣管支氣管支架的臨床應用......................................................3
2.1.1 呼吸道狹窄或阻塞的原因...............................................3
2.1.2 呼吸道狹窄或阻塞的臨床症狀.......................................3
2.1.3 呼吸道狹窄或阻塞.的治療..............................................3
2.1.4 呼吸道支架置放的適應症...............................................4
2.1.5 支架的分類.......................................................................5
2.1.5.1 矽膠支架..............................................................5
2.1.5.2 金屬支架..............................................................6
2.1.6 氣管支氣管支架置放後的效益........................................9
2.1.7 氣管支氣管支架置放後的合併症...................................10
2.2 呼吸道模型建構的文獻探討......................................................10
2.3 呼吸氣流的CFD文獻探討..........................................................10
第三章 材料與方法..............................................................................15
3.1 材料..............................................................................................15
3.2 方法..............................................................................................17
3.2.1 病人的收集.......................................................................17
3.2.2 放置支架的過程...............................................................18
3.2.3 電腦軟體模擬………………..….....................................18
3.2.4 肺葉體積測量……….......................................................19
3.3 統計方法......................................................................................20
第四章 結果.............................................................................................21
4.1 正常人的數值模擬結果分析......................................................21
4.1.1 正常人呼吸道的面積.......................................................21
4.1.2 正常人CFD的數值模擬結果分析...................................21
4.2 氣管支架置放前和後的數值模擬結果分析..............................22
4.2.1 氣管支架置放前和後的面積...........................................22
4.2.2 氣管支架置放前和後CFD的數值模擬結果分析...........22
4.3 支氣管支架置放前和後的數值模擬結果分析.........................25
4.3.1支氣管支架置放前和後的面積........................................25
4.3.2氣管支架置放前和後CFD的數值模擬結果分析............26
4.4 氣管支氣管狹窄程度與壓差的結果分析.................................28
4.5 氣管支氣管支架擴張程度的結果分析.....................................29
4.6 氣管支氣管支架置放前和後的體積結果分析.........................29
第五章 討論............................................................................................31
5.1 本研究結果之探討.....................................................................31
5.1.1 CFD的數值模擬討論.......................................................31
5.1.1.1 正常人 CFD的數值模擬討論………..............31
5.1.1.2 氣管支架置放前和後的 CFD數值討論..........32
5.1.1.3 氣管支架置放前與和正常人之比較.................33
5.1.1.4 氣管支架置放後與和正常人之比較……...…..33
5.1.1.5 支氣管支架置放前和後的CFD的數值模
擬結果討論…………………..………………..34
5.1.1.6 支氣管支架置放前與正常人之比較討論.........35
5.1.1.7 支氣管支架置放後與正常人之比較討論…….35
5.1.1.8氣管支架與支氣管支架置放後的比較………..36
5.1.2 氣管支氣管狹窄程度與壓差的結果分析討論…….….37
5.1.3 氣管支氣管支架擴張程度的結果討論………….…….37
5.1.4 氣管支氣管支架置放前和後的體積結果分析…….….37
5.2 本研究結果之限制.....................................................................39
5.3 未來的研究方向.........................................................................40
第六章 結論........................................................................................... 41
參考文獻..................................................................................................63
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