臺灣博碩士論文加值系統

根據根據世界衛生組織(World Health Organization, WHO)的報告，在已開發國家中，循環系統疾病是最主要的死亡原因。在近代基礎循環力學的研究，大都以Navior-Stoke方程式為基礎，從分析一小塊血液在主動脈的流動出發，研究循環系統中的血流。而動脈中的血壓波則因為血液阻力及慣性而衰減；在主動脈中，當血壓波往下傳遞時，平均動脈血壓值並沒有任何明顯的改變，但是血壓波的振幅卻明顯的增加。對此一現象，則認為是動脈分枝及周邊循環阻抗會造成反射波疊加而成。如果血流的慣性力是循環系統中主要的作用力，經過主動脈到周邊循環十幾階的分枝、網狀的微循環及反射波疊加，微循環中的血流應該不是脈動的。
反之，從徑向共振理論出發，各個器官或動脈血管樹叢各有其共振頻率，經由長波長的動脈血壓波藕合共振；藕合的動脈血壓波驅動在微循環中的血液流動。因此，微循環中的血流應該是脈動的，且在同一器官或動脈血管樹叢中，微循環血流是同相的。
考慮血流的路徑，在循環系統中兩種型態與功能的極端關聯中：(1)血流量最大的腎臟皮質表層微循環與腹主動脈血壓波，及(2)血流量最小的足部皮膚微循環與手橈動脈血壓波。以雷射都普勒血流計量測微循環血流，並同步量測動脈血壓波。結果顯示，微循環中的血流都是脈動的，而且同一組織內的微循環血流是同相的。這驗證了徑向共振理論與藕合共振理論對體循環與微循環血液動力關聯性的推論。
研究中進一步探索脈動血壓波對末梢微循環的血流的驅動效率。研究中定義一微循環血流及脈動血壓波面積比(Flux-to-Pressure-Area-Ratios, FPARs)，以評估脈動血壓波中峰值與較低血壓部分的效率差異。結果顯示脈動血壓之峰值是有較高的驅動效率的，且當血壓波之脈動比(Blood Pressure Pulsatile Index, BPPI) 超過一定閾值時，脈動血壓波中峰值的驅動效率會大幅增加。由此一結果推論，高血壓的成因可能是身體中的重要組織的周邊血管組織變硬阻塞時，循環系統回饋調節以循環血流，因而大幅提升脈動血壓波的結果。

According to the WHO report, in the developed countries, the circulatory diseases are the main causes of death. In haemodynamic research, most approaches based on the Navior-Stoke equation investigate the precise movement of a small element of liquid in the artery. Meanwhile, both the viscous force and inertial force would attenuate the blood pressure wave. However, the pulsatile blood pressure is amplified from aorta to the downstream artery. The strange phenomenon is regarded as by superposition of the reflected waves generated by the vascular branches and the impedance of peripheral vascular beds. If the flow does act the key role in the circulation, the peripheral vascular fluxes, which have to flow through a complex network and be interfered by the numerous reflected waves, would be constant and no phase could be detected.
On the contrary, according to the radial resonance theory, each organ or vascular bed has its own natural frequency; through the coupling by the long-wavelength blood pressure, the peripheral vascular fluxe is driven by the coupled blood pressure. Thus, it would be pulsatile and the fluxes in the same vascular bed would be coherent.
In this study, refer to the blood pathway, there are two critical conditions about the peripheral blood flux perfused by the arterial blood pressure. First, the flux in the most perfused renal cortical surface relates to the abdominal aortic blood pressure. Second, the flux in the skin of a foot relates to the radial blood pressure. We used a laser Doppler flowmetry (LDF) to measure the blood fluxes on different sites of the observed tissues and a pressure transducer simultaneously measured the blood pressure waves. The results show that the peripheral blood flux not only is pulsatile but also has constant phase relation with arterial blood pressure; moreover, all blood fluxes in the same tissue are coherent. It is coincident with the inference of the radial resonance and the coupled resonance theory.
Furthermore, the driving efficience of the pulsatile blood pressure in renal cortical surface was evaluated. We define a flux-to-pressure-area-ratio (FPAR) to evaluate the efficiency that the pulsatile blood pressure drives the renal cortical fluxe. The result shows that the higher the pulsatile blood pressure, the more the driven flux is, and it seems that there is a threshold of blood pressure pulsatile index (BPPI) that the driving efficiency would be amplified abruptly. That implies the pulsatility plays a role in lowering the vessel resistance of PVBs and it could also regulate the blood pressure in large arteries. As a result, we further infer that if the precapillary openings are obstructed or the peripheral blood vessels become stiffer the pulsatile pressure will be induced to become higher so as to keep the blood perfusion could be responsible for the hypertension.

封面
目錄
中文摘要
英文摘要
第一章 緒論
第二章 循環系統之血液動力學特性
第三章 近代血液動力學的回顧與徑向共振理論
第四章 動脈與微循環之血液動力學關聯性
第五章 脈動血壓波趨動微循環血流之效應及其高血壓之關聯
第六章 結論與未來方向
其他

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