Hemodynamics of brain arteriovenous malformation: clinical measurement and theoretical analysis

目的 报告脑动静脉畸形(arteriovenous malformation, AVM)血流动力学参数的临床实测与理论分析结果,探讨其变化的原因和意义.方法 对37例脑AVM患者和同期15例非心脑血管病患者的大脑前、中和后动脉的阻力、压力、流速、流量、直径和血管壁面切应力进行测量或测算及统计处理.并以电学和优化原理进行推导和解释.结果 病例组参与脑AVM供血的动脉与未参与供血的动脉相比,流速加快,流量增大,压力降低;病例组参与脑AVM供血的动脉与对照组的同名动脉相比,阻力降低,直径增粗,血管壁面切应力趋向守恒;上述变化可由电学原理推导证明或优化理论解释.结论 动静脉直接交通足脑AVM低阻力的结构基础,并导致AVM血管高流速和流量,而参与脑AVM供血的动脉直径增粗和血管壁面切应力趋向守恒是遵循能耗优化普遍性原理的适应性改变.Objective To report the hemodynamic parameter values of brain arteriovenous malformation (AVM) obtainning by clinical measurement and theoretical deduction, and to explore the cause of those changes. Method The parameter data including vessel resistance, pressure, flow velocity, flow rate, diameter and vessel wall shear stress at the A1, M1 and P1 segment respective of the anterior, middle and posterior cerebral artery (ACA-A1, MCA-M1 and PCA-P1) were measured or calculated to the brain AVM group (a series of 37 consecutive cases) and normal control group (15 contemporaneous cases without any cardio- and brain vascular disease), all the above data were analyzed statistically and farther verifying or deducing were done with the principle of electricity and minimum work. Results The statistical analysis on the data of those arteries supplied AVM verse un-supplied or verse normal control indicated that vessel resistance and blood pressure were decreased, flow velocity and flow rate increased, arterial diameter enhanced, but vessel wall shear stress trending conservational, and those changes can be deduced and explained from the formula of electricity and minimum work. Conclusions The arteriovenous shunt in brain AVM is its low resistance cause in angio-architecture, which leads to low pressure and high flow velocity and high flow rate, but the diameter widering and vessel wall shear stress trending conservational in those arteries supplied AVM are the accommodation following the general principle of minimum work.国家自然科学基金; 卫生部临床学科重点项目中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)06445-4472