论心脏功能的“泵说”与“波说”

王晖; 王礼立; 缪馥星; 龚文波; 浣石; 徐冲

doi:10.11883/bzycj-2020-0386

论心脏功能的“泵说”与“波说”

doi: 10.11883/bzycj-2020-0386

王晖^1,,
王礼立^2, ,,
缪馥星²,
龚文波¹,
浣石³,
徐冲³

1.
宁波市中医医院王晖工作室，浙江宁波 315000
2.
宁波大学冲击与安全工程教育部重点实验室，浙江宁波 315211
3.
季华实验室，广东佛山 528200

基金项目: 国家自然科学基金（11872218，11572161）；浙江省医药卫生科研项目（2018KY712）；宁波市首批医疗卫生品牌学科基金（PPXK2018-07）

详细信息

作者简介:
王　晖（1941－　），男，主任中医师，教授，zhengyedoc@163.com

通讯作者:
王礼立（1934－　），男，教授，博士生导师，wanglili@nbu.edu.cn

中图分类号: O347.4
计量
- 文章访问数: 1791
- HTML全文浏览量: 1805
- PDF下载量: 143
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-14
- 修回日期: 2020-10-21
- 刊出日期: 2020-11-05

On “pump theory” and “wave theory” of cardiac function

1.
WANG Hui Workroom, Ningbo Hospital of Traditional Chinese Medicine, Ningbo 315000, Zhejiang, China
2.
Key Laboratory of Impact and Safety Engineering, Ministry of Education, Ningbo University, Ningbo 315211, Zhejiang, China
3.
Jihua Laboratory, Foshan 528200, Guangdong, China

摘要

摘要: 分析了心脏功能的“泵说”和“波说”。研究表明，心脏扮演的角色实际上不是泵，而是脉搏波发生器，产生一系列携带能量的脉搏波。每个脉搏波由升支和降支组成。前者对应于加载过程：压力、粒子速度、能量和血氧饱和度均随时间升高。而后者则对应于卸载过程：压力、粒子速度、能量以及血氧饱和度都下降，直至为零。因此，“泵说”中诸如Windkessel效应、一机二泵和舒张泵等概念都难以成立。所谓约1.5 W的心脏功率实质上表征了每个脉搏波的功率。针对脉搏波是流-固耦合和纵波-横波耦合的复杂波之特征，研究表明，能量的主要部分(99.99%)由横波携带，它沿固体血管传播,损耗低，效率高。研究还表明，血管分支处广义波阻抗的增大有助于抵消脉搏波传播中的衰减耗散，升高传入血管分支的脉搏波脉压，可视为人体的一种自我调节机制。
- 心脏功能 /
- 泵说 /
- 波说 /
- 中医 /
- 脉搏波
Abstract: The “pump theory” and “wave theory” of cardiac function are analyzed. It is shown that the heart plays a role actually not as a pump but as a pulse generator, producing a series of pulse waves that carry energy. Each pulse wave consists of an ascending branch and a descending branch. The former corresponds to a loading process, in which the pressure, particle velocity, energy as well as oxygen saturation all increase with time. While the latter corresponds to an unloading process, in which the pressure, particle velocity, energy as well as oxygen saturation all decrease, up to zero. So the concepts proposed in the “pump theory”, such as the Windkessel effect, one engine-two pump and diastolic pump, all do not hold up. The cardiac power of about 1.5 W essentially represents the power of each pulse wave. Aimed at the characteristic that the pulse wave is a complex wave with fluid-solid coupling and longitudinal wave-transverse wave coupling, it is shown that the main part of energy (99.99%) is carried by the transverse waves, which propagate along the solid blood-vessel so that the dissipation is low and the efficiency is high. Moreover, it is shown that the increase of generalized wave impedance at the vascular branches may help to counteract the attenuation and dissipation of pulse waves and increase the pulse pressure propagating into the branches, which may be regarded as a kind of self-regulation mechanism of human body.
- cardiac function /
- pump theory /
- wave theory /
- traditional Chinese medicine (TCM) /
- pulse wave

HTML全文

图 1 心脏功率随主动脉血压和血液流动输出的变化

Figure 1. The dependence of cardiac power on the aortic mean pressure and the cardiac output

下载: 全尺寸图片幻灯片

图 2 动脉血管涨缩比拟为手压救火泵空气室的储能器效应^{[5, 20]}

Figure 2. Arterial vasoconstriction compared to the accumulator effect of the air chamber of a hand pressure fire pump^{[5, 20]}

下载: 全尺寸图片幻灯片

图 3 本构曲线p-v及其与波速c的关系

Figure 3. The constitutive curve p-v and its relation with wave velocity c

下载: 全尺寸图片幻灯片

图 4 脉搏波在动脉中的传播

Figure 4. Pulse wave propagation in the artery

下载: 全尺寸图片幻灯片

图 5 内能比随K_b/E_v和D_v/h_v的变化

Figure 5. Internal energy ratio varying with K_b/E_v and D_v/h_v

下载: 全尺寸图片幻灯片

图 6 血氧饱和度随氧分压和pH值的变化^[23]

Figure 6. Blood oxygen saturation varying with oxygen partial pressure and pH value^[23]

下载: 全尺寸图片幻灯片

参考文献(23)

[1]	孙庆伟, 王春梅, 高艳华, 等. 医用生理学[M]. 北京: 中国医药科技出版社, 2000.
[2]	朱思明. 医用生理学[M]. 北京: 北京科学出版社, 2002.
[3]	HALL J E. Guyton and Hall textbook of medical physiology [M]. Philadelphia: Elsevier, 2016.
[4]	BARRETT K E, BARMAN S M, BROOKS H L, et al. Ganong’s review of medical physiology [M]. 26th ed. New York: McGraw-Hill Education, 2019.
[5]	SALVI P. Pulse waves: how vascular hemodynamics affects blood pressure [M]. 2nd ed. Cham: Springer, 2017.
[6]	EULER L. Principia pro motu sanguinis per arterias determinando [M]. Opera Postuma, 1862: 814−823.
[7]	SKALAK R, KELLER S R, SECOMB T W. Mechanics of blood flow [J]. Journal of Biomechanical Engineering, 1981, 103(2): 102–115. DOI: 10.1115/1.3138253.
[8]	孙广仁. 中医基础理论[M]. 北京: 中国中医药出版社, 2002.
[9]	WANG L L, WANG H. Mechanics modeling and inverse analyses of pulse wave system from the view-point of traditional Chinese medicine [C] // Proceedings of the ASME 2016, 35th International Conference on Ocean, Offshore and Arctic Engineering. Busan, South Korea: ASME, 2016. DOI: 10.1115/OMAE2016-55106.
[10]	王礼立, 王晖. 脉搏波系统的力学模型及反演兼对若干中医学问题的讨论 [J]. 力学学报, 2016, 48(6): 1416–1424. DOI: 10.6052/0459-1879-15-322. WANG L L, WANG H. Mechanics modeling and inverse analyses of pulse waves system with discussions on some concepts in the traditional Chinese medicine [J]. Chinese Journal of Theoretical and Applied Mechanics, 2016, 48(6): 1416–1424. DOI: 10.6052/0459-1879-15-322.
[11]	王礼立, 王晖, 杨黎明, 等. 论脉搏波客观化和定量化研究的症结所在 [J]. 中华中医药杂志, 2017, 32(11): 4855–4863. DOI: CNKI:SUN:BXYY.0.2017-11-020. WANG L L, WANG H, YANG L M, et al. Crux of objectification and quantification of pulse waves [J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2017, 32(11): 4855–4863. DOI: CNKI:SUN:BXYY.0.2017-11-020.
[12]	王唯工. 气血的弦律[M]. 台北: 大塊文化, 2010.
[13]	王礼立. 应力波基础[M]. 2版. 北京: 国防工业出版社, 2005. WANG L L. Foundation of stress waves [M]. 2nd ed. Beijing: National Defense Industry Press, 2005.
[14]	COTTER G, WILLIAMS S G, VERED Z, et al. Role of cardiac power in heart failure [J]. Current Opinion in Cardiology, 2003, 18(3): 215–222. DOI: 10.1097/00001573-200305000-00007.
[15]	ASKARI A T, MESSERLI A W. Cardiovascular hemodynamics: an introductory guide [M]. New York: Humana Press, 2019.
[16]	FUSTER R, O’ROURKE R, WALSH R, et al. Hurst’s the heart [M]. 12th ed. New York: The McGraw-Hill Companies, Inc, 2008.
[17]	NOSÉ Y, YOSHIKAWA M, MURABAYASHI S, et al. Development of rotary blood pump technology: past, present, and future [J]. Artificial Organs, 2000, 24(6): 412–420. DOI: 10.1046/j.1525-1594.2000.06634.x.
[18]	NOSÉ Y, MOTOMURA T. Is it a mistake to develop a totally implantable blood pump for destination therapy? [J]. Artificial Organs, 2005, 29(2): 93–94. DOI: 10.1111/j.1525-1594.2005.29031.x.
[19]	BEHBAHANI M, BEHR M, HORMES M, et al. A review of computational fluid dynamics analysis of blood pumps [J]. European Journal of Applied Mathematics, 2009, 20(4): 363–397. DOI: 10.1017/S0956792509007839.
[20]	NICHOLS W W, O'ROURKE M, VLACHOPOULOS C. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles [M]. 6th ed. London: CRC Press, 2011.
[21]	缪馥星, 王晖, 王礼立, 等. 血液-血管耦合特性与脉搏波传播特性的关系 [J]. 爆炸与冲击, 2020, 40(4): 031101. DOI: 10.11883/bzycj-2020-0082. MIAO Fuxing, WANG Hui, WANG Lili, et al. Relationship between the blood-vessel coupling characteristics and the propagation of pulse waves [J]. Explosion and Shock Waves, 2020, 40(4): 031101. DOI: 10.11883/bzycj-2020-0082.
[22]	WANG LIN Y Y, WANG W K. A hemodynamics model to study the collective behavior of the ventricular-arterial system [J]. Journal of Applied Physics, 2013, 113(2): 024702. DOI: 10.1063/1.4775754.
[23]	WEBSTER J G. Design of pulse oximeters [M]. London: CRC Press, 1997.