CN105708545A - Method for carrying out clinical intelligent PMLR (Percutaneous Myocardial Laser Revascularization) - Google Patents

Abstract

The invention discloses a method for carrying out clinical intelligent PMLR (Percutaneous Myocardial Laser Revascularization). By using the method for carrying out the clinical intelligent PMLR, disclosed by the invention, the punching position, the punching number, the punching depth, the pore diameter and the energy during a PMLR process can be integrally optimized, and the method has the effects that under the situation that ischemic myocardium perfusion is met, the myocardium punching number is least, the distribution is uniform, and the heat injury to myocardium around laser punching positions is smallest. The method comprises the following steps of firstly determining an ischemia region of myocardial tissues and a needed total blood flow range; then carrying out grid partition on the ischemic region of the myocardial tissues; then computing the punching position, the punching number, the laser energy, the punching time, the depth and the pore diameter of a laser hole channel aiming at each grid, wherein an optimization method is provided.

Description

A kind of method of clinical intelligence transcutaneous laser myocardial blood transport reconstruction

Technical field

The present invention relates to technical field of medical information, a kind of method being specifically related to clinical intelligence transcutaneous laser myocardial blood transport reconstruction.

Background technology

Coronary heart disease (Coronaryheartdisease) is one of modal body illness of mid-aged population, is also called coronary heart disease.Immediate and mid-term, coronary heart disease worldwide sickness rate continues to increase, and becomes one of main cause of death, and the crowd of falling ill has rejuvenation trend.The patients with coronary heart disease of 80% adopts the modes such as traditional Drug therapy, Percutenous transluminal coro-nary angioplasty (PTCA) and coronary artery bypass grafting (CABG) to alleviate self symptom.But for diffusivity Coronary Artery Lesions, Small vessel, far-end pathological changes and repeatedly complexity case in late period after PTCA or CABG, and the case such as postoperative support or vascular restenosis, above-mentioned Therapeutic Method is often difficult to prove effective, therefore, how above-mentioned complicated case is effectively treated, become an important topic of medical science and field of pathology.

Since 20th century, laser science technology fast development, many scholars begin attempt to laser technology is applied to clinical medicine.1981, Mirhoscini etc. are by the coronary artery ligation of experimental dogs, then carbon dioxide laser is utilized to set up many laser ducts between its left ventricular cavity and cardiac muscle, the myocardial ischemia region attempting to make experimental dogs is recovered, the survival rate of final experimental dogs is more than 70%, and carry out the experimental dogs of some survivals after surgery dissecting and find when checking, the laser duct of foundation is unobstructed and endothelialization.Transmyocardial laser revascularization is divided into visceral pericardium to irradiate and endocardium irradiation.Visceral pericardium irradiation is also known as through breast laser blood transport reconstruction method (TransmyocardialLaserRevascularization, TMLR).The advantage of this method is the accurate positioning to laser duct, coronary artery will not be caused damage, is easier to judge laser duct effect；But it also has the shortcoming of self, as opened thoracic cavity due to needs, therefore health can be caused bigger damage, and the penetrability laser duct set up can cause hemorrhage more.Endocardium irradiation is also known as transcutaneous laser myocardial revascularization method (PercutaneousMyocardialLaserRevascularization, PMLR), and it is a kind of new Coronary Artery Disease Intervention Treatment technology grown up on the basis of visceral pericardium irradiation.Compared with TMLR, PMLR is possible not only to avoid PTCA and CABG postoperative support or vascular restenosis, is also equipped with not open breast, damages the plurality of advantages such as little, recovery is fast, health care costs is few；But the not accurate enough part being this technology and also needing to raising further in fibre-optic catheter location.

Laser type ideal at present is the laser of quasi-molecule class, such as carbon dioxide laser, Nd:YAG laser, Ho:YAG laser etc..The heat that this laser produces can be absorbed by tissue rapidly, is that tissue temperature raises and vaporizes, and forms relatively smooth laser duct, surface, and non-carbonized layer and coagulation necrosis.Clinical conventional laser parameter is each 2 pulses, each pulsed laser output energy 2J, power 3.5W, pulsewidth 200us, laser channel diameter is about 1.0mm, the laser duct degree of depth about 5.0～6.0mm, punching number depends on the area in ischemic myocardium region, for instance: left anterior descending branch chronic total occlusion is merged for left main coronary artery lesions and punches about 20.

Abroad, nineteen sixty-five Sen etc. just adopts needle point method to carry out zoopery, sets up many ducts, and confirms that the cardiac muscle after Canis familiaris L. infraction is had protective effect by duct, can effectively improve the ischemic conditions of cardiac muscle between the left ventricular cavity and cardiac muscle of experimental dogs.In January nineteen ninety, Crew etc. individually adopts high power (800W) CO in whole world first time₂The 1 example patients with coronary heart disease at advanced age of 83 years old has been carried out PMLR operation by laser in heartbeat situation, and after operation, the angina pectoris of patient disappears, other function of heart also be improved significantly.The food of the U.S. and Drug Administration (FDA) in 1990～1996 years through multiple research centers to high power CO₂Laser TMLR, up to the observation of 6 years, finally have approved the clinical practice of TMLR.China follows world's TMLR trend closely, successfully carries out clinic and the basic research of TMLR in 20 end of the centurys.Provincial Hospital is big with conjunction work, and the Capital University of Medical Sciences, TMLR has also been carried out a series of clinical research by southwest hospital of Third Military Medical University, Beijing 301 Hospital and Hospital No.1 Attached to Zhongsha Medical Science Univ. etc., is obtained for ideal result.

In PMLR operation process, the hemoperfusion ability in the laser duct set up will directly affect the therapeutic effect of operation, and in hematodinamics, with the blood flow flowing through a certain section in laser duct in the unit interval, the laser duct perfusion ability to ischemic myocardial tissue is described.The aperture in laser duct and the influence factor of the duct degree of depth are had to the spot radius and laser pulse duration etc. of the output of laser instrument, laser beam, it addition, it is also had a certain impact by the thermal diffusivity of the optical property parameter of cardiac muscular tissue self, density, the latent heat of vaporization, specific heat and tissue and thermal conductivity etc..In real process, also having partial heat tissue can cause hot injury, the degree of hot injury will directly influence the effect of operation.But being all that doctor empirically judges at present, subjective, results contrast is guarded.

Summary of the invention

In view of this, a kind of method that the invention provides clinical intelligence transcutaneous laser myocardial blood transport reconstruction, can punch position, quantity, the degree of depth, aperture and energy in global optimization transcutaneous laser myocardial blood transport reconstruction process, have under meeting ischemic myocardium perfusion situation, transmyocardial revascularization minimum number, it is uniformly distributed, and to the minimum effect of laser boring surrounding myocardium hot injury.

The method of the clinical intelligence transcutaneous laser myocardial blood transport reconstruction of the present invention, comprises the steps:

1st step, it is determined that the ischemic area of cardiac muscular tissue, according to total blood flow scope that clinical experience assessment is required；

2nd step, carries out stress and strain model according to the thickness of myocardial wall to the ischemic area of cardiac muscular tissue, the cardiac muscular tissue within the scope of certain thickness is divided in same grid, and all grids are numbered；Record the thickness range of each net region myocardium wall；

3rd step, for each grid, first makes a call to the 1st laser duct from the thickest position of grid element center flesh wall, and wherein, at echocardiography relaxing period MWT, < do not punch in 8mm place；Primarily determine that the output P of laser；

4th step, for present laser duct i, determines the punching time t in present laser duct according to formula (1)_i,

$\frac{P(t_i-t_0)}{\mathrm{\&rho;}(q+63c)}=\frac{{\mathrm{\&lambda;}}^2{z}_i^3}{3{\mathrm{\&pi;\&omega;}}_0^2}+{\mathrm{\&pi;\&omega;}}_0^2{z}_i---\left(1\right)$

Wherein, P is the output of laser；T₀For vaporizing the time experienced because laser action starts generation from Laser emission to cardiac muscular tissue；ρ is the density of cardiac muscular tissue；Q is the heat of vaporization of cardiac muscular tissue；C is the specific heat of cardiac muscular tissue；λ is optical maser wavelength；Z_iFor the degree of depth in i-th laser duct, wherein, the residual myocardium wall thickness in laser duct is be more than or equal to 4mm；ω₀For z_iThe waist radius of the Gaussian beam at=0 place；

5th step, utilizes the punching time t that step 4 is determined_i, adopt formula (2) to calculate the threshold power P of laser instrument_c,i；

$P_{c,t}=2\mathrm{q\&rho;}{k}^{\frac{1}{2}}{t_i}^{\frac{-1}{2}}$

Wherein, k is thermal diffusivity；

The threshold power P obtained will be calculated_c,iCompare with laser output power P, if P is < P_c,i, then tune up the output of laser, recalculate the punching time, until P >=P_c,i, perform the 6th step；

6th step, the laser output power P finally determined according to the 5th step and punching time t_i, utilize formula (3) to determine the aperture d in present laser duct_i；

$d_i=\frac{{\mathrm{\&omega;}}_0}{\sqrt{2}}\sqrt{ln\frac{{\mathrm{\&mu;}}_{a}P(t_i-t_0)}{{\mathrm{\&pi;\&omega;}}^2\&lsqb;1+{\left(\frac{{\mathrm{\&lambda;z}}_i}{{\mathrm{\&pi;\&omega;}}_0^2}\right)}^2\&rsqb;(63c\mathrm{\&rho;}+\mathrm{\&rho;}q)}}---\left(3\right)$

Wherein, μ_aFor cardiac muscular tissue's absorptance to laser；ω is Gaussian beam waist radius of arbitrary degree of depth in cardiac muscle；

If d_iIt is positioned at the pore diameter range of setting, then performs the 7th step, after otherwise increasing the degree of depth in laser duct, recalculate punching time and threshold power P_c,i, until P >=P_c,iAnd d_iIt is positioned at the pore diameter range of setting；If the degree of depth in laser duct has been maxed out value, namely residual myocardium wall thickness is 4mm, then the maximum laser duct degree of depth is the degree of depth in final laser duct；

7th step, determines the groundwater increment V in present laser duct according to formula (4)_i,

$V_i=\frac{{{\mathrm{\&pi;d}}_i}^4\mathrm{\&Delta;}p}{128{\mathrm{\&eta;h}}_i}---\left(4\right)$

Wherein, Δ p is left indoor pressure, and η is blood viscosity；

If V_iWithin the scope of the groundwater increment in the single laser duct set, then laser proceeds by punch operation, otherwise abandons punching, after again choosing laser output power P, returns the 4th step；

8th step, by the accumulation groundwater increment V of front i punching_i,sumThe maximum of total blood flow with needed for ischemic myocardiumCompare, ifThen punching according to the 4th step～the 7th step, wherein, the position in next laser duct is next time: and present laser duct interval 1cm；WhenTerminate punching.

Preferably, in stress and strain model, each grid element center is arranged in this net region maximum MWT place.

Further, during stress and strain model, first ischemic myocardium is carried out non-unified rational B-spline surface matching, then use mapping mode that structural model carries out stress and strain model, select the network of mixed type, to large deformation cardiac muscle based on hexahedral element；Irregular area cardiac muscle uses tetrahedral grid optimization, finally the cardiac muscular tissue within the scope of certain thickness is divided in same grid.

Preferably, in the 8th step, beat next laser duct along clockwise direction, until the ischemic myocardium punching in all grids.

Beneficial effect:

The inventive method, contrast prior art, can punch position, quantity, the degree of depth, aperture, energy in global optimization transcutaneous laser myocardial blood transport reconstruction process, have under meeting ischemic myocardium perfusion situation, transmyocardial revascularization minimum number, it is uniformly distributed, and to the minimum effect of laser boring surrounding myocardium hot injury.Myocardial surface punching number is the least possible, it means that can be less to the secondary insult of cardiac muscle；Drilling point is evenly distributed in myocardial surface, ensures microcirculation.

Accompanying drawing explanation

Fig. 1 is flow chart of the present invention.

Detailed description of the invention

Develop simultaneously embodiment below in conjunction with accompanying drawing, describe the present invention.

A kind of method that the invention provides clinical intelligence transcutaneous laser myocardial blood transport reconstruction, specifically includes following steps:

1st step, it is determined that the ischemia scope of cardiac muscular tissue, total blood flow that assessment is required.

Operation consent passes through the intrinsic pressure Δ p of hemodynamic examination heart left chamber, and blood viscosity η measured by hemorheology, and positron emission computerized tomography detection myocardial ischemia scope, according to blood flow scope total needed for clinical experience qualitative assessment ischemic myocardiumAnd the groundwater increment scope [V in single laser duct is set according to clinical experience_smin,V_smax], and the pore diameter range [d in single laser duct_min,d_max]。

2nd step, the ischemic area of gridding cardiac muscular tissue.

Whether the thickness being strengthened magnetic resonance detection myocardial wall by Three-Dimensional Dynamic is uniform.If it is not, the different-thickness according to myocardial wall adopts bounded unit/FInite Element to be divided into multiple grid, then successively all grids are numbered 1,2 ..., N；Assessment records the thickness range of each net region myocardium wallWherein,For the thickness of the minimum myocardial wall of jth grid,For the thickness of the maximum myocardial wall of jth grid, j=1,2 ..., N.Determine the minimum thickness of ischemic myocardium wallMaximum gaugeWhen cardiac muscle thickness distribution is uniform, regard grid number as 1.

During stress and strain model, ischemic myocardium is carried out non-unified Rational B-splines (NURBS) surface fitting, use mapping mode that structural model carries out stress and strain model, select the network of mixed type, to large deformation cardiac muscle based on hexahedral element；Irregular area cardiac muscle uses tetrahedral grid optimization.Cardiac muscular tissue within the scope of certain thickness is divided in same grid.

3rd step, primarily determines that the output P of laser.

Laser instrument is carried out type selecting the output P of laser under this laser conditions of initial option.

The laser instrument that transmyocardial laser revascularization is selected should have characteristics that (1) tissue penetration depths is big, and vaporization cardiac muscle degree of accuracy is high, and the thermocoagulation necrotic extent that surrounding myocardium is caused is little；(2) biological tissue's genetic mutation is not easily leaded to；(3) can utilizing fiber-optic transfer, combining with scope carries out body intracavity operation.Laser type ideal at present is the laser of quasi-molecule class, such as carbon dioxide laser, Nd:YAG laser, Ho:YAG laser etc..Carbon dioxide laser is gas laser, it is impossible to through fiber-optic transfer；Owing to Ho:YAG laser can transmit through low hydroxyl ion silica fibre, so the zoopery of Ho:YAG laser transcutaneous laser myocardial revascularization and clinical trial obtain and carry out widely.

For jth grid, when the output power density of laser is more than formulaDuring determined power density, the process that the process of laser vaporization cardiac muscle is just main from thermal conductivity is changed into the process that the latent heat of vaporization is master.At this moment laser can more accurately be vaporized cardiac muscular tissue, and reduces the damage to surrounding myocardium.Wherein, P_c,iFor the laser power density in i-th laser duct, q is the heat of vaporization of cardiac muscular tissue, and ρ is the density of cardiac muscular tissue, t_iFor the punching time in i-th laser duct, k is thermal diffusivity.

Selecting of position, laser duct: for each grid, first from the thickest position punching of grid element center flesh wall, every pitch of holes 1cm, at echocardiography relaxing period MWT, < not punching in 8mm place, it is achieved uniformly punches.

4th step: determine the punching time

Because laser action starts to vaporize from Laser emission to cardiac muscular tissue, the time that period is experienced is t₀.People is mainly composed of hydrone, and when temperature reaches 100 DEG C, water is vaporized, and the body temperature of human normal is 37 DEG C, it is assumed that cardiac muscular tissue's temperature is equal with normal body temperature, so t₀Can be expressed as

$t_0=\frac{{\mathrm{\&pi;K}}^2{T}^2}{4{\mathrm{kI}}_0^2}=\frac{{\mathrm{\&pi;K}}^2{(100-37)}^2}{4{\mathrm{kI}}_0^2}=\frac{3969{\mathrm{\&pi;K}}^2}{4{\mathrm{kI}}_0^2}$

Wherein, K is the pyroconductivity of cardiac muscular tissue；T=T (x, y, z, t), for the spatial and temporal distributions function that cardiac muscular tissue internal temperature raises, in cardiac muscular tissue, T=100-37；I₀For inciding the laser intensity of myocardial tissue surface.

When the 3rd step have selected laser output power be fixed value P time, cardiac muscle for jth grid, making a call to the 1st hole in the position that this grid element center flesh wall is the thickest (can in stress and strain model process, the thickest myocardial wall in this grid is made to be positioned at grid element center), again punch (can x-axis along stress and strain model and y-axis punching) with 1cm interval towards periphery.Relevant parameter (i.e. the MWT maximum, minimum of i-th grid) according to cardiac muscular tissue of punch position place, as long as providing required laser duct degree of depth z_i, it is possible to determine punching time t actually required with this understanding_i.Wherein, z_iIt it is the degree of depth in i-th laser duct.H_minFor the minimum MWT in this place, laser duct grid, and, after punching, remaining myocardial wall wall thickness should be greater than or equal to 4mm.

$\frac{P(t_i-t_0)}{\mathrm{\&rho;}(q+63c)}=\frac{{\mathrm{\&lambda;}}^2{z}_i^3}{3{\mathrm{\&pi;\&omega;}}_0^2}+{\mathrm{\&pi;\&omega;}}_0^2{z}_i$

Wherein, q is the heat of vaporization of cardiac muscular tissue, and c is the specific heat of cardiac muscular tissue, and ρ is the density of cardiac muscular tissue, ω₀For z_iThe waist radius of the Gaussian beam at=0 place (i.e. the myocardial wall surface at this place, laser duct), is constant, and λ is optical maser wavelength.

5th step, the comparison of the laser output power that threshold power sets with the 3rd step

Threshold power according to the laser instrument in unit are selects formulaBy the various parameters of cardiac muscular tissue: latent heat of vaporization q=2257J/g, density p=1.2g/cm³, thermal diffusivity k=1.400x10^-3cm²/ s, thermal diffusivityAnd the 4th punching time t of determining of step_iSubstitute in formula, it is thus achieved that threshold power P_c,i, by threshold power P_c,iThe laser output power P set with the 3rd step compares, if P is < P_c,i, then resetting output and the punching time of laser, method to set up is as follows: laser instrument is constant, tunes up the output of laser, recalculates the punching time, then compares P_c,iAnd P, until P >=P_c,i；Otherwise transfer the 6th step to.

6th step, it is determined that laser aperture.

The laser output power P that 5th step is finally determined and punching time t_iSubstitute into following formula and determine the aperture d in laser duct_i:

$d_i=\frac{{\mathrm{\&omega;}}_0}{\sqrt{2}}\sqrt{ln\frac{{\mathrm{\&mu;}}_{a}P(t_i-t_0)}{{\mathrm{\&pi;\&omega;}}^2\&lsqb;1+{\left(\frac{{\mathrm{\&lambda;z}}_i}{{\mathrm{\&pi;\&omega;}}_0^2}\right)}^2\&rsqb;(63c\mathrm{\&rho;}+\mathrm{\&rho;}q)}}$

Wherein, z_iFor the degree of depth in i-th laser duct, μ_aFor cardiac muscular tissue's absorptance to laser, ω is Gaussian beam waist radius of arbitrary degree of depth in cardiac muscle, is variable.

If d_i∈[d_min,d_max], then perform the 7th step, otherwise increase the degree of depth in laser duct, recalculate punching time and threshold power P_c,i, and by threshold power P_c,iCompare with laser output power P, until P >=P_c,iAnd d_i∈[d_min,d_max].If the degree of depth in laser duct has been maxed out value (namely residual myocardium wall thickness is 4mm), then the degree of depth in maximum laser duct is the degree of depth in final laser duct.

7th step, specifies i-th laser duct groundwater increment V_i。

Aperture d i-th laser duct_i, duct degree of depth z_i, left indoor pressure Δ p and hemorheology measure the parameters such as blood viscosity η and substitute into formulaCalculate the blood flow V of this punching input_i；If V_i∈[V_smin,V_smax] then laser proceed by punch operation, otherwise abandon punching, return the 3rd step and again choose laser output power, and then recalculate punching time, the duct degree of depth, laser aperture, redefine laser duct groundwater increment.

8th step: the related data of this punch operation is exported

I accumulation groundwater increment before calculatingExport print data (i, P, P simultaneously_c,i,t_i,h_i,d_i,V_i,V_i,sum)。

9th step: whether next time punches

Accumulation groundwater increment V by front i punching_i,sumThe maximum of total blood flow with needed for ischemic myocardiumCompare, ifThen calculate residue minimum filling amountRemain maximum groundwater incrementResidue can be punched number minimum reference valueResidue can be punched the maximum reference value of numberAnd print dataThen punch, it is determined that the next one is numbered i+1 punch position next time, repeat said process.Wherein, the position in next laser duct is: and present laser duct interval 1cm, punching is until all grids along clockwise direction, namely punches at whole ischemic myocardiums.WhenOutputCalculating process terminates.

In sum, these are only presently preferred embodiments of the present invention, be not intended to limit protection scope of the present invention.All within the spirit and principles in the present invention, any amendment of making, equivalent replacement, improvement etc., should be included within protection scope of the present invention.

Claims (4)

1. the method for a clinical intelligence transcutaneous laser myocardial blood transport reconstruction, it is characterised in that comprise the steps:

1st step, it is determined that the ischemic area of cardiac muscular tissue, according to total blood flow scope that clinical experience assessment is required；

2nd step, carries out stress and strain model according to the thickness of myocardial wall to the ischemic area of cardiac muscular tissue, the cardiac muscular tissue within the scope of certain thickness is divided in same grid, and all grids are numbered；Record the thickness range of each net region myocardium wall；

3rd step, for each grid, first makes a call to the 1st laser duct from the thickest position of grid element center flesh wall, and wherein, at echocardiography relaxing period MWT, < do not punch in 8mm place；Primarily determine that the output P of laser；

4th step, for present laser duct i, determines the punching time t in present laser duct according to formula (1)_i,

$\frac{P(t_i-t_0)}{\mathrm{\&rho;}(q+63c)}=\frac{{\mathrm{\&lambda;}}^2{z}_i^3}{3{\mathrm{\&pi;\&omega;}}_0^2}+{\mathrm{\&pi;\&omega;}}_0^2{z}_i---\left(1\right)$

Wherein, P is the output of laser；T₀For vaporizing the time experienced because laser action starts generation from Laser emission to cardiac muscular tissue；ρ is the density of cardiac muscular tissue；Q is the heat of vaporization of cardiac muscular tissue；C is the specific heat of cardiac muscular tissue；λ is optical maser wavelength；Z_iFor the degree of depth in i-th laser duct, wherein, the residual myocardium wall thickness in laser duct is be more than or equal to 4mm；ω₀For z_iThe waist radius of the Gaussian beam at=0 place；

5th step, utilizes the punching time t that step 4 is determined_i, adopt formula (2) to calculate the threshold power P of laser instrument_c,i；

$P_{c,i}=2{\mathrm{q\&rho;k}}^{\frac{1}{2}}{t_i}^{\frac{-1}{2}}---\left(2\right)$

Wherein, k is thermal diffusivity；

The threshold power P obtained will be calculated_c,iCompare with laser output power P, if P is < P_c,i, then tune up the output of laser, recalculate the punching time, until P >=P_c,i, perform the 6th step；

6th step, the laser output power P finally determined according to the 5th step and punching time t_i, utilize formula (3) to determine the aperture d in present laser duct_i；

$d_i=\frac{{\mathrm{\&omega;}}_0}{\sqrt{2}}\sqrt{ln\frac{{\mathrm{\&mu;}}_{a}P(t_i-t_0)}{{\mathrm{\&pi;\&omega;}}^2\&lsqb;1+{\left(\frac{{\mathrm{\&lambda;z}}_i}{{\mathrm{\&pi;\&omega;}}_0^2}\right)}^2\&rsqb;(63c\mathrm{\&rho;}+\mathrm{\&rho;}q)}}---\left(3\right)$

Wherein, μ_aFor cardiac muscular tissue's absorptance to laser；ω is Gaussian beam waist radius of arbitrary degree of depth in cardiac muscle；

If d_iIt is positioned at the pore diameter range of setting, then performs the 7th step, after otherwise increasing the degree of depth in laser duct, recalculate punching time and threshold power P_c,i, until P >=P_c,iAnd d_iIt is positioned at the pore diameter range of setting；If the degree of depth in laser duct has been maxed out value, namely residual myocardium wall thickness is 4mm, then the maximum laser duct degree of depth is the degree of depth in final laser duct；

7th step, determines the groundwater increment V in present laser duct according to formula (4)_i,

$V_i=\frac{{{\mathrm{\&pi;d}}_i}^4\mathrm{\&Delta;}p}{128{\mathrm{\&eta;h}}_i}---\left(4\right)$

Wherein, Δ p is left indoor pressure, and η is blood viscosity；

If V_iWithin the scope of the groundwater increment in the single laser duct set, then laser proceeds by punch operation, otherwise abandons punching, after again choosing laser output power P, returns the 4th step；

8th step, by the accumulation groundwater increment V of front i punching_i,sumThe maximum of total blood flow with needed for ischemic myocardiumCompare, ifThen punching according to the 4th step～the 7th step, wherein, the position in next laser duct is next time: and present laser duct interval 1cm；WhenTerminate punching.

2. the method for intelligence transcutaneous laser myocardial blood transport reconstruction as claimed in claim 1 clinical, it is characterised in that in stress and strain model, each grid element center is arranged in this net region maximum MWT place.

3. the method for clinical intelligence transcutaneous laser myocardial blood transport reconstruction as claimed in claim 1 or 2, it is characterized in that, during stress and strain model, first ischemic myocardium is carried out non-unified rational B-spline surface matching, then use mapping mode that structural model is carried out stress and strain model, select the network of mixed type, to large deformation cardiac muscle based on hexahedral element；Irregular area cardiac muscle uses tetrahedral grid optimization, finally the cardiac muscular tissue within the scope of certain thickness is divided in same grid.

4. the method for clinical intelligence transcutaneous laser myocardial blood transport reconstruction as claimed in claim 1, it is characterised in that in the 8th step, beat next laser duct along clockwise direction, until the ischemic myocardium punching in all grids.