CN106580303B - The bearing calibration of the pulse wave propagation time related to systolic pressure - Google Patents

The bearing calibration of the pulse wave propagation time related to systolic pressure Download PDF

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CN106580303B
CN106580303B CN201611045054.5A CN201611045054A CN106580303B CN 106580303 B CN106580303 B CN 106580303B CN 201611045054 A CN201611045054 A CN 201611045054A CN 106580303 B CN106580303 B CN 106580303B
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陈妍
陈瑜
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Zhejiang Pulse Union Medical Equipment Co Ltd
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Abstract

The invention belongs to arterial pressure field of measuring technique.The present invention provides the bearing calibration of the pulse wave propagation time related to systolic pressure, can carry out self adaptive correction to the mutation of pulse wave propagation time related to systolic pressure as caused by the reasons such as blood transfusion and infusion, vasoactive agent, operation intervention under clinical condition.The present invention by detecting ear pulse wave and toe pulse wave under same cardiac cycle in real time, calculate the pulse wave propagation time related to systolic pressure, and according to the morphological feature extraction correcting variable of pulse wave, acquisition correction matrix, mutation to above-mentioned pulse wave propagation time is corrected, propagation time after correction can be used for existing mathematical modeling, the systolic pressure of each cardiac cycle is continuously measured in the clinical setting, and accuracy is high.

Description

Method for correcting pulse wave propagation time related to systolic pressure
Technical Field
The invention relates to the technical field of arterial blood pressure measurement, in particular to a method for correcting pulse wave propagation time related to systolic pressure.
Background
Arterial blood pressure is one of the main indexes for reflecting the state of a circulatory system and evaluating organ perfusion, and is an important vital sign parameter monitored in the perioperative period. The blood pressure monitoring methods commonly used in perioperative period at present can be divided into invasive measurement and non-invasive measurement. Invasive measurement refers to a technique of placing a special pipeline into a circulatory system of a body, converting mechanical potential energy into an electronic signal through a converter, and displaying blood pressure change on a monitoring device in real time. The invasive measurement method can continuously and accurately measure the blood pressure of each stroke, but the possible danger and injury caused by the invasive measurement method cannot be ignored. The common method for non-invasive measurement is cuff oscillography, which is simple in operation and clinically accepted in accuracy and widely used for physical examination and perioperative monitoring. However, the cuff oscillometric method can only measure blood pressure intermittently every 3 to 5 minutes, and cannot track changes in arterial blood pressure in real time.
For this reason, continuous non-invasive blood pressure measurement techniques have been proposed in the medical field, and a method for continuously and non-invasively measuring blood pressure per stroke using pulse wave propagation time/velocity (PTT/PWV) is becoming a hot point of research. The measurement method synchronously obtains volume pulse wave (PhotoPlymorphy PPG) and Electrocardiosignal (ECG) through one or more photoelectric sensors and a group of electrocardio-electrodes, and calculates PTT/PWV by using the time difference between the PPG and the ECG or the time difference between the two PPGs; exploring the functional relationship between PTT/PWV and blood pressure and establishing a mathematical model by utilizingThe measured PTT/PWV is used to estimate blood pressure. Many academic papers have reported the principle of continuous non-invasive measurement of Blood Pressure per stroke using PTT/PWV, such as Yan Chen, changyun Wen, guocai Tao, min Bi, and Guoqi Li, ANovel Modeling method of the Relationship Between the BetWeen Blood Pressure and Pulse Wave Velocity; yan Chen, changyun Wen, guocai Tao and Min Bi "Continuous and Noninival Measurement of Systolic and Diastolic Blood Pressure by One Material Model with the Same Model Parameters and Two Separate pulse waves; younhe Choi, qiao Zhang, seokbum Ko, noninivave pool blood pressure estimation using pulse transit time and Hilbert-Huang transform; zheng Y, poon CC, yan BP, lau JY "Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension"; mukkamala R, hahn JO, inan OT, mestha LK, kim CS,kyal S Toward Ubiquitous Blood Pressure Monitoring vie Pulse Transit Time, the Theory and Practice. Many patents disclose specific methods or devices for continuous non-invasive measurement of blood pressure per stroke using PTT/PWV, such as chinese patents CN101229058A, CN102811659A, CN1127939C, us patents 5865755, 5857975, 5649543, 9364158 and european patent 0413267.
The existing methods and technologies for measuring blood pressure by using PTT/PWV all need to use the traditional cuff oscillometry to measure one or a group of blood pressure values for initial calibration, the calibration is because the correlation between PTT/PWV and blood pressure is subject-dependent, that is, there is a definite relationship between PTT/PWV and blood pressure of each individual, and the calibration is to determine the mathematical model parameters adapted to the subject.
However, the existing method has certain limitations, and can only be applied to the condition that the circulating system is not interfered by the outside. Since the relationship of PTT to blood pressure is strongly regular for an individual only in the absence of interference, it can be described by a deterministic function and mathematical model. However, in the perioperative period, under the influence of miscellaneous factors such as liquid treatment, medicines, operation operations, temperature and the like, the PTT of the circulatory system of a patient generates a series of abnormal changes, and the estimation of the blood pressure by using the varied PTT and the inherent mathematical model generates larger errors. Because the relation between the PTT of the variation and the blood pressure no longer has definite regularity, even if the variation of the PTT is adapted by frequently calibrating the parameters of the mathematical model, the fundamental problem is not solved, and the requirements of clinical measurement on accuracy and real-time performance cannot be met.
Disclosure of Invention
Aiming at the defects of the prior art, the invention provides the method for correcting the pulse wave propagation time PTT, which can carry out self-adaptive correction on the variation of the pulse wave propagation time related to the systolic pressure caused by blood transfusion, blood vessel active drugs, surgical intervention and the like under clinical conditions and has high accuracy.
The method for correcting the pulse wave propagation time related to the systolic pressure comprises the following steps:
s1) detecting the pulse wave at the ear position in each cardiac cycle in real time and analyzing to obtain the following data of the ear pulse wave: height h of aortic valve closing point on ear pulse wave sd Time t of contraction of ear pulse wave s In milliseconds, the diastolic time t of the ear pulse wave d In milliseconds, the maximum height h of the ear pulse wave max ；
S2) detecting pulse waves at toes under each cardiac cycle in real time and analyzing to obtain the following data of the toe pulse waves: systolic time t of toe pulse wave s-toe In milliseconds, the diastolic time t of the toe pulse wave d-toe In milliseconds, the maximum height h of the pulse wave of the toes max-toe Time t from the starting point of the toe pulse wave to the midpoint of the peak ch-toe Unit is millisecond, and time t from starting point of toe pulse wave to peak of peak max-toe In milliseconds; the middle point of the wave crest refers to the middle point of the turning point of the rising edge and the turning point of the falling edge at the wave crest;
s3) calculating pulse wave transmission related to systolic pressureBroadcasting time T s Said T is s The time difference from the closing point of the aortic valve on the ear pulse wave to the closing point of the aortic valve on the toe pulse wave is defined; h is the amplitude of the ear pulse wave or the toe pulse wave in the direction of the longitudinal axis;
s4) calculating to obtain a correction variable in the cardiac cycle by using the data obtained in the steps S1 and S2 in the same cardiac cycle;
s5) calculating to obtain a correction matrix under the cardiac cycle according to the correction variable under the cardiac cycle obtained in the step S4;
s6) continuously obtaining correction matrixes under a plurality of cardiac cycles, and performing correction on the T obtained in the step S3 s Carrying out correction; .
Preferably, the correction matrix in step S5a i Is the ith correction variable among the correction variables.
Preferably, the step S6 specifically includes: the correction matrix is acquired for 8 cardiac cycles in succession. The correction method comprises the following steps: t is a unit of sma ＝T sm (1-A m ) (ii) a Wherein the content of the first and second substances,A i for the correction matrix at the i-th cardiac cycle, T si Is T at the ith cardiac cycle s 。
Preferably, the first correcting variable a 1 Calculated by the following formula:
if d is 1 ≤k sd-m-0 ≤d 1-2 Then a is a 1 ＝(d 1-2 -k sd-m-0 )×0.50；
If k is sd-m-0 <d 1 Then a is 1 ＝28×0.50；
If k is sd-m-0 >d 1-2 Then a is 1 ＝0；
Wherein, the first and the second end of the pipe are connected with each other,d 1 ＝76～84，d 1-2 ＝104～112。
preferably, the second correcting variable a 2 Calculated by the following formula:
if k is sd-m >(d 2 + (age-14)/15/100), then a 2 ＝k sd-m -(d 2 +(age-14)/15/100)；
If k is sd-m ≤(d 2 + (age-14)/15/100), then a 2 ＝0；
Wherein if k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 Then k is sd-m ＝2×k sd-m-2 -(k sd-m-0 +k sd-m-ts ) /2, otherwise k sd-m ＝k sd-m-2 ；
age is age, d 2 ＝1.17～1.27。
Preferably, the third correcting variable a 3 Calculated by the following formula:
if c is 4 <k d-m-a <c 5 Then a is 3 ＝0；
If k is sd-m-0 <d 6 Or k sd-m-2 >d 7 Then a is a 3 ＝0；
If k is sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≤c 4 Then a is a 3 ＝(c 4 -k d-m-a )×67/100；
If it isOrThen a 3 ＝(c 4 -k d-m-a )×50/100；
If k is sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≥c 5 Then a is 3 ＝(c 5 -k d-m-a )×62/100；
If it isOrThen a is 3 ＝(c 5 -k d-m-a )×45/100；
Wherein if k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 And k is sd-m-ts ≥d 3-2 Then, thenOtherwise
If k is sd-m-ts ≤d 3-2 Then, thenIf it isThen theIf it isThen c 4 ＝(d 4 +(age-14)/8)/100，d 4 ＝23～35，c 5 ＝(d 5 +(age-14)/8)/100，d 5 ＝27～39，d 6 ＝0.97～1.03，d 7 ＝1.52～1.58，d 8 ＝1.42～1.48，d 3-2 ＝1.21～1.31，d 3 =0.02 to 0.14, age is age.
Preferably, the fourth correcting variable a 4 Calculated by the following formula: if k is s-t-toe &gt, 0.8, then a 4 ＝k s-t-toe -0.8；
If k is s-t-toe A is less than or equal to 0.8, then a 4 ＝0；
Wherein if t max-toe ≥t ch-toe Then, thenOtherwise
Preferably, the fifth correcting variable a 5 Calculated by the following formula:
if k is s-m-toe <d 9 Then a is 5 ＝0；
If k is s-m-toe ≥d 9 And k is s-t-toe A is more than or equal to 0.8 5 ＝k s-m-toe -d 9 ；
If k is s-m-toe ≥d 9 And k is s-t-toe &lt, 0.8, then a 5 ＝(k s-m-toe -d 9 )/2；
Wherein, d 9 ＝0.67～0.73，
Preferably, the sixth correcting variable a 6 Calculated by the following formula:
if k is s-m-toe-ear &1.0, then a 6 ＝0；
When k is s-m-toe-ear &gt, 1.08, then c 6 =1.08, at this time, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 1.0, if t s &lt 160 or k sd-m-0 &lt, 0.80, then a 6 ＝(c 6 -1.0). Times.0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝(c 6 -1.0)×0.67；
When k is more than or equal to 1.0 s-m-toe-ear C is less than or equal to 1.08, then 6 ＝k s-m-toe-ear -1.0, when t is s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 If t is s 160 or k or less sd-m-0 A is less than or equal to 0.80, then a 6 ＝c 6 X 0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝c 6 ×0.67；
Wherein the content of the first and second substances,
preferably, the seventh correcting variable a 7 Calculated by the following formula:
if k is ts-toe-ear &1.0, then a 7 ＝0；
When k is ts-toe-ear &gt, 1.08, then c 7 =1.08, at this time, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 1.0, if t s &lt 160 or k sd-m-0 &lt, 0.80, then a 7 ＝(c 7 -1.0). Times.0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝(c 7 -1.0)×0.67；
When k is more than or equal to 1.0 ts-toe-ear C is less than or equal to 1.08, then 7 ＝k ts-toe-ear -1.0, in this case, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 If t is s Less than or equal to 160 or k sd-m-0 A is less than or equal to 0.80, then a 7 ＝c 7 X 0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝c 7 ×0.67；
Wherein the content of the first and second substances,
according to the technical scheme, the systolic pressure related pulse wave propagation time correction method calculates the systolic pressure related pulse wave propagation time by detecting ear pulse waves and toe pulse waves in the same cardiac cycle in real time, extracts correction variables according to morphological characteristics of the pulse waves to obtain a correction matrix, performs adaptive correction on the variation of the pulse wave propagation time, and can continuously and accurately measure the systolic pressure of each cardiac cycle under clinical conditions, wherein the corrected propagation time can be used for the existing mathematical model.
Detailed Description
Hereinafter, embodiments of the present invention will be described in detail. The following examples are only for illustrating the technical solutions of the present invention more clearly, and therefore are only examples, and the protection scope of the present invention is not limited thereby.
Perioperative PTT changes can be divided into two categories. One type of variation: PTT changes due to blood pressure changes; two types of changes are as follows: PTT and unsynchronized changes in blood pressure (the direction or amount of change of both does not follow the conventional functional law). For example, PTT increases with mild hypovolemia, but blood pressure may not change much due to the body's own regulation of peripheral resistance; the use of the draw hook in the thoraco-abdominal operation may seriously affect PTT, but has little influence on blood pressure; norepinephrine causes strong constriction of arterioles, blood pressure rises significantly, but there is less effect on the average PTT throughout the body.
When PTT has a kind of change, the relation between PTT and blood pressure can still be expressed by a definite function, and the change of blood pressure can be estimated by a mathematical model. When there are two types of changes in PTT, a large error occurs in estimating blood pressure using a mathematical model based on the conventional circulatory system. Such errors are the principle errors in measuring blood pressure using PTT and cannot be accounted for by initial calibration and periodic calibration of the mathematical model parameters. The difference of PTT between different individuals and the PTT variation of the same individual are two kinds of problems with different properties, and different methods are needed to solve the problems. Therefore, the invention extracts a plurality of variables according to the morphological change of the pulse wave to indirectly identify and adaptively correct various two types of changes of the PTT, thereby overcoming the principle error; the method for continuously and non-invasively measuring the blood pressure with the self-adaptive calibration function can be formed by combining the existing mathematical model, and the repeated calibration by a conventional method such as a cuff oscillometric method is not required.
The positions of the human body for detecting the pulse waves are preferably ears and toes, and the pulse waves of the two parts can obtain physiological and pathological information of aorta and peripheral arteries, and are representative in propagation paths. The sensor that detects the pulse signal is preferably an infrared photoplethysmograph (PPG). The form change of the ear pulse wave and the toe pulse wave and the relative change of the form of the two pulse waves provide rich information for identifying the second kind of change of the PTT and the change of the difference of the blood pressure of different parts of the human body. The invention collects invasive arterial blood pressure, ear and toe pulse waveforms and PTT of a large number of operation cases for years to analyze, extracts various variables according to the two pulse waves and relative morphological changes, researches the relationship between different variables and different two types of changes of PTT, and defines the application range of various variables.
During clinical application, during the process of continuously measuring blood pressure by utilizing PPT, pulse waveforms are analyzed in real time and variables are extracted, whether PTT changes in two types or not is judged according to whether the variables fall into an application range or not, the nature and the degree of the PTT changes in two types are determined according to the nature of the applicable variables, and if a certain variable exceeds the application range, the PTT does not change in two types correspondingly, the variable is not applicable; and fusing the applicable variables, calculating a correction value to correct the PTT, wherein the corrected PTT/PWV is suitable for the existing mathematical model to accurately calculate the blood pressure.
The invention uses limited variables to express the most main and basic change rules of the pulse wave form and researches the relationship between the rules and PTT. In the following description, the ordinate of the pulse wave on a plane coordinate is amplitude h, the abscissa is time t, and the starting point of the pulse wave is the origin of coordinates.
Example (b):
the method for correcting the pulse wave propagation time related to the systolic pressure comprises the following steps:
s1) detecting the pulse wave at the ear position in each cardiac cycle in real time and analyzing to obtain the following data of the ear pulse wave: height h of aortic valve closing point on ear pulse wave sd I.e. the height of the junction between the systolic phase and the diastolic phase on the ear pulse wave, the systolic time t of the ear pulse wave s In milliseconds, the diastolic time t of the ear pulse wave d In milliseconds, the maximum height h of the ear pulse wave max ；
S2) detecting pulse waves at toes under each cardiac cycle in real time and analyzing to obtain the following data of the toe pulse waves: systolic time t of toe pulse wave s-toe In milliseconds, the diastolic time t of the toe pulse wave d-toe In milliseconds, the maximum height h of the pulse wave of the toes max-toe Time t from the starting point of the toe pulse wave to the midpoint of the peak ch-toe Unit is millisecond, and time t from starting point to peak of toe pulse wave max-toe Unit is millisecond; the middle point of the wave crest refers to the middle point of the turning point of the rising edge and the turning point of the falling edge at the wave crest; the definition of the mid-peak points can be understood by reference to YAN CHEN, CHANGYUN WEN, GUOCAI TAO, and MIN BI "Continuous and Noninival Measurement of Systolic and Diastolic Blood Pressure by One Material Model with the Same Model Parameters and Two Separate Pulse Wave vectors".
S3) calculating pulse wave propagation time T related to systolic pressure s The definitions of which can be understood by the references YANCHEN, CHANGYUN WEN, GUOCAI TAO, and MIN BI "Continuous and Noninational Measurement of Systolic and Diastolic Blood Pressure by One physical Model with the Same Model Parameters and Two Separate Pulse Wave dynamics"; h is ear pulse wave or toeThe amplitude of the pulse wave in the direction of the longitudinal axis;
s4) calculating to obtain a correction variable in the cardiac cycle by using the data obtained in the steps S1 and S2 in the same cardiac cycle;
s5) calculating to obtain a correction matrix under the cardiac cycle according to the correction variable under the cardiac cycle obtained in the step S4;
s6) continuously obtaining correction matrixes under a plurality of cardiac cycles, and carrying out comparison on T obtained in the step S3 s And (6) carrying out correction.
The method can detect ear pulse waves and toe pulse waves in the same cardiac cycle in real time, calculate pulse wave propagation time related to systolic pressure, extract correction variables according to morphological characteristics of the pulse waves, obtain a correction matrix, correct the variation of the pulse wave propagation time, and continuously measure the systolic pressure of each cardiac cycle by using the corrected propagation time in the existing mathematical model under clinical conditions.
First correcting variable a 1 ：
The correcting variables obtained in step S4 include a first correcting variable a 1 ，a 1 Correction of the propagation time T associated with the systolic blood pressure for hypotensive conditions s Two kinds of variations of (a) 1 Has an application range of a 1 >0，a 1 Larger indicates lower blood pressure.
k sd-m-0 Represents h sd The ratio of the average height of the ear pulse wave during systole. In some cases, the peak of the pulse wave appears as a triangle which is inclined forward in the hypotensive state. h is sd A great reduction of k sd-m-0 The smaller the size, the more the waveform at the end of aortic systole is reduced, the less the continuous power to push the pulse wave to spread, and the longer the spread time. In this state, the diastolic information is unstable and is not suitable for use. d 1 =76 to 84, preferably 80; d is a radical of 1-2 =104 to 112, preferably 108.
When the continuous power for pushing the propagation of the pulse wave is not availableTime of flight, propagation time T s Elongation, need a 1 And (6) correcting. I.e. if d 1 ≤k sd-m-0 ≤d 1-2 Then a is a 1 ＝(d 1-2 -k sd-m-0 )×0.50；
When the continuous power for pushing the pulse wave to spread is seriously insufficient, the spreading time T s A great deal of elongation a 1 The upper limit value is taken for correction. I.e. if k sd-m-0 <d 1 Then a is 1 ＝28×0.50；
When the continuous power for pushing the propagation of the pulse wave is sufficient, the T does not need to be corrected s ，a 1 Not applicable. I.e. if k sd-m-0 >d 1-2 Then a is 1 ＝0。
Second correcting variable a 2 ：
The correcting variables obtained in step S4 further include a second correcting variable a 2 ，a 2 Correcting the pulse wave propagation time T associated with the systolic pressure for a hypertensive state and for a change from a normotensive state to a hypertensive state s Two kinds of variations of (a) 2 Has an application range of a 2 >0，a 2 A larger indicates a higher systolic pressure.
k sd-m-ts Represents h sd And ear pulse wave diastolic period t s -2t s The ratio of the average heights of the segments is used for judging the variation of the pulse wave diastole. For example, in thoraco-abdominal surgery the upper retractor causes a change in aortic stress, resulting in a decrease in the diastolic waveform of the ear pulse wave, k sd-m-ts Becomes larger.
k sd-m-2 Denotes h sd 0-2t of ear pulse wave s The segment average height ratio, including the waveform information of the systolic phase and the partial diastolic phase, is mainly used for the hypertension state and the change process from the normal blood pressure state to the hypertension state, such as the result of tracheal intubationHeart rate and blood pressure rise. In the process of changing from the normal blood pressure state to the high blood pressure state, the wave crest of the ear pulse wave gradually presents a regular triangle or a backward-inclined triangle, h sd Gradually increase, k sd-m-2 Gradually becoming larger; in the state of hypertension, the whole ear pulse wave is in a regular triangle or a retroverted triangle h sd Is much higher, k sd-m-2 Becomes very large; the triangular tips of the two waveforms (i.e., the systolic blood pressure) have very short durations, the sustained power corresponding to the systolic blood pressure is insufficient, and the propagation time T is short s Is relatively elongated.
If k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 ，
Then k is sd-m ＝2×k sd-m-2 -(k sd-m-0 +k sd-m-ts )/2，
Otherwise k sd-m ＝k sd-m-2 ；
If the waveform variation of ear pulse wave in diastole, such as aorta stress variation caused by retractor in thoraco-abdominal operation and significant pulse wave form change, then k is measured sd-m Correction is made, otherwise k sd-m ＝k sd-m-2 。d 2 =1.17 to 1.27, preferably 1.22.
If k is sd-m >(d 2 Age-14/15/100), wherein age is age, age is 14 years old or more, indicating that the whole ear pulse wave or its peak becomes regular triangle or retroverted triangle, persistent hypomotility corresponding to the highest blood pressure, and propagation time T s Relatively long, requires a 2 To correct, then a 2 ＝k sd-m -(d 2 +(age-14)/15/100)。
If k is sd-m ≤(d 2 + (age-14)/15/100), the peak of the pulse wave is gentle, the continuous power corresponding to the maximum blood pressure is sufficient, and a is not required 2 To correct, let a 2 ＝0。
Third correcting variable a 3 ：
The correcting variables obtained in step S4 further include a third correcting variable a 3 ，a 3 For measuring T in the state of blood volume change or body temperature change at the sensor mounting part s And (6) carrying out correction.
Mean height and maximum height h of ear pulse wave in diastole max In-line with the above and (4) the ratio. The blood volume is reduced when the patient fasts and drinks little water before the operation,the reduction and the prolongation of the pulse wave propagation time are realized, when blood transfusion and fluid infusion in the operation cause the increase of blood volume,the propagation time is shortened.
If k is sd-m-ts ≤d 3-2 Indicating a waveform rise in the early diastolic phase of the ear pulse wave and exceeding the normal range, the pairMake a correction, and record the correction result as
If it isCan determine if the ear pulse wave is interferedd 3 =0.02 to 0.14, preferably 0.08; d 3-2 =1.21 to 1.31, preferably 1.26.
Mean height and maximum height h of toe pulse wave in diastole max-toe Ratio of (a) to (b), t s-toe Representing the systolic time, t, of recognition on the toe pulse wave d-toe Representing the identified diastolic time on the toe pulse wave. If it isThenAndthe function and the property of (2) are the same.
Combining two variables with the same property of ear and toe pulse waves, and taking the average value as calibration T s A variable of (d); if the waveform of the pulse wave in diastole is varied, k is added d-m-a And (6) carrying out correction.
If k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 And k is sd-m-ts ≥d 3-2 ，
Then
In a state where blood volume is normal and body temperature at the sensor mounting site is normal, a 3 Not applicable. If a 4 <k d-m-a <c 5 Then let a 3 ＝0。c 4 ＝(d 4 +(age-14)/8)/100，d 4 =23 to 35, preferably 29; c. C 5 ＝(d 5 +(age-14)/8)/100，d 5 =27 to 39, preferably 33.
In the state of very low or very high blood pressure, the diastolic information is unstable, a 3 Not applicable. I.e. if k sd-m-0 <d 6 Or k sd-m-2 >d 7 Then let a 3 ＝0。d 6 =0.97 to 1.03, preferably 1.00; d 7 =1.52 to 1.58, preferably 1.55.
In the normal blood pressure state, when the blood volume is decreased or the body temperature at the sensor mounting part is decreased, a 3 Take 67% of the positive values. I.e. if k sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≤c 4 Then a is 3 ＝(c 4 -k d-m-a )×67/100。d 8 =1.42 to 1.48, preferably 1.45.
In the state of low or high blood pressure, blood volume reduction or body temperature reduction at the sensor mounting part, a 3 50% of the value of the normal blood pressure state was taken. That is to say ifOrThen a is 3 ＝(c 4 -k d-m-a )×50/100；
In the normal blood pressure state, blood volume increase or body temperature rise at the sensor mounting site, a 3 Taking 62% of the negative value. I.e. if k sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≥c 5 Then a is a 3 ＝(c 5 -k d-m-a )×62/100；
In the state of low or high blood pressure, blood volume increase or body temperature rise at the sensor mounting site, a 3 45% of the negative value of the normal blood pressure state is taken. That is to say ifOrThen a 3 ＝(c 5 -k d-m-a )×45/100。
Fourth correcting variable a 4 ：
The correcting variables obtained in step S4 further include a fourth correcting variable a 4 ，a 4 In the case of lower limb blood pressure (relative to radial artery blood pressure) decrease due to peripheral vascular dilatation, the blood pressure of T is measured s Correction is carried out, a 4 Has an application range of a 4 >0，a 4 Larger indicates more reduction in lower limb blood pressure relative to radial artery blood pressure.
The contraction and expansion of the peripheral blood vessels causes the peak of the toe pulse wave to move back and forth in position on the time axis. If t is max-toe ≥t ch-toe Then, thenOtherwise
k s-t-toe The ratio of the time from the starting point to the peak of the toe pulse wave to the time of the systolic phase is 200, which is an adjustment coefficient. When the peak of the peak is moved backward beyond the midpoint, i.e. t max-toe ≥t ch-toe Then, to k s-t-toe Carrying out correction; k is a radical of formula s-t-toe When the value of (A) is larger, the toe vasodilatation is prompted, and the lower limb blood pressure is reduced. I.e. if k s-t-toe &gt, 0.8, then a 4 ＝k s-t-toe -0.8. If k is s-t-toe ≤0.8，a 4 Not applicable, then order a 4 ＝0。
Fifth correcting variable a 5 ；
The correcting variables obtained in step S4 further include a fifth correcting variable a 5 ，a 5 Action and Properties of 4 Same, for T with lower limb blood pressure relative to radial artery blood pressure s And (6) carrying out correction.
k s-m-toe The mean height and the maximum height h of the toe pulse wave in the systolic period max-toe The ratio of (A) to (B); k is a radical of s-m-toe When the pulse wave peak of the toe is large, the pulse wave peak is broad and gentle, which indicates that the blood vessel of the toe is expanded, and the blood pressure of the lower limb is reduced relative to the radial artery, a 5 Action and Properties of 4 The same applies.
When the blood vessel of the toe is not expanded, a 5 Not applicable. I.e. if k s-m-toe <d 9 Then let a 5 ＝0。d 9 =0.67 to 0.73, preferably 0.7.
When the toe blood vessel expands and the peak of the pulse wave peak moves backwards to exceed the midpoint, a 5 Take the positive value. I.e. if k s-m-toe ≥d 9 And k is s-t-toe Not less than 0.8, then a 5 ＝k s-m-toe -d 9 。
When the toe blood vessel expands and the peak position of the pulse wave crest does not exceed the midpoint, a 5 The positive value is halved. I.e. if k s-m-toe ≥d 9 And k is s-t-toe &lt, 0.8, then a 5 ＝(k s-m-toe -d 9 )/2。
A sixth correcting variable a 6 ；
The correcting variables obtained in step S4 further include a sixth correcting variable a 6 ，a 6 Representing the relative change of two pulse wave areas, and is used for treating T when toe blood vessel is dilated and lower limb blood pressure is reduced relative to radial artery blood pressure s And (6) carrying out correction. a is 6 Has an application range of a 6 >0。
k s-m-toe-ear The ratio of the area of the toe pulse wave in the contraction period to the area of the ear pulse wave in the contraction period is 100, which is an adjustment coefficient; k is a radical of formula s-m-toe-ear And k is ts-toe-ear The effect and the property of the same.
When the area of the toe wave is smaller than that of the ear wave, the blood vessels of the toes are not expanded relatively, a 6 Not applicable. I.e. if k s-m-toe-ear &1.0, then let a 6 ＝0。
Under the first prerequisite, the area of the toes is much larger than that of the ears, the blood vessels of the toes are much expanded, and c 6 The constant 1.08 is taken as a maximum value for standby. I.e. if k s-m-toe-ear &gt, 1.08, order c 6 ＝1.08。
If the ear pulse waveform is normal, a 6 And taking the maximum correction value. If t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 -1.0。
If the ear pulse wave has a very sharp forward triangle or a very narrow waveform, which indicates that the waveform state of the ear pulse wave is severely changed, the relative change between the two pulse waves is amplified and the calibration value needs to be reduced for use, a 6 Take 1/3 of the maximum calibration value. If t s &lt 160 or k sd-m-0 &lt, 0.80, then a 6 ＝(c 6 -1.0)×0.34。
When the ear pulse wave morphology is not too severe, a 6 Take 2/3 of the maximum correction. That is, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝(c 6 -1.0)×0.67。
In the second prerequisite, the area of the toes is larger than the area of the ears, the relative expansion of the blood vessels of the toes is less severe, c 6 Taking the positive variable for standby. I.e. if k is not less than 1.0 s-m-toe-ear C is less than or equal to 1.08, then 6 ＝k s-m-toe-ear -1.0。
If the ear pulse waveform is normal, a 6 Taking the positive variable as a correction value. If t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 。
If the ear pulse wave form is seriously varied, the relative variation between the pulse waves is amplified and the calibration value needs to be reduced for use, a 6 Take 1/3 of the positive variable. I.e. if t s Less than or equal to 160 or k sd-m-0 A is less than or equal to 0.80, then a 6 ＝c 6 ×0.34。
If the ear pulse wave is not too severely altered, a 6 Take 2/3 of the positive variable, i.e.If 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝c 6 ×0.67。
A seventh correcting variable a 7 ；
The correcting variables obtained in step S4 further include a seventh correcting variable a 7 ，a 7 Action and Properties of 6 Using the same, a 7 Representing the relative change in the systolic width (systolic time) of the two pulse waves.
k ts-toe-ear Is the ratio of the time of the identified systole on the toe pulse wave to the time of the identified systole on the ear pulse wave, 825 is the adjustment coefficient; k is a radical of ts-toe-ear The increase indicates that the blood vessels in the toes are dilated and the blood pressure in the lower limbs is reduced relative to the blood pressure in the radial artery.
When there is no relative expansion of the blood vessels in the toes, a 7 Not applicable. I.e. if k ts-toe-ear &1.0, then let a 7 ＝0。
In the first prerequisite, when the toe vessels are relatively dilated, c 7 The constant 1.08 is taken as a maximum value for standby. I.e. if k ts-toe-ear &gt, 1.08, order c 7 ＝1.08。
If the ear pulse waveform is normal, a 7 And taking the maximum correction value. If t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 -1.0。
If the ear pulse wave forms are seriously changed, the relative change between the pulse waves is amplified, and the calibration value needs to be reduced for use, a 7 Take 1/3 of the maximum correction. If t s &lt 160 or k sd-m-0 &lt, 0.80, then a 7 ＝(c 7 -1.0)×0.34。
If the ear pulse wave morphology is not too severe, a 7 Take 2/3 of the maximum correction. That is, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝(c 7 -1.0)×0.67。
Under the second prerequisite, when the toe width is greater than the ear width, the relative dilation of the toe vessels is less severe, c 7 Taking the positive variable for standby. I.e. if k is not less than 1.0 ts-toe-ear C is less than or equal to 1.08, then 7 ＝k ts-toe-ear -1.0。
If the ear pulse waveform is normal, a 7 Taking the positive variable as a correction value. If t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 。
If the waveform of the ear pulse is severely changed, a 7 Take 1/3 of the positive variable. If t s 160 or k or less sd-m-0 A is less than or equal to 0.80, then a 7 ＝c 7 ×0.34。
If the variation of the ear pulse wave morphology is not too severe, a 7 Take 2/3 of the positive variable. That is, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝c 7 ×0.67。
The correction matrix in the step S5Wherein if there is a i =0 denotes a i Not applicable. The step S6 specifically includes: continuously acquiring correction matrixes under 8 cardiac cycles, overcoming the interference of respiratory fluctuation by using the average value of the variables of the 8 cardiac cycles, selecting the 8 variables in a recursion mode, and eliminating one oldest variable every time a latest variable is calculated. The correction method comprises the following steps: t is sma ＝T sm (1-A m ) (ii) a Wherein the content of the first and second substances,A i for the correction matrix at the i-th cardiac cycle, T si Is T at the ith cardiac cycle s 。
Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; such modifications and substitutions do not depart from the spirit and scope of the present invention, and they should be construed as being included in the following claims and description.

Claims (10)

1. A method for correcting the pulse wave propagation time related to the systolic pressure, characterized by comprising the steps of:
s1) detecting the pulse wave at the ear position in each cardiac cycle in real time and analyzing to obtain the following data of the ear pulse wave: height h of aortic valve closure point on ear pulse wave sd Time t of contraction of ear pulse wave s In milliseconds, the diastolic time t of the ear pulse wave d In milliseconds, the maximum height h of the ear pulse wave max ；
S2) detecting pulse waves at toes in each cardiac cycle in real time and analyzing to obtain the following data of the toe pulse waves: systolic time t of toe pulse wave s-toe In milliseconds, the diastolic time t of the toe pulse wave d-toe In milliseconds, the maximum height h of the toe pulse wave max-toe Time t from the starting point of the toe pulse wave to the midpoint of the peak ch-toe Unit is millisecond, and time t from starting point of toe pulse wave to peak point of peak max-toe In milliseconds; the middle point of the wave crest refers to the middle point of the turning point of the rising edge and the turning point of the falling edge at the wave crest;
s3) calculating the pulse wave propagation time T related to the systolic pressure s Said T is s The time difference from the closing point of the aortic valve on the ear pulse wave to the closing point of the aortic valve on the toe pulse wave is defined; h is the amplitude of the ear pulse wave or the toe pulse wave in the direction of the longitudinal axis;
s4) calculating to obtain a correction variable under the cardiac cycle by using the data obtained in the steps S1 and S2 under the same cardiac cycle;
s5) calculating to obtain a correction matrix in the cardiac cycle according to the correction variable in the cardiac cycle obtained in the step S4;
s6) continuously obtaining correction matrixes under a plurality of cardiac cycles, and carrying out comparison on T obtained in the step S3 s And (6) carrying out correction.
2. The method for correcting systolic blood pressure-related pulse wave propagation time according to claim 1, characterized in that the correction matrix in step S5a i Is the ith correction variable among the correction variables.
3. The method for correcting systolic pressure-related pulse wave propagation time according to claim 1, characterized in that said step S6 is specifically: continuously acquiring correction matrixes under 8 cardiac cycles; the correction method comprises the following steps: t is sma ＝T sm (1-A m ) (ii) a Wherein, the first and the second end of the pipe are connected with each other,A i for the correction matrix at the i-th cardiac cycle, T si Is T at the ith cardiac cycle s 。
4. Method for correcting the pulse wave propagation time related to systolic pressure according to claim 2, characterised in that the first correcting variable a 1 Calculated by the following formula:
if d is 1 ≤k sd-m-0 ≤d 1-2 Then a is a 1 ＝(d 1-2 -k sd-m-0 )×0.50；
If k is sd-m-0 <d 1 Then a is a 1 ＝28×0.50；
If k is sd-m-0 >d 1-2 Then a is a 1 ＝0；
Wherein, the first and the second end of the pipe are connected with each other,d 1 ＝76～84，d 1-2 ＝104～112。
5. method for correcting the pulse wave propagation time related to systolic pressure according to claim 2, characterised in that the second correcting variable a 2 Calculated by the following formula:
if k is sd-m >(d 2 + (age-14)/15/100), then a 2 ＝k sd-m -(d 2 +(age-14)/15/100)；
If k is sd-m ≤(d 2 + (age-14)/15/100), then a 2 ＝0；
Wherein if k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 Then k is sd-m ＝2×k sd-m-2 -(k sd-m-0 +k sd-m-ts ) /2, otherwise k sd-m ＝k sd-m-2 ；
age is age, d 2 ＝1.17～1.27。
6. Method for correcting the pulse wave propagation time in relation to the systolic pressure according to claim 2, characterised in that the third correcting variable a 3 Calculated by the following formula:
if c is 4 <k d-m-a <c 5 Then a is 3 ＝0；
If k is sd-m-0 <d 6 Or k sd-m-2 >d 7 Then a is 3 ＝0；
If k is sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≤c 4 Then a is 3 ＝(c 4 -k d-m-a )×67/100；
If it isOrThen a 3 ＝(c 4 -k d-m-a )×50/100；
If k is sd-m-0 ≥d 6 +0.10 and k sd-m-2 ≤d 8 And k is d-m-a ≥c 5 Then a is 3 ＝(c 5 -k d-m-a )×62/100；
If it isOrThen a 3 ＝(c 5 -k d-m-a )×45/100；
Wherein if k sd-m-0 -k sd-m-ts | ≧ 40 and (k) sd-m-0 +k sd-m-ts )/2≥k sd-m-2 And k is sd-m-ts ≥d 3-2 Then, thenOtherwise
If k is sd-m-ts ≤d 3-2 Then, thenIf it isThen theIf it isThen
c 4 ＝(d 4 +(age-14)/8)/100，d 4 ＝23～35，c 5 ＝(d 5 +(age-14)/8)/100，d 5 ＝27～39，d 6 ＝0.97～1.03，d 7 ＝1.52～1.58，d 8 ＝1.42～1.48，d 3-2 ＝1.21～1.31，d 3 Age is 0.02 to 0.14, age is age.
7. Method for correcting the pulse wave propagation time related to systolic pressure according to claim 2, characterised in that the fourth correcting variable a 4 Calculated by the following formula: if k is s-t-toe &gt, 0.8, then a 4 ＝k s-t-toe -0.8；
If k is s-t-toe A is less than or equal to 0.8, then a 4 ＝0；
Wherein if t max-toe ≥t ch-toe Then, thenOtherwise
8. Method for correcting the pulse wave propagation time in relation to systolic pressure according to claim 2, characterised in that the fifth correcting variable a 5 Calculated by the following formula:
if k is s-m-toe <d 9 Then a is a 5 ＝0；
If k is s-m-toe ≥d 9 And k is s-t-toe A is more than or equal to 0.8 5 ＝k s-m-toe -d 9 ；
If k is s-m-toe ≥d 9 And k is s-t-toe &lt, 0.8, then a 5 ＝(k s-m-toe -d 9 )/2；
Wherein, d 9 ＝0.67～0.73，
9. Method for correcting the pulse wave propagation time in relation to systolic pressure according to claim 2, characterised in that the sixth correcting variable a 6 Calculated by the following formula:
if k is s-m-toe-ear &lt, 1.0, then a 6 ＝0；
When k is s-m-toe-ear &gt, 1.08, then c 6 =1.08, at this time, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 1.0, if t s &lt 160 or k sd-m-0 &lt, 0.80, then a 6 ＝(c 6 -1.0). Times.0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝(c 6 -1.0)×0.67；
When k is more than or equal to 1.0 s-m-toe-ear C is less than or equal to 1.08, then 6 ＝k s-m-toe-ear -1.0, when t is s &gt, 220 and k sd-m-0 &gt, 0.88, then a 6 ＝c 6 If t is s Less than or equal to 160 or k sd-m-0 A is less than or equal to 0.80, then a 6 ＝c 6 X 0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 6 ＝c 6 ×0.67；
Wherein the content of the first and second substances,
10. systolic pressure related pulse wave propagation according to claim 2Method for correcting time, characterized in that said seventh correcting variable a 7 Calculated by the following formula:
if k is ts-toe-ear &lt, 1.0, then a 7 ＝0；
When k is ts-toe-ear &gt, 1.08, then c 7 =1.08, at this time, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 1.0, if t s &lt 160 or k sd-m-0 &lt, 0.80, then a 7 ＝(c 7 -1.0). Times.0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝(c 7 -1.0)×0.67；
When k is more than or equal to 1.0 ts-toe-ear C is less than or equal to 1.08, then 7 ＝k ts-toe-ear -1.0, in this case, if t s &gt, 220 and k sd-m-0 &gt, 0.88, then a 7 ＝c 7 If t is s 160 or k or less sd-m-0 A is less than or equal to 0.80, then a 7 ＝c 7 X 0.34, if 160<t s Less than or equal to 220 or 0.80<k sd-m-0 A is less than or equal to 0.88, then a 7 ＝c 7 ×0.67；
Wherein the content of the first and second substances,
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JP2019541843A JP6736110B2 (en) 2016-11-22 2017-11-20 Method of correcting pulse wave transit time for arterial blood pressure
EP17874481.9A EP3545832B1 (en) 2016-11-22 2017-11-20 Correction method for pulse wave propagation time related to diastolic blood pressure and systolic blood pressure
PCT/CN2017/111799 WO2018095291A1 (en) 2016-11-22 2017-11-20 Correction method for pulse wave propagation time related to diastolic blood pressure and systolic blood pressure
US16/391,287 US20190246919A1 (en) 2016-11-22 2019-04-22 Method and system for correcting pulse transit time associated with arterial blood pressure or blood pressure value calculated by pulse transit time
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