CN101518439A - Cardiac function detecting system based on cardiac sound and electrocardiogram - Google Patents
Cardiac function detecting system based on cardiac sound and electrocardiogram Download PDFInfo
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Abstract
The invention relates to a cardiac function detecting system based on cardiac sound and electrocardiogram, which comprises a multi-physiological-parameter signal hardware collecting and processing module, a USB HUB module and a computer processing system, wherein the multi-physiological-parameter signal hardware collecting and processing module comprises a cardiac sound collecting module with independent A/D conversion function and USB communication control function, an electrocardiogram collecting module and a non-invasive blood pressure collecting module; and the USB HUB module realizes the electrical safety isolation between the human body and a computer and transmits input signals to the computer processing system. The system simultaneously analyzes the cardiac function state from four aspects of cardiac force, cardiac rhythm, cardiac rate and blood pressure, can realize the myocardial ischemia detection, the pulseless electrical activity detection, the cardiac reserve detection of arrhythmia patients, and the like and is beneficial to discovering cardiac abnormalities in advance and adopting corresponding medical treatments, thereby improving the accuracy of cardiac disease diagnosis and the survival rate of cardiac patients and being beneficial to reducing the medical expenditure of patients.
Description
Technical field
The present invention relates to a kind of human heart function detecting system and method, particularly a kind of based on hear sounds and cardiac electrical cardiac function detection system and method, belong to the century electronic instrument of medicine technical field.
Background technology
Cardiechema signals is one of most important acoustical signal of human body, the change of hear sounds and the appearance of noise, the sign the earliest of organic heart disease often, be not enough to produce other sings and symptomses (as patient's pain sensation, ECG unusual etc.) and before, can from hear sounds, obtain effective early diagnosis information when cardiovascular disease develops into as yet.And the subject matter of most of heart failure patients is reductions of myocardial contraction.Electrocardioscopy is cardiac chronotropic and becomes conductive best monitoring method, but can not be used for monitoring the variable force of heart.
The mechanical pump changes of function of cardiac muscle is prior to the variation of electric work energy.Clinically, electrocardiogram can not as cardiac arrest whether direct foundation.In like manner, excitement is not equal to premature beat before the phase, and is excited before can only diagnostic period with electrocardiogram, can not diagnose premature beat.
Sudden cardiac arrest is a kind ofly to lose the urgent clinical events that blood-pumping function causes cardiac output to die-off or stop suddenly because of heart, can reverse recovery as timely intervention (as defibrillation etc.), otherwise be exactly sudden cardiac death.Mainly show as large artery trunks and radial artery pulse disappearances such as carotid artery, femoral artery, hear sounds disappears, no blood pressure etc.Common mechanism is that pulseless electrical activity etc. are quivered in pulsus deletus chamber speed or chamber.
The pulsus deletus electrical activity is called electromechanical in the past and separates, and still can show on electrocardiogram and clocklike represent myocardium depolarization and process of repolarization, but heart does not have effective contraction, does not promptly finish enough mechanical powers.This result is also referred to as " depletion of pump capacity ".So in a single day the electromechanical segregator occurs clinically, the prognosis extreme difference almost is whole end property final result." american heart association in 2005 cardio-pulmonary resuscitation and cardiovascular first aid guide " points out that the time has determined all aspects of cardiovascular first aid, and with the depletion of cardio-pulmonary function, chance for survival may obviously descend; And the rescuer can not only determine whether carrying out cardio-pulmonary resuscitation by touching arteriopalmus.
Heart reservation refers to the rise ability of cardiac function, comprises heart rate reserve, diastolic reserve and systolic reserve etc.Heart reservation still is the important determiner of normal population and heart patient's motor capacity, and motor capacity and survival rate are closely related.The not normal most important aspect of cardiac function is not the inhibition of observed cardiac performance under the quiescent condition on basis during heart failure, but the forfeiture of heart reservation.
From cardiechema signals, extract cardiac contractility ability signal and cardiac cycle signal, analyze mental and physical efforts variation tendency and changes in heart rate trend, thereby heart reservation is carried out noninvasive objective quantification assessment.
1) heart self blood supply time evaluation index D/S
The D/S index is the ratio in diastole time limit and systole time limit.Because heart self blood supply mainly is implemented in relaxing period, so whether assess relaxing period heart self the blood supply time with this index sufficient.If the relaxing period time limit is longer, heart self blood supply time abundance, just can for heart at more nutriment of Syst active redundancy and oxygen, at this moment, myocardial contraction is strong; If the relaxing period time limit is too short, the ventricular filling deficiency, cardiac output is low, heart self blood supply insufficiency, myocardial contraction just can weaken, and may cause myocardial damage, even causes sudden cardiac death.
2) the dynamic change index S 1/S2 of heart contraction ability and Peripheral resistance
S1/S2 refers to the ratio of phonocardiogram first heart sound amplitude maximum (maxS1) to second heart sound amplitude maximum (maxS2).First heart sound amplitude size and the strong and weak height correlation of myocardium of left ventricle contractility, and the second heart sound amplitude is relevant with Peripheral resistance, surveys S1/S2 and can observe the dynamic change of cardiovascular compensation.
3) the load condition evaluation index T1/M1 of right ventricle and left ventricle
Obtain the load condition that the phonocardiogram peaked ratio of S1 amplitude (T1/M1) is assessed right ventricle and left ventricle with the acquisition phonocardiogram S1 amplitude maximum and the apex of the heart under the xiphoid-process.
4) changes in heart rate trend HRI
HRI is for according to finishing 7000 joules and finish 1750 joules of quantity of motion, the phonocardiogram of the phonocardiogram of quiescent condition record and motion back instant recording extracts heart rate respectively before the motion, heart rate before postexercise heart rate/motion is called the changes in heart rate trend indicator, is used for assessing myocardium chronotropic function.
It is high 3.5 times that resting heart rate is lower than 60 times/minute persons faster than 75 times/minute person's risk of dying suddenly ratios; It is higher 4 times than the ordinary people that the too fast and exercise heart rate of resting heart rate quickens slow person's (increase is less than 89 times/minute) risk of dying suddenly; It is higher 2 times than the ordinary people that postexercise heart rate can not resemble ordinary person recuperator (reduction is less than 25 times/minute) risk of dying suddenly.
5) mental and physical efforts variation tendency index CCCT (1) and CCCT (1/4)
The multiple that the S1 maximum amplitude increased when the S1 maximum amplitude was to peace and quiet after different load moved down is defined as CCCT, is used to assess experimenter's cardiac reserve.The quantity of motion gained CCCT that wherein finishes 7000 joules is designated as CCCT (1), finishes 1750 joules of quantity of motion gained CCCT and is designated as CCCT (1/4).
Sudden cardiac death is one of ultimate challenge of facing of human society and clinical medicine.World Health Organization (WHO) about the definition of sudden cardiac death is: the evidence of sudden cardiac arrest is arranged clinically, from the burst symptom to time of death within an hour, the death of unknown cause, patient is good in 24 hours before.But the classification that this definition might lead to errors, increasing epidemiological study tend to support that the many indexs combined monitoring based on incident generation ambient conditions realizes clearly classification.All there are certain limitation in the detection method and the index that are used to screen the sudden cardiac death high-risk patient at present, and can only discern the high-risk group, can't discern high-risk individuality.As time goes on a lot of risk stratification indexs (comprise LVEF, chamber property differently fight, HRV) all can change.Mainly concentrate on clinical symptoms when approaching one's end about the early warning of sudden cardiac death, and the research index mainly is that the left ventricular ejection mark and the rhythm of the heart in the article of death change, ignored (in recent years from several aspects complete observation researchs such as mental and physical efforts, the rhythm of the heart, hearts rate, heart failure further investigation back is found that a large amount of heart failure patient LVEF are normal; The end last link or intermediate link of the mechanism that arrhythmia is just died suddenly due to muscle power overwork or the defatigatio mentis, and not necessarily initial link or initial performance).Do not have the cardiac contractility ability index about cardiovascular monitoring index in cardiac monitoring chamber and critical care nursing, the anesthesia monitoring project, ignored from mental and physical efforts, the rhythm of the heart, heart rate, blood pressure aspect observational study simultaneously.In the clinical practice monitoring, exhausted most pregnant and lying-in women are in person between twenty and fifty, and ARR incidence rate is extremely low, need new technology and method to use to improve pregnant and lying-in women's heart safety.Chinese scholars is all recognized the importance of the cardiac safety assessment of women in pregnancy period and stages of labor, but lacks the research of carrying out the cardiac safety assessment from the angle of heart reservation.
About hear sounds and cardiac electrical joint-detection research, many trials have been arranged both at home and abroad, but cardiac function detector in the past, perhaps only limit to traditional cardiac auscultation digitized, underuse the clinical value of hear sounds, perhaps utilized some the physiology's relations between hear sounds and the electrocardio, detect patient and whether be in pulsus deletus electrical activity state, but also only limit to traditional clinical practice about hear sounds and ECG Signal Analysis research, do not carry out the expansion of application indexes.As Chinese patent 95214529.4 disclosed " non-invasive complex electrocardio heart sound analyzer ", Chinese patent 200410011302.5 disclosed " domestic real-time analysis electrocardio hear sounds monitor ", disclosed a kind of heartbeat detection method and the device etc. based on hear sounds of US Patent No 6440082.
In sum, existing known patent and document all have some common features, all there is certain limitation (to fight and index such as heart rate variability for the detection of heart function state as left ventricular ejection mark, chamber property are different, can As time goes on change), and all underuse the clinical value of cardiechema signals, from hear sounds, do not extract heart reservation index, and carry out analysis-by-synthesis, realize that heart function state objective comprehensively, easy popularization and application detects with electrocardio, non-invasive blood pressure index.
Summary of the invention
At the prior art above shortcomings, and the demand of clinical heart function state detection, the objective of the invention is at general population, heart patient, especially pregnant and lying-in women, high-risk heart patient, enclose anesthetic stage and peri-operation period patient special requirement in the heart function state context of detection, provide a kind of, detect heart function state simultaneously from mental and physical efforts, the rhythm of the heart, heart rate and four aspects of blood pressure based on hear sounds and cardiac electrical cardiac function detection system.
Based on this heart function detecting system, the present invention realizes, and heart function state objective comprehensively, low-cost, easily popularization and application detects, and improves pregnant and lying-in women's cardiac safety, the cardiac safety of enclosing anesthetic stage and peri-operation period patient and high-risk heart patient's cardiac safety.
The object of the present invention is achieved like this: a kind of based on hear sounds and cardiac electrical cardiac function detection system, comprise collection of multi-physiological-parameter signal hardware and processing module, USB HUB module, computer processing system and outut device, collection of described multi-physiological-parameter signal hardware and processing module are by the hear sounds acquisition module with independently A/D conversion and usb communication control function parallel with one another, electrocardiogram acquisition module and non-invasive blood pressure acquisition module are formed, be respectively applied for the cardiechema signals of gathering the experimenter, electrocardiosignal and arm arterial pulse wave signal and the above-mentioned signal that will collect are imported USB HUB module by usb bus, electrical safety between USB HUB module realization human body and the computer is isolated and the signal of importing is transferred to computer processing system, thereby above-mentioned signal is handled the heart reservation index that obtains the experimenter by computer processing system, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index, described index is exported by outut device.
Described USB HUB module comprises DC-DC reduction voltage circuit, electrical safety buffer circuit, USB HUB controller, USB HUB power-supply controller of electric and usb bus interface; The DC-DC insulating power supply module that adopts the electrical safety buffer circuit realizes the electrical isolation of power supply, adopts the magnetic isolating device to realize the electrical isolation of signal.
Described hear sounds acquisition module comprises heart sound transducer, hear sounds frequency-division section circuit, gain control circuit, level modulate circuit, A/D conversion and usb communication control circuit; The electrocardiogram acquisition module comprises the body surface ecg utmost point and three lead integral type cardiac diagnosis lead-line, prestage safety protective circuit, pre-amplification circuit, bandwidth-limited circuit (0.05-100Hz), 50Hz trap circuit, level modulate circuit, driven-right-leg circuit, A/D conversion and usb communication control circuit; The non-invasive blood pressure signal acquisition module comprises blood pressure cuff, cuff pressure and pulse signal testing circuit, air pump air valve control circuit, level modulate circuit, A/D conversion and usb communication control circuit, and air pump air valve control circuit and level modulate circuit are parallel between cuff pressure and pulse signal testing circuit, A/D conversion and the usb communication control circuit.
Described hear sounds frequency-division section circuit is made up of intrasonic circuit, extremely low frequency circuit, low-frequency channel, intermediate-frequency circuit and high-frequency circuit; Wherein, intrasonic circuit frequency range is 0.05-5Hz; Extremely low frequency circuit frequency range is 5-30Hz; The low-frequency channel frequency range is 30-80Hz; The intermediate-frequency circuit frequency range is 80-120Hz; The high-frequency circuit frequency range is 120-1000Hz.
Use above-mentioned cardiac function detection system to the method that heart detects, the steps include:
(1) utilize above-mentionedly based on hear sounds and cardiac electrical cardiac function detection system, synchronous acquisition hear sounds, electrocardio, arm arterial pulse wave signal obtain synchronous phonocardiogram, electrocardiogram, pulse wave;
(2) extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index from synchronous phonocardiogram and electrocardiogram, extract the non-invasive blood pressure index from pulse wave;
(3) from mental and physical efforts, the rhythm of the heart, heart rate and four aspects of blood pressure, analysis-by-synthesis heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index.
Described step (2) adopts the adaptive boosting wavelet transformation that cardiechema signals, electrocardiosignal are carried out the denoising pretreatment, adopt Xi Er-artificial method of revising of Bert Huang combination to carry out the location of phonocardiogram composition, electrocardiogram composition, realize the extraction of heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index then.
Described heart reservation index comprises heart reservation tranquillization index and heart reservation motion index, and heart reservation tranquillization index comprises that S1/S2, D/S, T1/M1, S1 and S2 are inverted and heart rate; The heart reservation motion index comprises HRI, %S3, %S4, CCCT (1) and CCCT (1/4); Described electrocardiogram index comprises P-P interval, P-R interval and S-T interval; Described phonocardiogram and electrocardiogram aggregative indicator comprise EMAT, AAFT and PAFT; Described non-invasive blood pressure index comprises systolic pressure, diastolic pressure and mean arterial pressure.
Compared to existing technology, the present invention has following beneficial effect:
1, monitors simultaneously by cover system realization hear sounds, electrocardio and arm arterial pulse wave signal, obtain synchronous phonocardiogram, electrocardiogram, pulse wave, extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index; And then propose a kind of based on hear sounds and the method for electrocardio analysis-by-synthesis human heart functional status, arrhythmia patient's heart reservation analytical method, realize the early warning of sudden cardiac death, this method can not only be discerned the sudden cardiac death high-risk group, can also discern high-risk individuality.
2, be the monitoring of the additional cardiac contractility ability index of heart function state index of cardiac monitoring chamber and critical care nursing, anesthesia monitoring, detect heart function state simultaneously from mental and physical efforts, the rhythm of the heart, heart rate and four aspects of blood pressure, reach and improve critical patient's cardiac safety, enclose the purpose of anesthetic stage and the safety of peri-operation period heart of patient.
3, in the clinical practice monitoring, exhausted most pregnant and lying-in women are in person between twenty and fifty, and ARR incidence rate is extremely low.The present invention can realize the detection of pregnant and lying-in women's mental and physical efforts, electrocardio and non-invasive blood pressure index by a cover system, reach improve pregnant and lying-in women's cardiac safety purpose.
4, a kind of method that a cover system realizes that arrhythmia patient's heart reservation index is analyzed of passing through is proposed; Propose a kind of athlete heart function detecting method, particularly adopt D/S, S1/S2, S1 and S2 inversion, HRI, CCCT (1), the athletic heart function state of CCCT (1/4) index evaluation simultaneously; A kind of pulsus deletus electrical activity detection method is proposed, particularly from mental and physical efforts, the rhythm of the heart, heart rate and the check and analysis simultaneously of four aspects of blood pressure.
5, noinvasive safety of the present invention, simple and efficient, low-cost, extensive use under household condition.
Description of drawings
Fig. 1-a kind of based on hear sounds and cardiac electrical cardiac function detection system structure chart;
Fig. 2-a kind of based on hear sounds and cardiac electrical cardiac function detection system theory diagram;
Fig. 3-cardiac auscultation district sketch map;
Fig. 4-phonocardiographic four composition sketch maps;
Fig. 5-heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index are extracted sketch map.
The specific embodiment
Introduce the present invention in detail below in conjunction with the drawings and specific embodiments.
The present invention is by adopting the modular medical instrument construction method based on USB HUB, makes up a kind of based on hear sounds and cardiac electrical cardiac function detection system, by this system synchronization collection hear sounds, electrocardio and arm arterial pulse wave signal; Obtain synchronous phonocardiogram, electrocardiogram, pulse wave; Extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index; From mental and physical efforts, the rhythm of the heart, heart rate and four aspects of blood pressure check and analysis simultaneously heart function state; And then propose a kind of based on hear sounds and cardiac electrical cardiac function detection method.
Below detection system is described in detail.As shown in Figure 1, the present invention is based on hear sounds and cardiac electrical cardiac function detection system, comprise collection of multi-physiological-parameter signal hardware and processing module, USB HUB module, power module, computer processing system (including software platform) and outut device based on PC.Wherein, collection of multi-physiological-parameter signal hardware and processing module comprise: cardiechema signals acquisition module, ecg signal acquiring module and non-invasive blood pressure acquisition module.
See Fig. 2, wherein the cardiechema signals acquisition module comprises by the signal trend: heart sound transducer, hear sounds frequency-division section circuit, signal conditioning circuit (gain control circuit, level modulate circuit), A/D conversion and usb communication control circuit.Hear sounds frequency-division section circuit comprises: intrasonic circuit (0.05-5Hz), extremely low frequency circuit (5-30Hz), low-frequency channel (30-80Hz), intermediate-frequency circuit (80-120Hz), high-frequency circuit (120-1000Hz); Gain control circuit is by operational amplifier, resistor network, and the multiway analog switch device constitutes, and selects by the microprocessor ride gain; Heart sound transducer is selected active heart sound transducer (as the JXH-5 type heart sound transducer of Beijing Astronautics Medical Engineering Inst.), and its inside includes pre-amplifying circuit, has good interference free performance, characteristics such as sensitivity height; A/D conversion and usb communication control circuit can be by the microprocessors (as the C8051F32X/34X series of products of SILAB company) of integrated ADC in inside and USB controller, and perhaps adopting independently, the mode of A/D conversion chip, microcontroller, USB interface chip realizes.
Wherein, the ecg signal acquiring module comprises by signal trend: the body surface ecg utmost point and three lead integral type cardiac diagnosis lead-line, prestage safety protective circuit, signal conditioning circuit (pre-amplification circuit, bandwidth-limited circuit (0.05-100Hz), 50Hz trap circuit, level modulate circuit), driven-right-leg circuit, A/D conversion and usb communication control circuit.The 50Hz trap circuit adopts the integrated switched capacitor wave filter to make up (having realized the fertile 50Hz wave trap now of one eight rank Bart as the LTC1068-200 that adopts U.S. Linear Techn Inc.); A/D conversion and usb communication control circuit, can be by the microprocessor (as the C8051F32X/34X series of products of Silicon Laboratories company) of integrated ADC in inside and USB controller, perhaps adopting independently, the mode of A/D conversion chip, microcontroller, USB interface chip realizes; Other circuit adopts existing design commonly used to realize.
Wherein, the non-invasive blood pressure signal acquisition module comprises by the signal trend: blood pressure cuff, cuff pressure and pulse signal testing circuit, air pump air valve control circuit, level modulate circuit, A/D conversion and usb communication control circuit.Air pump air valve control circuit and level modulate circuit are parallel between cuff pressure and pulse signal testing circuit, A/D conversion and the usb communication control circuit, cuff pressure and pulse signal testing circuit comprise: pressure transducer and differential amplifier circuit, high-pass filtering amplifying circuit, second-order low-pass filter circuit constitute (the BP01 type pressure transducer of the sharp Kanggong of pressure transducer employing moral department, this pick off adopts inner the demarcation and the temperature-compensating mode, thereby has improved precision, the stability and repeatable measured; High-pass filtering amplifying circuit design two-stage RC high-pass filtering circuit and discharge circuit are used for faint pulse wave signal and cuff pressure signal are separated, to extract purified pulse wave signal; The second-order low-pass filter circuit is removed the High-frequency Interference in the pulse wave signal); A/D conversion and usb communication control circuit, but monolithic is by the microprocessor (as the C8051F32X/34X series of products of U.S. Silicon Laboratories company) of integrated ADC in inside and USB controller, and perhaps adopting independently, the mode of A/D conversion chip, microcontroller, USB interface chip realizes; Other circuit adopts existing design commonly used to realize.
Above-mentioned three modules have separately independently A/D conversion and usb communication function.
Wherein, USB HUB module is the four-hole USB HUB module with electrical safety isolation features, and it comprises: DC-DC reduction voltage circuit, electrical safety buffer circuit, USB HUB controller, usb bus interface.The electrical safety buffer circuit adopts DC-DC insulating power supply module to realize the electrical isolation (as the G0505D-2W of Jin Shengyang company) of power supply, adopt the magnetic isolating device to realize the electrical isolation (as ADuM1250) of signal, realize that the electrical safety between human body and the computer is isolated and transfer of data; USB HUB controller adopts the TUSB2046B of American TI Company to realize; Other circuit adopts existing design commonly used to realize.
Wherein, the electric power source pair of module system carries out the power supply supply; Power module adopts power supply adaptor and the battery powered mode of Li to realize, collection of multi-physiological-parameter signal hardware and processing module are directly obtained power supply from usb bus, comprise 220V AC adapter (output 15V, the 1A dc source), (directly adopt PC USB port power supply is the Li battery powered to the Li battery charger, charger adopts the Max1811 of Maxim company), DC-DC booster circuit and DC-DC reduction voltage circuit (obtain+3.3V and+5.0V, the for example Max1797 of Maxim company and Max1837), voltage reversal circuit (the reversed charge pump that is adopted such as the MAX889 of Maxim company).
Computer processing system is by the USB driver, realization to the identification of each module, communicate to connect and transfer of data, realize signals collecting, processing, store, from phonocardiogram, extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index by signal processing algorithm with screen demonstration, data base.It comprises computer operating system, driver, signal analysis and processing algorithm, user interface, data base etc., and the data base realizes the storage to institute's image data.
Outut device realizes the printout of analysis report, the audio frequency output of hear sounds, comprises printer and audio amplifier etc.
Use above-mentioned cardiac function detection system to the method that heart detects, the steps include:
(1) utilize above-mentioned cardiac function detection system, synchronous acquisition hear sounds, electrocardio, arm arterial pulse wave signal obtain synchronous phonocardiogram, electrocardiogram, pulse wave;
(2) from synchronous phonocardiogram and electrocardiogram, extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, extract the non-invasive blood pressure index from pulse wave;
(3) from mental and physical efforts, the rhythm of the heart, heart rate and four aspects of blood pressure, above-mentioned heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index are carried out analysis-by-synthesis.
Definition and medical significance to the specific targets under above-mentioned four types of indexs describes below.
As shown in Figure 4, each cardiac cycle all comprises first heart sound (S1), second heart sound (S2), third heart sound (S3), fourth heart sound (S4).The normal person can record S1 and S2, can record S3 and S4 sometimes.
The Bicuspid valve component list of first heart sound S1 is shown M1;
The Tricuspid valve component list of first heart sound S1 is shown T1;
The aortic valve closing component list of second heart sound S2 is shown A2;
The valve of pulmonary trunk closing component of second heart sound S2 is expressed as P2.
Wherein heart reservation index comprises heart reservation tranquillization index and heart reservation motion index, heart reservation tranquillization index comprises: S1/S2, D/S, T1/M1, heart rate, S1 and S2 are inverted that (S1 and S2 are inverted definition: the phonocardiogram that the carried out 24 seconds detection of holding one's breath, analyze the phonocardiogram that is write down, maximum amplitude ratio S1/S2 〉=1 of S1 and S2 in 5 continuous cardiac cycles when beginning to detect, and maximum amplitude ratio S1/S2＜1=of S1 and S2 in last 5 continuous cardiac cycles when detect finishing;
The heart reservation motion index comprises: HRI, %S3 (the %S3 computing formula is:
, wherein aS3 is for after the experimenter finishes 1750～7000 joules of motions, in 30 second writing time, the total degree that S3 occurs, N is total cardiac cycle number in back 30 seconds of the motion, bS3 for motion before quiescent condition, in 30 second writing time, the total degree that S3 occurs), %S4 (the %S4 computing formula is:
, wherein aS4 is for after the experimenter finishes 1750～7000 joules of motions, in 30 second writing time, the total degree that S4 occurs, N is total cardiac cycle number in back 30 seconds of the motion, bS4 for motion before quiescent condition, in 30 second writing time, the total degree that S4 occurs), CCCT (1), CCCT (1/4).
Wherein the electrocardiogram index comprises: P-P interval, P-R interval, S-T interval.
Phonocardiogram and electrocardiogram aggregative indicator: EMAT (starting point of Q ripple is to the interval of S1 amplitude maximum point), AAFT (starting point of P ripple is to the interval of S1), PAFT (S2 is to the interval of P ripple).
Blood pressure index: systolic pressure, diastolic pressure, mean arterial pressure.
Leading indicator stage division and medical significance:
The marginal value of D/S ratio is elected to be 1.5.Anemia of pregnant woman D/S reduces gradually, and prompting heart self the blood supply time shortens gradually.Native system is divided into Pyatyi with D/S: 1 grade 〉=1.50,2 grades 1.49-1.40,3 grades of 1.39-1.30,4 grades of 1.29-1.20,5 grades＜1.20.1 grade of expression relaxing period heart blood supply time abundance, 2 grades of expression relaxing period heart blood supply times slightly shorten, 3 grades of expression relaxing period heart blood supply time moderates shorten, and 4 grades of expression relaxing period heart blood supply time moderates shorten, and 5 grades of expression relaxing period heart blood supply time severes shorten.
The statistical value of S1/S2 is 1.89 ± 0.94, is divided into following three kinds of situations:
1.S1/S2 the physiological compensatory increases (S1/S2〉3.7): see physical exertion, 1-2 stages of labor, situation such as excited, can restore by nature.S1/S2 ratio can be used to the safety of puerpera in noninvasively estimating pregnancy period and deposit dynamic change of stages of labor cardiac and the stages of labor.
2.S1/S2 the pathologic compensatory increases (S1/S2〉3.7): see multiple cardiopulmonary and angiopathy and cardiovascular function is had the disease of significant impact, as hypertension, chronic obstructive pulmonary disease, hyperthyroidism, diabetes etc.
3.S1/S2 reduce: when blood pressure is on the low side, if S1/S2 ratio＜1, prompting blood pressure is on the low side may weaken by mental and physical efforts due to.
The T1/M1 classification:
T1/M1〉3 o'clock, point out right cardiac load overweight, right heart failure danger is arranged.At this moment available T1/M1 monitors whole diagnosis and treatment process, in the hope of to the narration in the diagnosis basis of chronic pulmonary heart disease right ventricular hypertrophy " under the xiphoid-process hear sounds strong than the apical region of heart hear sounds " give the index of objective quantification.
S1 and S2 are inverted: the prompting cardiac muscle is in anaerobic condition, and heart fine setting phenomenon occurs, i.e. difference phenomenon between mental and physical efforts adjusting and heart rate are regulated.For example, in the exercise stress process, mental and physical efforts variability and heart rate variability are not in the same way, and in the recovery process of exercise stress, mental and physical efforts are recovered trend and heart rate recovery trend is nonsynchronous.
%S3 and %S4:
%S3: experimenter %S3 〉=5%, prompting heart burden, left ventricular end-diastolic pressure increases and compliance descends, and is used for the detection of general population's cardiac function, coronary heart disease diagnosis and patients with coronary heart disease cardiac function and detects.
%S4: experimenter %S4 〉=5%, prompting heart burden, left ventricular end-diastolic pressure increases and compliance descends, and is used for the detection of general population's cardiac function, coronary heart disease diagnosis and patients with coronary heart disease cardiac function and detects.
The CCCT classification:
The marginal value of CCCT (1) is elected to be 5; The marginal value of CCCT (1/4) is elected to be " 3 ".Mental and physical efforts variation tendency CCCT＜3 after the gait test in six minutes, the prompting cardiac reserve reduces, and instructs clinical concrete analysis reason.
Phonocardiogram and electrocardiogram aggregative indicator:
EMAT heart failure evaluation index; PAFT, AAFT acute myocardial infarction and myocardial ischemia evaluation index.
Obtain the method for each check and analysis index:
Heart sound transducer is fixed on each index of experimenter obtains corresponding area of auscultation (as shown in Figure 3), the body surface ecg utmost point is fixed on experimenter's left hand and right hand wrist, right crus of diaphragm ankle, blood pressure cuff is fixed on experimenter's left hand upper arm; Hear sounds, electrocardio, blood pressure signal are input to computer behind signal condition; Computer processing system, by the characteristic information that stores in USB driver and each module, realize identification to each module, foundation communicates to connect with hardware system, finish record, pretreatment, data analysis, demonstration, data storage to hear sounds, electrocardio, blood pressure signal.Wherein signal record, pretreatment, demonstration are realized by graphic programming system design platform Labview8.20 programming; The data base stores and adopts MySQL Server5.0.67 data base, is realized by graphic programming system design platform Labview8.20 programming; The data analysis Processing Algorithm adopts the Matlab7.0 programming, and by the seamless embedded software system of labview MathScript node, the data of record is handled, and extracts the characteristic point of waveform correlation, and calculates index of correlation.
Heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index are extracted as shown in Figure 5:
Wherein, obtaining of heart reservation index: at first, adopt the adaptive boosting wavelet transformation to carry out the denoising pretreatment to the cardiechema signals that collects; Then, pretreated signal is adopted Hilbert-Huang transform, obtain each rank intrinsic mode function (IMF).Choose the first and second rank intrinsic mode functions and carry out Hilbert transform, obtain the envelope of hear sounds; At last, adopt Xi Er-Bert Huang, first heart sound (S1) and second heart sound (S2) are located, obtain S1/S2 in conjunction with the artificial method of revising, D/S, heart rate index, S1 and S2 are inverted.
T1/M1: by the cardiechema signals S1 location to xiphoid-process and twice record of the apex of the heart, get S1 amplitude maximum twice, being divided by obtains the desired value of T1/M1.
In general the characteristic point of calculating by above-mentioned rule is accurately, correctly the deal with data file.But the individual variation between the patient is more serious, or signal is interfered and causes waveform change and influence recognizer identification, or a large amount of cardiac murmurs occurs, need increase artificial correction on feature identification, to obtain desired value accurately.
Wherein, obtaining of electrocardiogram index: adopt the adaptive boosting wavelet transformation to carry out the denoising pretreatment to the electrocardiosignal of gathering earlier, adopt Xi Er-Bert Huang in conjunction with the artificial method of revising then, electrocardiosignal is carried out real-time analysis, identification patient Electrocardiographic P ripple, QRS ripple, T ripple, ST section (at first discern the R ripple, then near the QRS ripple, according to P ripple, T ripple and R ripple interval search P ripple and the T ripple on cardiac electrophysiology), after determining P, QRS, T ripple separation, carry out various parameter measurements and calculating, and be presented on the computer screen.Measurement parameter comprises P-P interval, P-R interval, S-T interval desired value.
In general the characteristic point of calculating by above-mentioned rule is accurately, correctly the deal with data file.But the individual variation between the patient is more serious, or signal is interfered and causes waveform change and influence recognizer identification, need increase artificial correction on feature identification, to obtain desired value accurately.
Phonocardiogram and electrocardiogram aggregative indicator: at S1, S2, the P ripple on the QRS ripple base of recognition, adds manually and revises, and extracts EMAT, AAFT, PAFT desired value.
The non-invasive blood pressure index is obtained: based on the ultimate principle of vibration measuring method, by analyzing the control of the stagewise pulse signal realization of pressure to pump and valve, and then realization circulation ladder pressure detecting, simultaneously the signal on each ladder is nursed one's health, analyzed, calculate mean arterial pressure by curve fitting, by the pulse wave envelope flex point after the ladder venting is detected, realize systolic pressure, the extraction of diastolic pressure index.
Utilization can obtain index said system, comprehensive based on hear sounds and cardiac electrical cardiac function detection system, understand different indexs and combination thereof and can realize that dissimilar experimenters' health detects, specifically comprise following several but be not limited to following several situation:
1, pulsus deletus electrical activity detection method, a kind of by adopting based on hear sounds and cardiac electrical cardiac function detection system, patient is carried out hear sounds, electrocardio and non-invasive blood pressure simultaneously detect, extract heart reservation tranquillization index, electrocardiogram index, the detection of non-invasive blood pressure index realization pulsus deletus electrical activity; Wherein, as heart reservation index D/S, S1/S2, heart rate begin to descend, and the prompting heart reservation reduces, and the heart pump function begins to weaken; After the QRS wave group occurs, S1 does not appear in 20～40mS interval, and the blood pressure desired value reduces simultaneously, and the prompting heart is in pulsus deletus electrical activity state.
2, arrhythmia patient's cardiac function detection method, a kind of by adopting based on hear sounds and cardiac electrical cardiac function detection system, carrying out electrocardiogram detects, when the electrocardiogram index of obtaining unusual, show when the experimenter is the arrhythmia patient, carry out the detection of hear sounds, electrocardio, non-invasive blood pressure simultaneously, extract heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index, from mental and physical efforts, the rhythm of the heart, heart rate, four aspects of blood pressure, while comprehensive assessment arrhythmia patient's heart function state.
3, pregnant and lying-in women's cardiac function detection method, a kind of by adopting based on hear sounds and cardiac electrical cardiac function detection system, pregnant and lying-in women are carried out simultaneously the detection of hear sounds, electrocardio, non-invasive blood pressure, obtain heart reservation tranquillization index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index, from mental and physical efforts, the rhythm of the heart, heart rate, four aspects of blood pressure, while comprehensive assessment pregnant and lying-in women's heart function state; Particularly adopt D/S, S1/S2, HR, S1 and S2 to be inverted index evaluation pregnant and lying-in women's heart function state simultaneously.
4, enclose anesthetic stage and peri-operation period patient or critical patient's cardiac function detection method, a kind of by adopting based on hear sounds and cardiac electrical cardiac function detection system, carry out the detection of hear sounds, electrocardio, non-invasive blood pressure simultaneously to enclosing anesthetic stage and peri-operation period patient or critical patient, obtain heart reservation tranquillization index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index, from mental and physical efforts, the rhythm of the heart, heart rate, four aspects of blood pressure, comprehensive assessment is enclosed anesthetic stage and peri-operation period patient or critical patient's heart function state simultaneously; Particularly adopt D/S, S1/S2, the assessment of HR heart reservation index to enclose anesthetic stage and peri-operation period patient or critical patient's heart function state simultaneously; Wherein, heart reservation tranquillization index S 1 and S2 are inverted and do not detect.
5, athlete heart function detecting method, a kind of by adopting based on hear sounds and cardiac electrical cardiac function detection system, the athlete is carried out simultaneously the detection of hear sounds, electrocardio, non-invasive blood pressure, obtain heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index, non-invasive blood pressure index, from mental and physical efforts, the rhythm of the heart, heart rate, the athletic heart function state of blood pressure four aspects while comprehensive assessment; Particularly adopt D/S, S1/S2, S1 and S2 inversion, HRI, CCCT (1), the athletic heart function state of CCCT (1/4) index evaluation simultaneously.
The invention is not restricted to the embodiment that this description exemplifies.Those of ordinary skills adopt technique known, make not breaking away from various variation of the present invention or retrofiting all belonging to the scope of protection of the invention.
Claims (6)
1, a kind of based on hear sounds and cardiac electrical cardiac function detection system, comprise collection of multi-physiological-parameter signal hardware and processing module, USB HUB module, computer processing system and outut device, it is characterized in that: collection of described multi-physiological-parameter signal hardware and processing module are by the hear sounds acquisition module with independently A/D conversion and usb communication control function parallel with one another, electrocardiogram acquisition module and non-invasive blood pressure acquisition module are formed, be respectively applied for the cardiechema signals of gathering the experimenter, electrocardiosignal and arm arterial pulse wave signal, and the above-mentioned signal that will collect is by usb bus input USB HUB module, electrical safety between USB HUB module realization human body and the computer is isolated and the signal of importing is transferred to computer processing system, thereby above-mentioned signal is handled the heart reservation index that obtains the experimenter by computer processing system, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index, described index is exported by outut device.
2, according to claim 1 based on hear sounds and cardiac electrical cardiac function detection system, it is characterized in that: described USB HUB module comprises electrical safety buffer circuit, USB HUB controller and usb bus interface; The DC-DC insulating power supply module that adopts the electrical safety buffer circuit realizes the electrical isolation of power supply, adopts the magnetic isolating device to realize the electrical isolation of signal.
3, according to claim 1 and 2 based on hear sounds and cardiac electrical cardiac function detection system, it is characterized in that: described hear sounds acquisition module comprises heart sound transducer, hear sounds frequency-division section circuit, gain control circuit, level modulate circuit, A/D conversion and usb communication control circuit; The electrocardiogram acquisition module comprises the body surface ecg utmost point and three lead integral type cardiac diagnosis lead-line, prestage safety protective circuit, pre-amplification circuit, bandwidth-limited circuit, 50Hz trap circuit, level modulate circuit, driven-right-leg circuit, A/D conversion and usb communication control circuit; Arm arterial pulse wave signal acquisition module comprises blood pressure cuff, cuff pressure and pulse signal testing circuit, air pump air valve control circuit, level modulate circuit, A/D conversion and usb communication control circuit, and air pump air valve control circuit and level modulate circuit are parallel between cuff pressure and pulse signal testing circuit, A/D conversion and the usb communication control circuit.
4, according to claim 3 based on hear sounds and cardiac electrical cardiac function detection system, it is characterized in that: described hear sounds frequency-division section circuit is made up of intrasonic circuit, extremely low frequency circuit, low-frequency channel, intermediate-frequency circuit and high-frequency circuit; Wherein, intrasonic circuit frequency range is 0.05-5Hz; Extremely low frequency circuit frequency range is 5-30Hz; The low-frequency channel frequency range is 30-80Hz; The intermediate-frequency circuit frequency range is 80-120Hz; The high-frequency circuit frequency range is 120-1000Hz.
5, according to claim 1 based on hear sounds and cardiac electrical cardiac function detection system, it is characterized in that: described heart reservation index, phonocardiogram and electrocardiogram aggregative indicator, electrocardiogram index and non-invasive blood pressure index synchronous acquisition and get.
6, cardiac function detection system according to claim 1 or 5, it is characterized in that: described heart reservation index comprises heart reservation tranquillization index and heart reservation motion index, and heart reservation tranquillization index comprises that S1/S2, D/S, T1/M1, S1 and S2 are inverted and heart rate; The heart reservation motion index comprises HRI, %S3, %S4, CCCT (1) and CCCT (1/4);
Described electrocardiogram index comprises P-P interval, P-R interval and S-T interval;
Described phonocardiogram and electrocardiogram aggregative indicator comprise EMAT, AAFT and PAFT;
Described non-invasive blood pressure index comprises systolic pressure, diastolic pressure and mean arterial pressure;
Wherein, the %S3 computing formula is:
, wherein aS3 is for after the experimenter finishes 1750～7000 joules of motions, in 30 second writing time, and the total degree that S3 occurs; N is total cardiac cycle number in back 30 seconds of the motion; BS3 is the preceding quiescent condition of motion, in 30 second writing time, and the total degree that S3 occurs;
The %S4 computing formula is:
, wherein aS4 is for after the experimenter finishes 1750～7000 joules of motions, in 30 second writing time, and the total degree that S4 occurs; N is total cardiac cycle number in back 30 seconds of the motion; BS4 is the preceding quiescent condition of motion, in 30 second writing time, and the total degree that S4 occurs.
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| CN109875544A (en) * | 2019-01-31 | 2019-06-14 | 湖北省体育科学研究所 | Heart function assessment method for the accurate selection of sportsman |
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| CN114081462B (en) * | 2021-11-19 | 2023-06-09 | 齐齐哈尔大学 | Heart health monitoring system based on multidimensional physiological information |
| CN115736938A (en) * | 2022-11-17 | 2023-03-07 | 东南大学 | Multi-mode physiological signal acquisition device |
| CN116759102A (en) * | 2023-08-17 | 2023-09-15 | 北京慧兰医疗科技有限公司 | Analysis management system based on heart rehabilitation data |
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