CN101766481A - Thermal dilution method for haemodynamics - Google Patents
Thermal dilution method for haemodynamics Download PDFInfo
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- CN101766481A CN101766481A CN200810231519A CN200810231519A CN101766481A CN 101766481 A CN101766481 A CN 101766481A CN 200810231519 A CN200810231519 A CN 200810231519A CN 200810231519 A CN200810231519 A CN 200810231519A CN 101766481 A CN101766481 A CN 101766481A
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Abstract
The invention relates to the fields of computer techniques and biomedical engineering, in particular to a thermal dilution method in a haemodynamic module of heart-mediated treatment equipment. In the indexes for judging perfusion of important organs with cardiac function, the most direct and effective ones are: cardiac output (CO), ejection fraction (EF), pulmonary artery wedge pressure (PAWP) and saturation mixed venous blood oxygen (SvO2). The acquisition of haemodynamic parameters is highly complex. The invention aims to discover a more simple and reliable method for analysis, measurement and computation. Therefore, the doctor can know the condition of the patient more simply and intuitively and give a diagnosis result timely; and the operation time is shortened, and the life of the patient is saved. The thermal dilution method for the haemodynamics needs analyzing and measuring the following systems: cardiac output, pressure gradient, pressure, various characteristic points of invasive blood pressure, and valve area.
Description
Technical field
The present invention relates to field of computer technology and biomedical engineering field, relate in particular to the hot dilution process in a kind of heart intervention treating equipment hemodynamics module.
Background technology
Heart is a pump blood organ, is keeping the perfusion of vitals such as brain, kidney, liver.Judge in the quality and the dabbling index of important organ of cardiac function, the most direct, effective index is cardiac output CO (CardiacOutput), ejection fraction (EF), pulmonary wedge pressure (PCWP) and (SvO2) mixed venous oxygen saturation, these data all can collect in the conduit that floats, for in time instructing treatment, judge that the state of an illness and patient lapse to all significant.
Cardiac output (CO) monitoring has important effect in operation on heart and critical illness people rescue, the method of measuring at present cardiac output clinically has traumatic and noninvasive method, noninvasive method comprises ultrasonic doppler, electrical impedance, carbon dioxide inhalation etc., have non-invasi, advantage such as easy and simple to handle, but absolute value error is bigger; Traumatic method comprises dye dilution method, temperature dilution method etc.
The showy conduit of heat dilution is proposed in 1954 by Dr.Fegler, i.e. the blood ability is penetrated in the speed reflection that raises by the temperature of injecting the liquid in the heart.1970, at first be used for this imagination clinical by Swan and Dr.Ganz.Therefore, the showy conduit of heat dilution is called the Swan-Ganz conduit again.
The temperature dilution method is measured cardiac output mainly according to the FickShi formula, and distribution equaled the concentration difference that flow velocity is taken advantage of this material near-end and far-end after promptly certain material injected working fluid.At present clinically with of the standard method of temperature dilution method as the mensuration cardiac output, this method with cool brine as indicator, inject right ventricle by proximal orifice, flow into right ventricle and blood mixing wherein immediately, low temperature blood drains into pulmonary artery, and the critesistor through catheter tip produces a series of potential change, transport to monitor and draw temperature curve, calculate cardiac output and corresponding hemodynamic parameter.
Summary of the invention
It is that the Swan-Ganz conduit is gathered the hemodynamics relevant parameter that thermal dilution method for haemodynamics of the present invention adopts the showy conduit of heat dilution.
Hemodynamic parameter mainly comprises: cardiac output CO, mean arterial pressure MAP, pulmonary artery pressure PAP (Pulmonary Artery Pressure), central venous pressure CVP (Central Venous Pressure), mean right atrial pressure RAP, pulmonary artery wedge pressure PCWP (Pulmonary Capllary Wedge Pressure), left ventricular end diastolic presssure LVEDP (being similar to PCWP), LAMP LAP (being similar to LVEDP); Cardiac index CI, whenever blood discharge amount SV fights, SI SI, pulmonary vascular resistance PVR, body circulation resistance SVR, total peripheral resistance TPR, pulmonary vascular resistance indices P VRI, body circulation resistance index SVRI, total peripheral resistance index TPRI, chamber, the left side merit (g.m) of whenever fighting, left side chamber per minute merit (kg.m/min), stroke work index SWI, core power index CWI, instantaneous pressure rate of change dp/dt, blood phase DFP is penetrated in diastole, SEP SEP, the valve of pulmonary trunk pressure differential, Bicuspid valve is striden lobe pressure differential MVG, aortic valve pressure differential AVG, mitral valve area MVA, aortic valve area A VA.
Obtaining of hemodynamic parameter is quite complicated, the present invention is exactly in order to seek a kind of simpler, more reliable analysis, measurement, Calculation Method, make the doctor simpler and more direct, get more information about patient, in time the patient is made diagnostic result, shorten operating time, save patient's life.Thermal dilution method for haemodynamics of the present invention needs the system of analysis to measure to have: heart stroke is measured; Barometric gradient is measured, the detection of the various characteristic points of invasive blood pressure; Pressure measxurement; Valve area is measured.
Thermal dilution method for haemodynamics of the present invention has following clinical meaning:
(1) understands the cardiovascular system situation
According to the hemodynamic index parameter, can understand situations such as circumfusion situation, cardiac pumping function, circulation volume or cardiac preload, circulation resistance or cardiac afterload.
(2) help Clinical differential diagnosis
Very according to measured hemodynamic parameter, tight monitoring circulatory function in the time of can helping in cardiovascular disease such as shock that diagnosis myocardial infarction, heart failure, acute lung edema, acute pulmonary embolism, a variety of causes cause, cardiopulmonary arrest and severe multiple injuries, multiple organ dysfunction syndrome, the capital operation critical illness such as average of operation periods is so that instruct the doctor that the patient is diagnosed.
(3) guiding clinical treatment
The purpose of patient's hemodynamic monitoring is to determine amount of infusion, the kind of vasoactive agent application and the application of dosage and diuretic, so that keep the effective blood perfusion, guarantee that competent oxygen supplies, exceeding again simultaneously increases heart burden and myocardial oxygen consumption, so should in time solve principal contradiction according to the monitoring index analysis-by-synthesis.
Also in conjunction with the accompanying drawings the present invention is described in further detail below by specific embodiment.
Description of drawings
Fig. 1 monitors flow chart in real time for the heart row of thermal dilution method for haemodynamics of the present invention;
The pressure analysis process figure of Fig. 2 thermal dilution method for haemodynamics of the present invention.
The specific embodiment
Thermal dilution method for haemodynamics of the present invention adopts Swan-Ganz heat dilution float catheter (adult 7F, children's 5F, baby 4F) to gather relevant parameter.
The Swan-Ganz conduit, at conduit right ventricle near-end one thermal release is arranged, by emission energy pulse regional flow is heated up, with blood mixing cooling on every side and inflow pulmonary artery, calculate heart stroke through top critesistor perception, thereby can record heart stroke continuously, reduce complication such as operate miss, bacterial infection, circulating load change and taken place.
Utilize this conduit can directly or indirectly obtain relevant parameter.
The hemodynamics relevant parameter data of table 1 for can directly measuring by this conduit:
| The data that the Swan-Ganz conduit directly records: | Range of normal value |
| 1. pulmonary artery pressure (PAP) | ??S15～30/D5～15mmHg |
| 2. pulmonary wedge pressure (PCWP) | ??6-12mmHg |
| 3. central venous pressure (CVP) | ??0-6mmHg |
| 4. cardiac output (CO) | ??4-8L/min |
| The data that the Swan-Ganz conduit directly records: | Range of normal value |
| 5. blood oxygen saturation (SvO2) | ??65-83％ |
The relevant parameter data of table 2 for obtaining indirectly by calculating:
| The data that obtain indirectly | Computational methods | Range of normal value |
| 1. the every amount of fighting (SV) | ??SV＝Co/HR | 6-90ml/ fights |
| 2. ejection fraction (EF) | EF=SV/ left ventricular end-diastolic volume * 100% | ??60～80％ |
| 3.CI index (CI) | ??CI＝Co/BSA×100％ | ??2.4-4.01/m2 |
| 4. body circulation resistance (SVR) | ??SVR＝(MAP-PCWP)/Co×80/cm2 | 900-1500 dyne second |
| 5. pulmonary vascular resistance (PVR) | ??PVR＝(PMP-PCWP)/Co×80/cm2 | 50-150 dyne second |
As obtaining heart acting and pulmonary hemodynamics situation exactly, just need to measure heart output CO and ventricular filling pressure PCWP (indirect reaction LVEDP).
As shown in Figure 1, the heart row for thermal dilution method for haemodynamics of the present invention monitors flow chart in real time.The invention provides a kind of the detection and adopt thermodilution method, calculate patient's heart stroke parameter according to the temperature variation curve before and after the cool brine injection by heart stroke.The present invention is to be main carrier with computer system.
Its concrete implementation step:
A., contents such as blood heat, injection temperature, injection volume, conduit parameter, detected state are set.
B. begin data acquisition function, and the real-time detection of start-up temperature change curve.
C. according to the parameters value and the given formula of area under the detected temperature variation curve and above-mentioned setting, calculate the heart stroke numerical value under the current state.
D. every result of calculation and temperature variation curve are shown to the heart stroke detection window.
E. the user can be according to automatic testing result, and the terminal of manual modification temperature variation curve also recomputates heart stroke.
Show input:
The parameter that needs when heart stroke calculates:
Vi-----injection volume,
Blood heat before the TB-----injection,
Ti-----injection temperature,
The blood heat at measuring point place, TB-----injection back,
K-----conduit temperature coefficient, the temperature variation curve data.
According to thermodilution method measure CO formula: CO=k*Vi (TB-Ti)/∫ TB ' dt
Show output: calculate heart stroke result of calculation according to formula.
As shown in Figure 2, be the pressure analysis process figure of thermal dilution method for haemodynamics of the present invention.This flow chart is imported by the parameter inlet: a, blood pressure title and relevant blood pressure data
B, R ripple position and periodicity
Can analyze and draw: (1) pressure mean values (2) pressure peak-to-peak gradient (3) valve area.
According to shown in Figure 2, for calculating pressure mean values, its implementation method is: according to the testing result of heart rate, analyze the pressure data in the corresponding time period, obtain the relevant parameter of invasive blood pressure.
Concrete implementation step: draw pressure type by the pressure measxurement analysis:
1. arterial pressure
Input: a, blood pressure signal data and length thereof
B, interior II of identical time period lead and go up actual heart beat cycle number
The particular location of c, R ripple
D, blood pressure title
Output: calculate systolic pressure value, diastolic blood pressure values;
2. venous pressure;
3. press in the atrium
Input: a, blood pressure signal data and length thereof
B, interior II of identical time period lead and go up actual heart beat cycle number
The particular location of c, R ripple
D, blood pressure title
Output: calculate A ripple, V wave number;
Force value according to measurement calculates can draw pressure mean values by formula.
According to shown in Figure 2, for obtaining pressure peak-to-peak gradiometry,, analyze the pressure data in the corresponding time period according to the testing result of heart rate, can obtain the gradient parameter of invasive blood pressure.Its method is: calculate two-way systolic pressure separately by formula, draw pressure peak-to-peak Grad then.
Specific implementation method is:
Input: a, blood pressure signal data and length thereof
B, interior II of identical time period lead and go up actual heart beat cycle number
The particular location of c, R ripple
D, blood pressure title
E, heart stroke
Output: calculate the barometric gradient value.
According to shown in Figure 2, for calculating valve area, can analyze the pressure data in the corresponding time period according to the testing result of heart rate, obtain the valve area of invasive blood pressure.Its method is: search two-way pressure intersection point calculation ejection time, calculate parameters such as pressure average gradient, flow by formula.
Specific implementation method is:
Input: a, blood pressure signal data and length thereof
B, interior II of identical time period lead and go up actual heart beat cycle number
The particular location of c, R ripple
D, blood pressure title
E, heart stroke
Output: pressure clack membrane area.
It should be noted that at last: above embodiment only in order to technical scheme of the present invention to be described, is not intended to limit; Although with reference to previous embodiment the present invention is had been described in detail, those of ordinary skill in the art is to be understood that: it still can be made amendment to the technical scheme that aforementioned each embodiment put down in writing; And these are revised, and do not make the spirit and scope of the essence disengaging various embodiments of the present invention technical scheme of appropriate technical solution.
Claims (4)
1. the hot dilution process in the heart intervention treating equipment hemodynamics module, purpose is in order to seek a kind of simpler, more reliable analysis, measurement, Calculation Method, obtain relevant hemodynamic parameter, make the doctor simpler and more direct, get more information about patient, the system that thermal dilution method for haemodynamics of the present invention is characterized by analysis to measure comprises: heart stroke is measured; Barometric gradient is measured, the detection of the various characteristic points of invasive blood pressure; Pressure measxurement; Valve area is measured.
2. thermal dilution method for haemodynamics as claimed in claim 1 is characterized in that heart stroke detects the employing thermodilution method, calculates the heart stroke parameter of case according to the temperature variation curve before and after the cool brine injection.Its method is:
A., contents such as blood heat, injection temperature, injection volume, conduit parameter, detected state are set.
B. begin data acquisition function, and the real-time detection of start-up temperature change curve.
C. according to the parameters value and the given formula of area under the detected temperature variation curve and above-mentioned setting, calculate the heart stroke numerical value under the current state.
D. every result of calculation and temperature variation curve are shown to the heart stroke detection window.
E. the user can be according to automatic testing result, and the terminal of manual modification temperature variation curve also recomputates heart stroke.
3. thermal dilution method for haemodynamics as claimed in claim 1 is characterized in that pressure peak-to-peak gradiometry, and method is: according to the testing result of heart rate, analyze the pressure data in the corresponding time period, obtain the gradient parameter of invasive blood pressure.According to showing the input data: blood pressure signal data and length thereof are led with interior I I of identical time period and are gone up the particular location of actual heart beat cycle number and R ripple, blood pressure title, heart stroke; Calculate barometric gradient.
4. thermal dilution method for haemodynamics as claimed in claim 1 is characterized in that calculating valvular surface, and its method is: according to the testing result of heart rate, analyze the pressure data in the corresponding time period, obtain the valve area of invasive blood pressure.
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103784132A (en) * | 2012-10-30 | 2014-05-14 | 日本光电工业株式会社 | Blood volume measurement method and blood volume measurement apparatus |
| CN108366748A (en) * | 2015-10-21 | 2018-08-03 | 爱德华兹生命科学公司 | Heat dilution injection measures and control |
| CN112568879A (en) * | 2020-12-09 | 2021-03-30 | 中国人民解放军海军军医大学第一附属医院 | Monitoring of blood flow mechanics and instruction system of using medicine |
-
2008
- 2008-12-26 CN CN200810231519A patent/CN101766481A/en active Pending
Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103784132A (en) * | 2012-10-30 | 2014-05-14 | 日本光电工业株式会社 | Blood volume measurement method and blood volume measurement apparatus |
| US9591976B2 (en) | 2012-10-30 | 2017-03-14 | Nihon Kohden Corporation | Method and apparatus for measuring blood volume |
| CN108366748A (en) * | 2015-10-21 | 2018-08-03 | 爱德华兹生命科学公司 | Heat dilution injection measures and control |
| CN112568879A (en) * | 2020-12-09 | 2021-03-30 | 中国人民解放军海军军医大学第一附属医院 | Monitoring of blood flow mechanics and instruction system of using medicine |
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