CN1020066C - Equipment for testing heart functions by electric excitation - Google Patents
Equipment for testing heart functions by electric excitation Download PDFInfo
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- CN1020066C CN1020066C CN 87106622 CN87106622A CN1020066C CN 1020066 C CN1020066 C CN 1020066C CN 87106622 CN87106622 CN 87106622 CN 87106622 A CN87106622 A CN 87106622A CN 1020066 C CN1020066 C CN 1020066C
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Abstract
The present invention relates to a device and a method for recognizing an R-R interphase, a Q-T interphase and a diastolic pressure value of electrocardio signals through detecting an electrocardio waveform and a blood pressure waveform. A cardiac catheter is used for exerting sphygmus regulation impulse sequence on a right atrium for regular cardiac rhythm according to the parameters, the cardiac catheter exerts induction pulses on the right atrium every N sphygmus regulation impulses, the induction pulses act during the cardiac vulnerable period, and meanwhile, the variation of the blood pressure and the electrocardio waveform is measured; finally, earlier atrium or quicker ventricle heartbeat is induced through the position regulation of the action of induction pulses and the progressive increase of the amplitude value, and the existence of the earlier atrium or the quicker ventricle heartbeat is determined through the variation of the blood pressure and the electrocardio waveform; the pulse sending is stopped, the waveform and the amplitude value of the induction pulses are output, and a ventricular fibrillation threshold is calculated.
Description
The present invention relates to a kind of device that detects cardiac function by electricity irritation, specifically, utilize device of the present invention can detect the electrocardiosignal and the blood pressure waveform of live body simultaneously, the stimulus signal that predetermined structure is arranged to the heart output device by intracardiac electrode according to this testing result again, measure the variation of electrocardio and blood pressure signal under the stimulus signal effect simultaneously, obtain the information of reflection cardiac function with this.
Cardiac sudden death is one of first cause of middle-aged and elderly people death, and among sudden the dead, about 25% people there is no any subjective symptoms in advance.Therefore detecting cardiac function is the scientific research field that medical science and scientific and technological circle extremely pay close attention to the generation that prevents cardiac sudden death all the time.
As everyone knows, heart is the rhythm and pace of moving things is arranged to beat under himself action of electric signals, and normal human heart excitement originates from sinuatrial node, is called sinus rhythm.If ventricle is risen in the heart excitement, then be called ventricular rhythm, this ventricular rhythm is how relevant with sudden death.In electrocardiosignal, examine a roomy lopsided QRS wave group person (QRS interval＞0.12 second), be called premature ventricular beat or be called for short PVC(Premature Ventricular Contraction).All have continuous more than three lopsided QRS wave group person be called multiple premature ventricular beat or be called for short ME(Multiple Extrasystoles).Allly there is lopsided QRS wave group person more than continuous ten (QRS interval＞0.12 second, heart rate 90-240 time/minute) to be called ventricular tachycardia or is called for short VT(Ventricular Tachycardia).The complete obiteration of QRST wave group replaces wave group in irregular shape in all electrocardiograms, and frequency is that 250～500 times/minute persons are called ventricular fibrillation or are called for short VF(Ventricular Fibrillation).A large amount of research datas prove: (1) cardiac sudden death is by due to the ventricular fibrillation.(2) have the patient that the potential probability of cardiac sudden death takes place, there is ecg instability already in its cardiac muscle.(3) heart generation premature ventricular beat (PVC or ME), ventricular tachycardia (VT) then show and exist ecg instability.In prior art, in order to study ecg instability, set up the notion of ventricular fibrillation threshold, abbreviate VFT(Ventricular Fibrillation Threshold as), it is meant the value of bringing out the minimal stimulation electric current that quivers the chamber that directly measures, with VFT can the quantitatively characterizing animal or human the stability of electrocardio-activity, so it has become a quantitative target of forecast cardiac sudden death probability.
In order to measure VFT, at first to bring out VF by artificial mode, adopting in test at present is electrical stimulation method the most widely.This method be between a given period in heartbeat cycle in (be called heart vulnerable period) to myocardium input current, cause the inharmonic excitement of adjacent cardiac muscle fiber, to causing promptly that to a certain degree the chamber quivers, electrical stimulation method commonly used in the prior art has following several:
(1) square wave pulse stimulus method.With certain amplitude, the single square-wave pulse of certain pulsewidth acts in the ventricular vulnerable period, and stimulus intensity is ascending, with the minimal stimulation current's intensity value that can cause VF as VFT.Because after stimulus intensity being increased progressively at every turn, must scan to seek vulnerable period diastole, and the current value when causing VF at last by individual pulse is often very big, so this measuring process that progressively increases progressively is very consuming time, advantage is to measure the starting point of vulnerable period simultaneously.
(2) sequential R/T stimulus method.This method is done pulse above on two suitably to arrange, each pulse sequentially drops in the vulnerable period of the ventricular premature contraction ripple that certain position behind the normal QRS wave group and previous electric pulse cause just, as VFT, generally use three boost pulses with the current intensity of last stimulation.This method is more easily brought out VF, but still needs scanning to seek vulnerable period, so the mensuration process is still more time-consuming.
(3) series impulse stimulus method.It is to utilize several electric pulse strings (being generally continuous 8～14) to tens to stimulate.Bring out VF owing to long bursts can drop in vulnerable period regularly, need not scan vulnerable period, and last fibrillating current is also less.So the advantage of this method is a fast measuring.
(4) square wave stimulus method and alternating current stimulus method continuously continuously.It is with continuous square wave or alternating current cardiac stimulus randomly, do not need the time-delay mechanism behind the ECG R wave, but this method is long to the cardiac stimulation time, and damage is big, now seldom uses.
Multifunctional heart program stimulation instrument in the prior art (as U.S. Medtronics S325 type, Japan's three flourish device 3F51 type, Chinese FD-A types surveyed) is the common tool of Clinical Electrophysiologic Study of Idiopathic.It can carry out non-invasive to the atrium by esophagus electrode and transfers and to fight, and also can utilize vena caval catheter electrode to transfer in the chambers of the heart and fight, measure to comprise sinuatrial node, and atrioventricular node, wish-pumping system and abnormal conduction pathways be in interior multiple electrophysiological function and parameter.This technology is referred to as electrophysiological stimulation or physiology electricity irritation (EPS-PES) technology.
In prior art, generally acknowledge can the quantitative description ecg stability index be ventricular fibrillation threshold (VFT), promptly in the process of electricity irritation heart, can bring out the minimal stimulation current value that quivers the chamber.Yet the method for measuring VFT in the prior art has very big danger, is used for zoopery more.Disclose a kind of device that VFT measures that carries out in animal experiment in No. 85201706 Chinese utility model patents that are entitled as " VFT-1 type heart ventricular fibrillation threshold automatic analyzer ", the design people of this patent is the inventor, and its patentee is the applicant.In addition, the measuring method in the prior art is by manual operations, utilizes several to tens instruments to finish whole measuring process, and such method wastes time and energy and is difficult to be used among the clinical practice by the medical worker who does not understand electronics knowledge.Be also pointed out that when utilizing prior art that experimental animal is detected that the physiological status of tested animal can change, and causes the comparability of the data that obtain to be subjected to very big influence in long measuring process.
In prior art, can utilize program stimulation instrument and EPS-PES method to bring out ventricular tachycardia (VT), but this result of bringing out can not be used for representing quantitatively ecg stability.And this method of bringing out can not guarantee that quiver in the chamber of preventing in stimulating course, therefore still can not solve the dangerous problem when clinical practice.In prior art, owing to be subjected to the restriction of method and technological means, the detection of ecg stability is still a unsolved difficult problem.
According to achievement in research of the present invention, the inventor has at first set up following new ideas:
1. ventricular premature contraction threshold value or chamber threshold value PVCT(Premature Ventricular Contraction Threshold early): the minimal stimulation current value that induces the premature ventricular beat ecg wave form.
2. multiple chamber is threshold value MET(Multiple Extrasystoles Threshold early): the minimal stimulation current value that induces multiple ventricular premature contraction ecg wave form.
3. ventricular tachycardia threshold value or chamber speed threshold value VTT(Ventricular Tachycardia Threshold): the minimal stimulation current value that induces the ventricular tachycardia ecg wave form.
According to testing result of the present invention, the inventor at first proposes, and the ventricular fibrillation threshold in prior art (VFT), the chamber is threshold value PVCT early, and multiple chamber threshold value MET morning and chamber speed threshold value VTT also can the quantitative description ecg stabilities.Testing result of the present invention also further shows: above-mentioned each threshold value PVCT, and MET, the actual measured results of VTT and VFT is to increase successively, and no matter at normal myocardium or ischemic myocardium, each threshold value all presents the height cross-correlation.Therefore, measurement result of the present invention proves, measures PVCT by handy and safe ground, MET and VTT can replace VFT extremely dangerous in the prior art and measure, and describe ecg stability quantitatively and reliably with this, simultaneously can be according to the PVCT that measures, MET or VTT extrapolate the VFT of testee.
For safety with measure PVCT exactly, MET and VTT, the invention provides the stimulating pulsatile series of specific coding, comprise the electrotherapy pulse that is used to form the artificial rhythm of the heart in this pulse train and be used to bring out the chamber early, the pulse-induced of chamber speed, by number to electrotherapy pulse, the adjustment of interval and amplitude, can make the artificial rhythm of the heart of tested heart-shaped one-tenth, then the artificial rhythm of the heart is carried out vulnerable period scanning, by repeating be applied to vulnerable period in incremental manner pulse-induced, face with electrocardio and blood pressure simultaneously and survey the chamber early and the generation of chamber speed, can be accurately and identify PVCT, MET and the VTT of tested heart safely.
Measurement result of the present invention also shows, generation chamber is early in cycle when heartbeat, when quiver in chamber speed or chamber, diastolic blood pressure values when its real-time pressure value promptly is lower than normal heartbeat, the chamber early, chamber speed or chamber time of quivering is long more, it is also long more that in real time pressure value is lower than time of diastolic pressure, have only sinus rhythm to recover after, blood pressure just returns on the original level substantially in real time.Like this, early or during the speed of chamber, can utilize real-time pressure value to verify this recognition result, avoid causing the inaccurate of threshold test because sum of errors disturbs when the ecg analysis with this by ecg analysis identification chamber.
Cardiac function checkout gear according to the present invention comprises: a plurality of electrocardio detecting electrodes, can adopt the electrode of any conventional structure; A pressure transducer can adopt the ductus arteriosus pick off, and doppler blood pressure sensor or other are converted to blood pressure the pick off of the signal of telecommunication; A pre-amplification circuit, the electrocardio and the blood pressure signal that are used for electrocardio detecting electrode and pressure transducer are detected amplify and form multi-channel parallel output; An A/D converter is used for the multi-channel parallel output of above-mentioned amplifying circuit is converted to the multi-path digital signal; A signal processing unit, this unit is handled to produce the control signal of cardiac stimulation above-mentioned multi-path digital signal; A stimulus signal generating unit, this unit produces the cardiac stimulation pulse sequence under the control signal control of signal processing unit output; An intracardiac stimulating electrode, this electrode is introduced in the chambers of the heart by cardiac catheter, so that above-mentioned cardiac stimulation pulse sequence is exported to heart, with an output device, the result that is used for the output of shows signal processing unit, wherein be upset time spent of doing of pulse when heart, above-mentioned a plurality of electrocardio detecting electrode and pressure transducer are monitored the variation that cardiac function takes place under the boost pulse effect simultaneously, and monitor signal carrying out Real time identification by signal processing unit, signal processing unit sends the result that the instruction that stops to stimulate will discern simultaneously to the stimulus signal generating unit and shows by output device early or during the speed signal of chamber in the chamber of identifying.Utilize cardiac function checkout gear of the present invention can measure PVC, MET, VTT safely, automatically, exactly, and extrapolate VFT, use for clinical and scientific research.
According to cardiac function checkout gear of the present invention, detect the electrocardiogram of heart and the waveform that the arterial pressure amplitude changes by conventional electrocardio detecting electrode and pressure transducer; Calculate real-time heart rate according to the electrocardiosignal that detects, transfer the signal sequence of fighting according to the electrocardio that the real-time heart rate generation frequency that has calculated is higher than heart rate, and the pulse-induced that on position moves successively and amplitude progressively increases progressively in this sequence, form the cardiac stimulation pulse sequence with this, above-mentioned pulse train is imported the chambers of the heart by cardiac catheter, detect in real time the variation of electrocardio and blood pressure signal under above-mentioned pulse train effect, electrocardio and blood pressure signal are carried out real-time analysis with the chamber of identifying early and/or chamber speed waveform; According to the chamber identified early and/or chamber speed waveform stop to apply the process of electrical stimulation signal to heart, show that through output device the chamber identified is early and/or chamber speed waveform, its corresponding blood pressure waveform and induce the amplitude of electric stimulation pulse of above-mentioned waveform and the ventricular fibrillation threshold of extrapolating thus again.
An object of the present invention is to provide a kind of cardiac function checkout gear, this device is by the manual-induced electrocardio of the electrical stimulation signal with specific coding sequence chamber morning and/or chamber speed waveform, and extrapolate the ventricular fibrillation threshold VFT of heart according to the amplitude of the boost pulse that induces above-mentioned waveform, detect cardiac electrical stability quantitatively with this.
A further object of the present invention provides the electric stimulation pulse sequence with specific coding structure, comprise in this sequence that one the tunnel is applied in the right atrium cardiac cycle spare Qi Tiaobo producing the electrotherapy pulse of the artificial rhythm of the heart, and another road is applied to the pulse-induced that brings out chamber morning and/or chamber speed in the right ventricle between a plurality of electrotherapy pulses.The frequency of electrotherapy pulse is a little more than experimenter's real-time heart rate, and all there is little moving the position of pulse-induced at each accent all after dates of fighting, scan cardiac electrical vulnerable period with this, in addition, amplitude through pulse-induced after the scanning of each vulnerable period all has little increasing progressively, till the chamber of inducing morning and/or chamber speed waveform.
Utilize device of the present invention, electric stimulation pulse sequence and detection method can be brought out the chamber and be quivered and promptly detect cardiac electrical stability quantitatively, thereby the safety of testing process is improved greatly.Therefore can under normal condition, detect clear-headed human or animal.Make its become a kind of can be in widely used technology in the clinical and scientific research.
Device of the present invention has been realized the automatic control of whole testing process, thereby testing process can be carried out quick, easy and safely, and the training that any medical worker need not be special can be grasped the operation and the use of this device.
Device of the present invention by applying specific coding electrical stimulation signal and measure the blood pressure real-time waveform simultaneously, the accuracy of measurement result and comparability are improved greatly, make its testing result become in clinical and the research practice can extensive use useful indicators.
Device of the present invention can be used to predict that the probability of cardiac sudden death takes place patient, thereby the equipment of a new medical diagnosis on disease is provided for clinical practice.
Device of the present invention also can be used for crowd's electrocardio threshold value generaI investigation, be cardiopathic prevention therefore, and the cardiac selects for use cardiac pacemaker and defibrillator that quantitative index is provided.
Device of the present invention also can be used for the influence of detection of drugs to animal and human's electrocardio threshold value, therefore can when the clinician selects medicine for use for patient, provide reference index, and can in laboratory, carry out providing quantitative target in the zoopery that pharmacological action analyzes.According to same principle, device of the present invention can be widely used in the middle of the kinds of experiments such as physiology, pharmacology, environmental conservation, occupational disease prevention, biological study.
The 15 Geneva international that device of the present invention has obtained to hold in Geneva on April 4th, 1987 invented and new technique exhibition gold medal and Grand Prix.
The present invention above-mentioned and other purpose, feature, advantage and purposes will in the detailed description of the Invention of doing below in conjunction with accompanying drawing, more clearly embody.
Fig. 1 illustrates the mutual relation between PVCT, MET, VTT and the VFT that measures with device of the present invention.
Fig. 2 A illustrates the statistical Butut of each threshold value of measuring with device of the present invention to 2F.
Fig. 3 A to 3D illustrate respectively the chamber of measuring with device of the present invention early, multiple chamber early, the electrocardio that quivers of chamber speed and chamber and the oscillogram of blood pressure.
Fig. 4 illustrates the schematic block diagram of cardiac function checkout gear of the present invention.
Fig. 5 illustrates the schematic block diagram of signal processing unit 50 among Fig. 4.
Fig. 6 illustrates the speed/chamber, morning/chamber, chamber of being carried out by recognition unit among Fig. 5 505 electric blood pressure liquid shape identification process figure that quivers.
Fig. 7 illustrates the coding structure figure of heart electric stimulating pulse train of the present invention.
Fig. 8 illustrates the relation of boost pulse and cardiac electrical cycle.
Fig. 9 illustrates the coding flow chart of the heart electric stimulating pulse train that is produced by arithmetic element among Fig. 5 504.
Figure 10 illustrates the structured flowchart of Fig. 4 moderate stimulation signal generating unit 60.
Referring to Fig. 1, be depicted as the median average of PVCT, the MET, VTT and the VFT that utilize device of the present invention that the normal person is measured, mark the sample number n and the standard deviation SD of each mean among the figure respectively.By result shown in the figure as can be known, by progressively increasing the intensity of boost pulse, can bring out the chamber early successively in same position experimenter's electrocardiosignal, quiver in chamber speed and chamber.
To 2F, be depicted as the statistical Butut that utilizes the threshold value determination that device of the present invention carries out normal myocardium and ischemic myocardium referring to Fig. 2 A, the corresponding relation of two different threshold values that the every bit representative is gone out by same body examination among the figure.Fig. 2 A illustrates MET that 91 routine normal myocardiums the are measured statistical distribution to VTT, Fig. 2 B illustrates MET that 163 routine normal myocardiums the are measured statistical distribution to VFT, Fig. 2 C illustrates VTT that 103 routine normal myocardiums the are measured statistical distribution to VFT, Fig. 2 D illustrates MET that 8 routine ischemic myocardiums the are measured statistical distribution to VTT, Fig. 2 E illustrates MET that 32 routine ischemic myocardiums the are measured statistical distribution to VFT, and Fig. 2 F illustrates VTT that 17 routine ischemic myocardiums the are measured statistical distribution to VFT.Above statistics shows, no matter in normal myocardium still is ischemic myocardium, MET all is height cross-correlation (correlation coefficient ν between 0.72 to 0.99, p＜0.01) between VTT and the VFT three.Triangular regression equation sees Table 1.
Table 1
Normal myocardium
MET/VTT VTT＝1.4265+0.9719MET
MET＝0.1419+0.6675VTT
MET/VFT VFT＝2.4709+0.9222MET
MET＝0.3116+0.5560VFT
VTT/VFT VFT＝0.3617+1.1137VTT
VTT＝0.7211+0.6980VTT
Ischemic myocardium
MET/VTT VTT＝0.2448+1.1921MET
MET＝0.1309+0.7346VTT
MET/VFT VFT＝0.0082+1.3995MET
MET＝0.4741+0.5860VFT
VTT/VFT VFT＝0.3209+1.0161VTT
VTT＝0.9413VFT-0.1517
Formula shown in the table 1 shows whether have myocardial ischemia according to the experimenter, can select different formula, utilizes MET or VTT to extrapolate VFT, avoids carrying out the direct measurement of dangerous very high VFT with this.The reliability of calculating the result has obtained confirmation by test.
Referring to Fig. 3 A to 3D, be depicted as utilize chamber that device of the present invention measures respectively early, multiple chamber early, chamber speed and chamber quiver electrocardiosignal and the corresponding real-time waveform figure of arteriotony when taking place.Transverse axis among the figure is the time, and a last curve is an arterial pressure waveform, and next curve is an ecg wave form.When unusual ventricular beat (as the chamber early, quiver in chamber speed and chamber) took place in the process of heart in rhythmic movement, the human body artery pressure also can produce corresponding decline, the diastolic pressure when making it be lower than normal heartbeat.The type decided of unusual heartbeat persistent period of descending of arterial pressure, by the order of quivering in chamber morning, chamber speed, chamber, the corresponding prolongation of the time of anomalous beat, the persistent period that the arterial pressure of their correspondences descends is correspondingly prolongation also.According to this phenomenon, checkout gear of the present invention can carry out the aid identification of unusual heartbeat type by detecting the length that arterial pressure is lower than the persistent period of normal diastolic pressure.Because this to utilize arterial pressure to carry out in the identification mode differentiating relation simple and clear, and be not subject to the interference of electrical stimulation signal that heart is applied, thus it be easy to realize and reliability higher.Fig. 3 A illustrates generation chamber waveform a early, pairing arterial pressure T fall time during b
BP, the diastolic pressure the when BPo among the figure has marked normal heartbeat.Fig. 3 B illustrates multiple chamber waveform a early takes place, b, and c, d ... the time pairing arterial pressure T fall time
BP, the length of this section period has surpassed Fig. 3 A.Fig. 3 C illustrates generation chamber speed waveform a, b, and c, d ... the time pairing arterial pressure T fall time
BP, its length has surpassed again significantly with the situation shown in the 3B.The situation that the arterial pressure of correspondence descended when Fig. 3 D illustrated generation chamber and quivers, at this moment as do not take measures T
BPTo continue for a long time, and with entail dangers to experimenter's life.
Referring to Fig. 4, be depicted as the schematic block diagram of cardiac function checkout gear of the present invention.Among the figure, reference number 10 is represented conventional electrocardio detecting electrode, and electrode of the present invention can carry out multi-lead (leading as 12 of routine) electrocardio and detect.Reference number 20 is represented an arterial pressure transducer, and it can adopt the arterial pressure transducer of any routine, as the ductus arteriosus pick off, and the doppler blood pressure sensor, or the like.Reference number 30 is represented a pre-amplification circuit, and it can amplify multichannel electrocardiosignal and one road blood pressure signal, to produce multidiameter delay output.40 is an A/D converter, and it is converted to the multi-path digital signal with the multi-path parallel signal of pre-amplification circuit 30 outputs.Above electrocardio detecting electrode 10, arterial pressure transducer 20, pre-amplification circuit 30, A/D converter 40 all can be realized in prior art, therefore no longer their structure are further introduced.Reference number 50 is represented a signal processing unit, and 60 is a stimulus signal generating unit, and 70 is an intracardiac stimulating electrode, and as the two-way cardiac catheter electrode of routine, 80 is an input/output unit.When system starts working, digital signal by signal processing unit 50 input multichannel electrocardios and blood pressure, these digital signals are handled, and instruct to stimulus signal generating unit 60 output services according to result, according to the information in this instruction, stimulus signal generating unit 60 produces the stimulating pulsatile series with specific coding structure, and apply these boost pulses to right atrium and right ventricle respectively through stimulating electrode 70, meanwhile, the heart of detecting electrode 10 and arterial pressure transducer 20 butt joint irriates carries out the detection of electrocardio and blood pressure, result by 50 pairs of detections of signal processing unit discerns, waveform up to the chamber of identifying morning or chamber speed, send instruction to stimulus signal generating unit 60 immediately then and stop stimulation heart, while is through the chamber morning of input/output unit 80 output identifications or the intensity of chamber speed waveform and the boost pulse that produces this waveform, with the ventricular fibrillation threshold VFT that extrapolates in view of the above.
Fig. 5 illustrates the structured flowchart of signal processing unit 50 among Fig. 4.Wherein, reference number 501 is represented a memory element, deposits the multidiameter delay data in by it, for further processing.502 is the electrocardiosignal measuring unit, and this unit extracts the multi-lead electrocardiogram (ECG) data from memory element 501, and to the R-R interval of electrocardiogram (ECG) data, and the Q-T interval, the electrocardio measuring-signal is measured and produced to parameters such as ST field offset.Because this measurement is prior art, therefore no longer further illustrated.503 is a measuring unit of blood pressure, and this unit extracts the arterial pressure data from memory element 501, and to arterial pressure waveform, systolic pressure, diastolic pressure is measured, and produces the blood pressure waveform measuring-signal.Reference number 504 is represented an arithmetic element, the blood pressure measurement signal of the electrocardio measuring-signal of these unit input ecg signal measuring unit 502 outputs and measuring unit of blood pressure 503 outputs, calculate the parameters of the boost pulse series that the reply heart applies according to the value of these signals, then these reference numbers are sent to stimulus signal generating unit 60 as work order.Reference number 505 is represented a recognition unit, this unit is respectively from electrocardiosignal measuring unit 502 input electrocardio measuring-signals, with measuring unit of blood pressure 503 input blood pressure measurement signals, at first this signal is carried out the identification of chamber morning and chamber speed, to get rid of the situation of experimenter's existing ventricular rhythm when not accepting stimulus signal, normal person just sends stimulation instructions to the rhythm of the heart.The electrocardio that produces under the effect of electrical stimulation signal according to heart and the variation chamber of identifying of blood pressure waveform are early or chamber speed waveform, and when identifying unusual heartbeat waveform, send the instruction that stops to stimulate, the amplitude of bringing out the boost pulse of heartbeat unusual waveforms simultaneously from this unit input to arithmetic element 504.Demonstrate waveform and measurement and the MET that extrapolates, VTT and the VFT of the unusual heartbeat that induces then through input/output unit 80.
Fig. 6 illustrates speed/chamber, morning/chamber, chamber that recognition unit among Fig. 5 505 carries out electric blood pressure waveform identification process figure that quivers.At first,, differentiate the chamber of having or not morning and chamber speed waveform in step 100 then, if change step 112 over to, do not carry out electricity irritation, if no abnormal waveform enters step 101 in the measurement data of step 90 input electrocardio and blood pressure waveform.Step 101 is sent the instruction that begins to carry out cardiac stimulation to arithmetic element 504, step 102 is from electrocardiosignal measuring unit 502 and measuring unit of blood pressure 503 input measurement signals (BP and R-R interval, the Q-T interval, the ST offset amplitude), judge whether the order of having stopped paying out boost pulse in step 103 then, if not then enter 104 and judge that real-time pressure value BP is whether less than the normal diastolic pressure BPo of heartbeat to 60 outputs of stimulus signal generating unit; If, then after step 107 is carried out the Co zero clearing, after step 108 shows the electrocardio blood pressure waveform, return step 101 again for not.If being judged as of step 104 is, then entering step 105 makes enumerator Co add 1, judge the length of blood pressure drops duration then in step 106, if this length does not surpass predetermined value, then after showing the electrocardio blood pressure waveform, step 108 returns step 101, if the blood pressure drops duration surpasses predetermined value, then stopping the instruction of electricity irritation to stimulus signal generating unit 60 after, step 109 changes step 110; 103 to be judged as be then to change step 110, passes through step 111 then, takes out the enough data points before and after the unusual heartbeat waveform of having discerned, demonstrates the waveform of electrocardio and blood pressure in step 112.Step 113 is calculated according to the unusual heartbeat that has identified and is shown and MET, VTT and VFT finishes whole procedure through printing step 114 backs then.The computing formula of using in the step 113 can be referring to table 1, for cardiac muscle whether exist ischemia situation can according in the electrocardiosignal recognition unit 502 to the automatic recognition result of ECG ST section, also can be carried out keying in for information about after the artificial cognition to ECG signal before applying electrical stimulation signal by the operator, the suitable formula to calculating in the option table 1 goes out corresponding VFT value then.
Fig. 7 is illustrated in the oscillogram of the stimulating pulsatile series that stimulus signal generating unit 60 produces under arithmetic element 504 controls shown in Figure 5, the stimulating pulsatile series of the present invention and comprises the pulse that the two-way effect is different, the first via is to be applied to electrotherapy pulse on the right atrium by conduit, its effect is that the Artificial Control heart rate makes heart beating even neat so that cardiac cycle is selectively stimulated, this pulse is designated as So in the drawings, and its cycle is TS.Control it as interval, be generally 50～80% of R-R interval, can make testing process not be subjected to the influence of sinus rhythm like this less than R-R; The pulse amplitude of So is represented that by ASo it can be adjusted in 1～20mA scope.The second tunnel pulse is to be applied to pulse-induced on the right ventricle inner membrance by cardiac catheter, its effect is to bring out chamber morning and/or chamber speed, this pulse is designated as S in the drawings because in a Cardiac cycle, is 20～40 milliseconds interval from electrocardio T ripple starting point to a width is arranged the peak value, it be the easiest generation chamber of heart early, chamber speed and the chamber interval of quivering, medically be referred to as vulnerable period, pulse-induced S
1Should be applied to selectively in this interval.So that assurance safety and accurate in measuring process, the amplitude that is applied to pulse-induced in vulnerable period should progressively increase progressively, and increment should be smaller or equal to 0.1mA, and until the chamber of inducing morning and/or chamber speed, the pulse-induced width of cloth AS chamber of being at this moment is threshold value or chamber speed threshold value early.Because the influence of individual variation, the position of the vulnerable period of different people and width are all variant, in order to cover this zone selectively, the invention provides the following concrete practice:
(1) series impulse method referring to Fig. 7 C, at first makes the rhythm of the heart even neat with electrotherapy pulse So, through inserting a string n S behind N the So
1Pulse, amplitude 0.1mA, N So and first S
1The spacing of pulse is the Q-T interval that the Tso-s basis has been measured, can make the S train of pulse cover the interval of the starting point of T ripple to the T crest value selectively.Utilize this method can guarantee to have at least a S
1Be in heart in vulnerable period, if the first string S
1The pulse chamber of not inducing morning or chamber speed then apply the second string S by the same manner after N So pulse
1Pulse, amplitude increase progressively and are 0.2mA, by that analogy, and until generating chamber early or chamber speed waveform.If S
1Pulse amplitude is added to 50mA and does not bring out chamber morning or chamber speed yet, then stops to stimulate.This shows the ecg stability height.Each N So at interval is in order to eliminate last S
1Pulse is to the influence of heart.N can be 1～10, is generally 8.The width of S pulse is 1mS
1Cycle is 5mS
1, its number depends on the interval width of T ripple starting point to peak value.
(2) sequential method, being at every turn with series impulse method difference is not the train of pulse that applies n S.But apply 1 S
1Pulse is through applying the S of second same amplitude again behind N the So
1Pulse, but move 5mS behind the position, like this through after n the circulation, finished the first string S that is equivalent to the series impulse method
1Impulse stimulation is again with S
1Amplitude increases 0.1mA, repeats this process, and this method is longer detection time than the series impulse method, but owing to avoided the effect of a string n pulse to cardiac muscle, thereby the measuring accuracy height, if each cycle S
1Pulse is to begin to the peak value direction to be called just sequential (seeing Fig. 7 A) along moving from T ripple starting point.If S
1Pulse begins oppositely to move from following crest value, is called negative phase-sequence and passes through (seeing Fig. 7 B).Specifically illustrate electrotherapy pulse So among Fig. 8, pulse-induced S
1Relation with cardiac electrical cycle.
Referring to Fig. 9, be depicted as the boost pulse encoding procedure that arithmetic element 504 is carried out among Fig. 5, produce pulse train shown in Figure 7 by this program.The R-R interval of the electrocardiosignal of measuring from electrocardiosignal measuring unit 502 and measuring unit of blood pressure 503 in step 200 input at first, the Q-T interval, ST field offset, and blood pressure waveform, the data such as amplitude of systolic pressure and diastolic pressure, and can key in the stimulation mode that the operator selects.In step 201 according to above-mentioned input data computation or select TSo, ASo, N, n, MaxTso-s
1, MinTso-s
1, AS
1Wherein TSo is 50～80% R-R interval, and ASo can be adjusted by the operator, so that set up the even neat rhythm of the heart, N is 1～10, n=(Tr)/5+1, and wherein Tr is the width of 1/2T ripple, unit is mS.MaxTso-S
1Be the time of P ripple starting point to the T crest value, MinTso-s
1Be the time of P ripple starting point to T ripple starting point, AS
1Assignment is 0.In step 215, information according to operator's key entry, automatically select the subprogram of stimulation mode, step 202 to 208 is positive sequential method, step 209 is negative sequential method, step 216-230 is the series impulse method, and negative sequential method step 209 can adjust accordingly and finish value of calculation with just sequential method program.Step 202 goes out N electrotherapy pulse So earlier, then in step 203 at interval MinTso-s
1Sending an amplitude on the point is AS
1Pulse-induced S
1In step 204 with the 5mS that delays time the action time of next pulse-induced S.Judge whether not cover as yet whole electrocardio vulnerable period 205, if yes, then be back into step 202 and retransmit next pulse-induced S
1,, enter step 206 then until having covered whole vulnerable period.Whether at first differentiate from recognition unit 505 receive the order of stopping paying out boost pulse (promptly whether the chamber of identifying early or chamber speed waveform, the step 109 among Fig. 6); If there is not this order, judge again whether AS equals 50mA, if less than 50mA, then enter step 207, with AS
1Increment 0.1mA, Tso-S
1Restore the pulse-induced S that has increased with amplitude
1In next stimulation cycle, cover the heart vulnerable period again, when unusual waveforms or AS take place
1When reaching 50mA, then in step 208 with AS
1Amplitude as PVCT, MET or VTT to recognition unit 505 outputs, be used to calculate ventricular fibrillation threshold VET.If the operator selects the series impulse method, then enter 216 by step 215, send N So electrotherapy pulse earlier, then in step 217 from MinTso-s
1The pulse-induced string that n cycle takes place at the place is the wide 1ms of 5ms.Judge whether to take place unusual waveforms or the S pulse amplitude reaches 50mA in step 218, if not, enter step 219, with the S 0.1mA that rises in value, the repetitive stimulation process is till inducing unusual waveforms or reaching 50mA, to recognition unit output AS
1As threshold value.
Referring to Figure 10, be depicted as the block diagram that swashs thorn signal generating unit 60 among Fig. 4.Wherein, label 601 is a D/A converter, for example can adopt 12 of dual pathwayss, switching levels is the conventional D/A converter spare of 05 ν, this transducer is converted to analogue signal with the command signal of the electric stimulation pulse sequence of 504 outputs of arithmetic element among Fig. 5, buffer stage through being used for impedance matching 602 is sent to buffer circuit 604 with the attenuator 603 that is used for the level adjustment then, the effect of this circuit is that the ground wire of the ground reference of stimulating electrode outfan and whole device is floated, to guarantee experimenter's safety, carry out impedance matching through buffer stage 605 then, to become current signal through buffered voltage signal by V/I changer 606 at last, be applied in the chambers of the heart by intracardiac stimulating electrode 70 shown in Figure 1, it is constant current output that feedback circuit 607 can keep intracardiac stimulating electrode, make it not be subjected to the influence of intracardiac impedance, with this accuracy that guarantees threshold test, schematically show heart impedance by 608 among the figure.Stimulus signal is finished by the intracardiac stimulating electrode 70 among Fig. 1, and this electrode can adopt the cardiac catheter of commercially available 4F type belt electrode, and in two counter electrode of this cardiac catheter, a pair of being used for applies electrotherapy pulse So to the atrium, and another applies a pulse S to being used for to ventricle
1
After utilizing the device of the present invention chamber of identifying morning or chamber speed waveform, process is to the peak value number of abnormal electrocardiogram waveform and the identification of width, can the chamber of determining that it is early, multiple chamber morning or chamber speed, select for use the suitable formula to calculating in the table 1 to go out VFT according to the skew of ST section then, export demonstration and storage by one output device 80 of the input among Fig. 1, adopt the printing display device in the prior art, can finish waveform of the presently claimed invention and show, in addition, by adopting conventional input equipment, as keyboard etc., can key in operational order and the information relevant to system by this input-output equipment with patient and since these all the technology known by the people of crowd, be not described further.
Apparatus and method of the present invention are at the above exemplary illustration that carried out in conjunction with the drawings; skilled person in this area need not deviate from essence of the present invention and principle; can carry out the modification and the replacement of various ways to it; therefore, protection scope of the present invention only depends on claims of the application.
Claims (6)
1, a kind of device of measuring cardiac function is characterized in that comprising:
A plurality of electrocardio detecting electrodes;
An arterial pressure transducer;
A pre-amplification circuit, its input link to each other with arterial pressure transducer with above-mentioned electrocardio detecting electrode respectively, and form the multidiameter delay output of electrocardio and arterial pressure signal;
Mould one number converter, its input links to each other with the multidiameter delay output of above-mentioned pre-amplification circuit, so that its mimic electrocardio and arterial pressure signal are converted to digital signal;
A signal processing unit, its input links to each other with the numeral output of above-mentioned mould one number converter and the data of its output is handled, to produce stimulation instructions and identification waveform;
A stimulus signal generating unit, this unit produce the heart electric stimulating signal under the control of the stimulation instructions that above-mentioned signal processing unit sends;
Two groups of intracardiac stimulating electrodes, this electrode link to each other with the outfan of above-mentioned stimulus signal generating unit and are applied to respectively in atrium and the ventricle with the heart electric stimulating signal with its generation; With
Input one output device, this device link to each other with above-mentioned signal processing unit with to its input control order and information and export its result and discern waveform;
Wherein, above-mentioned signal processing unit is at first handled electrocardio detecting electrode and the detected electrocardio of arterial pressure transducer and arterial pressure signal, to above-mentioned stimulus signal generating unit output heart is carried out the instruction of electricity irritation according to this result, generation has the stimulus signal of specific waveforms and it is applied to respectively in atrium and the ventricle by intracardiac stimulating electrode group according to the information in the instruction by the stimulus signal generating unit, discern being subjected to after the electricity irritation variation of electrocardio and arterial pressure waveform simultaneously, early and the waveform of chamber speed and send the instruction that stops to stimulate according to recognition result to the stimulus signal generating unit and by importing an output device waveform that identifies and the stimulus signal amplitude of bringing out this waveform are exported simultaneously with the chamber of identifying by signal processing unit.
2, the cardiac function checkout gear of claim 1, it is further characterized in that:
Described signal processing unit comprises:
A memory element, its input links to each other with the outfan of described analog-digital converter, is used to store digitized electrocardio and blood pressure waveform signal;
An electrocardiosignal measuring unit, this unit optionally take out electrocardiosignal and the characteristic parameter of electrocardiosignal are measured from memory element;
A measuring unit of blood pressure, this unit optionally take out blood pressure signal from memory element, and the waveform and the diastolic pressure of blood pressure are measured;
A recognition unit, this unit are imported ecg characteristics parameter and blood pressure waveform and the diastolic blood pressure values that above-mentioned electrocardiosignal measuring unit and measuring unit of blood pressure are measured;
An arithmetic element, ecg characteristics parameter that above-mentioned electrocardiosignal measuring unit and measuring unit of blood pressure measure and blood pressure waveform and diastolic pressure are imported as initial value in this unit, and produce the heart electric stimulating control signal and it is sent to described stimulus signal generating unit under above-mentioned recognition unit control;
Wherein send the electricity irritation control signal according to identification control arithmetic element to electrocardio and blood pressure waveform by above-mentioned recognition unit, proceed identification to accepting after the electricity irritation variation of electrocardio and blood pressure waveform then, to judge the appearance of chamber morning or chamber speed waveform, according to chamber morning of identifying or chamber speed waveform sending the instruction that stops electricity irritation, show waveform that identifies and the boost pulse amplitude of bringing out this waveform by described input-output equipment simultaneously to arithmetic element.
3, according to the cardiac function checkout gear of claim 2, it is further characterized in that,
The stimulating pulsatile series that is produced under arithmetic element control by described stimulus signal generating unit comprises two paths of signals:
One the tunnel is to be applied to intra-auricular electrotherapy pulse sequence, and its cycle is 50%～80% of the R-R interval measured by described electrocardiosignal measuring unit, and amplitude is 1～20mA;
Another road is to be applied to intraventricular pulse-induced sequence, it is that a plurality of trains of pulse of n constitute by string length, it applies mode for to send a pulse-induced string every N electrotherapy pulse to ventricle, it is acted on T ripple starting point in the interval of peak value, the value of N is 1～10, wherein 8 is preferred value, cycle in the pulse-induced string is 4～10mS, wherein 5mS is a preferred value, n depends on the value in above-mentioned cycle and the time that T ripple starting point arrives peak value, the amplitude of pulse-induced string is for from 0.1mA, and every string increases progressively and is no more than 0.1mA, until the chamber of inducing early or chamber speed waveform.
4, the cardiac function checkout gear of claim 2, it is further characterized in that;
The stimulating pulsatile series that is produced under arithmetic element control by described stimulus signal generating unit comprises two paths of signals:
One the tunnel is to be applied to intra-auricular electrotherapy pulse sequence, and its cycle is 50～80% of the R-R interval measured by described electrocardiosignal measuring unit, and amplitude is 1～20mA;
Another road is to be applied to intraventricular pulse-induced sequence, it applies mode is every N electrotherapy pulse, entad indoorly send a pulse-induced, the span of N is 1～10, wherein 8 is preferred value, the application point of pulse-induced is from T ripple starting point, move 4～10mS backward every N electrotherapy pulse, it wherein is preferred value with 5mS, the amplitude of pulse-induced is from 0.1mA, when its application point move on to after successively reach the T crest value after, with its amplitude increment and turn back to T ripple starting point and restart next circulation, each not conventional 0.1mA of increment amplitude is until the chamber of inducing morning or chamber speed waveform.
5, the cardiac function checkout gear of claim 2, it is further characterized in that:
The stimulating pulsatile series that is produced under arithmetic element control by described stimulus signal generating unit comprises two paths of signals:
One the tunnel is to be applied to intra-auricular electrotherapy pulse sequence, and its cycle is 50～80% of the R-R interval measured by described electrocardiosignal measuring unit, and amplitude is 1～20mA;
Another road is to be applied to intraventricular pulse-induced sequence, it applies formula is every N electrotherapy pulse, entad indoorly send a pulse-induced, the span of N is 1～10, wherein 8 is preferred value, the application point of pulse-induced is from T crest value point, wherein is preferred value every N electrotherapy pulse with 5mS to reach 4～10mS, the amplitude of pulse-induced is from 0.1mA, after its application point moves forward arrival T ripple starting point successively, with the increment of its amplitude and turn back to the T crest value and restart next circulation, increment amplitude at every turn is no more than 0.1mA, until the chamber of inducing early or chamber speed waveform.
6, the cardiac function checkout gear of claim 2, it is further characterized in that:
Accept the electrocardio that produces after the electricity irritation and the measured value of blood pressure waveform by described recognition unit from described electrocardiosignal measuring unit and measuring unit of blood pressure input heart, will be when ventricle applies pulse-induced blood pressure waveform value with apply electrotherapy pulse during the diastolic blood pressure values measured compare, and measure the persistent period that this blood pressure waveform is lower than diastolic pressure, according to the length of this time can determine the abnormal electrocardiogram waveform be the chamber early or chamber speed, when the chamber of determining morning or chamber speed, send the instruction that stops electricity irritation to described arithmetic element, and from this unit, extract the boost pulse amplitude signal that brings out unusual waveforms, show the amplitude of unusual waveforms that identifies and the ventricular stimulation pulse of bringing out this waveform then through described input-output equipment.
Priority Applications (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 87106622 CN1020066C (en) | 1987-09-30 | 1987-09-30 | Equipment for testing heart functions by electric excitation |
| US07/175,514 US4870974A (en) | 1987-09-30 | 1988-03-31 | Apparatus and method for detecting heart characteristics by way of electrical stimulation |
| AU14183/88A AU605715B2 (en) | 1987-09-30 | 1988-04-05 | Apparatus and method for detecting heart characteristics by way of electrical stimulation |
| JP63129408A JPH01110345A (en) | 1987-09-30 | 1988-05-26 | Apparatus and method for detecting heart character by electric stimulation |
| EP88305329A EP0310216A3 (en) | 1987-09-30 | 1988-06-10 | Apparatus for detecting heart characteristics using electrical stimulation |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 87106622 CN1020066C (en) | 1987-09-30 | 1987-09-30 | Equipment for testing heart functions by electric excitation |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN1032287A CN1032287A (en) | 1989-04-12 |
| CN1020066C true CN1020066C (en) | 1993-03-17 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN 87106622 Expired - Fee Related CN1020066C (en) | 1987-09-30 | 1987-09-30 | Equipment for testing heart functions by electric excitation |
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| Country | Link |
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| CN (1) | CN1020066C (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN100438939C (en) * | 2002-03-14 | 2008-12-03 | 伊诺维思医疗公司 | Method and apparatus for detecting and transmitting electrical and related audio signals from a single, common anatomical site |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1325018C (en) * | 2004-02-02 | 2007-07-11 | 北京科技大学 | Cardiac muscle and skeletal muscles physiologically electrical signal data gathering and signal handling system |
| US7925337B2 (en) * | 2009-02-17 | 2011-04-12 | Mindray Ds Usa, Inc. | Systems and methods for graphic display of ST-segment deviation |
| CN104698250A (en) * | 2013-12-06 | 2015-06-10 | 展讯通信（上海）有限公司 | Mobile terminal, current decomposing and positioning method and system thereof and current testing device |
| US10939832B2 (en) * | 2015-02-11 | 2021-03-09 | Microlife Intellectual Property Gmbh | Device and method for measuring blood pressure and for indication of the presence of atrial fibrillation |
| CN109106361A (en) * | 2017-06-23 | 2019-01-01 | 周厚荣 | A kind of monitoring device inducing animal ventricular fibrillation |
| CN109567805A (en) * | 2017-09-29 | 2019-04-05 | 上海交通大学 | High-performance pulmonary function detection system and method based on thorax impedance measurement |
| CN111657927B (en) * | 2020-07-20 | 2023-12-08 | 杭州市第一人民医院 | Electro-shock device |
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1987
- 1987-09-30 CN CN 87106622 patent/CN1020066C/en not_active Expired - Fee Related
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN100438939C (en) * | 2002-03-14 | 2008-12-03 | 伊诺维思医疗公司 | Method and apparatus for detecting and transmitting electrical and related audio signals from a single, common anatomical site |
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|---|---|
| CN1032287A (en) | 1989-04-12 |
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