CN1026752C - Device and method for detecting heart function by using electrical stimulation - Google Patents
Device and method for detecting heart function by using electrical stimulation Download PDFInfo
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- CN1026752C CN1026752C CN88101253.XA CN88101253A CN1026752C CN 1026752 C CN1026752 C CN 1026752C CN 88101253 A CN88101253 A CN 88101253A CN 1026752 C CN1026752 C CN 1026752C
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Abstract
The present invention relates to a device and a method for determining a pulse structure of a cordis electric stimulation signal through detecting electrocardio waveshapes and recognizing R-R and Q-T interphases thereof. The change of the electrocardio waveshapes is detected during the stimulation, the waveshapes with the width of smaller than 10 milliseconds are filtered off, and QRS wave groups with the frequency of 17Hz are recognized in order to find out abnormal heart beat with the R-R interphases of smaller than heart beat regulation stimulus signal peroids. When early ventricle waveshapes are induced, an electrocardio vulnerable period is determined according to the position of an induced pulse in order to quicken a detection process. A floating circuit is used in order that the detection, the stimulation and a signal processing part of the present invention can not mutually interfered in order to ensure the waveshape recognition accuracy.
Description
The present invention relates to a kind of improved pass through the apparatus and method that electricity irritation detects cardiac function, specifically, apparatus and method of the present invention can be discerned to obtain the information of reflection cardiac function by the abnormal electrocardiogram waveform that stimulus signal is brought out utilizing stimulating electrode to measure the variation of electrocardiosignal when heart applies the stimulus signal with predetermined structure.
Apparatus and method of the present invention are that the title of this invention also is " by the apparatus and method of electricity irritation detection cardiac function " to the further improvement of No. 87106622 applications for a patent for invention of being finished by same inventor and being submitted to Patent Office of the People's Republic of China JIUYUE in 1987 30 days by same applicant.Finish and above-mentionedly in this description the following description, all be referred to as " original application " by the inventor in first to file by what the applicant submitted to, all by quoting the part as this description as proof, this description only is described in detail the improvement part that the present invention finished disclosed full content in this " original application ".
In original application, the inventor has at first defined following new ideas:
1. the ventricular premature contraction threshold value or the chamber of crying threshold value PVCT(Premature Ventricular Contraction Threshold early): this is meant the minimal stimulation current value that goes out the premature ventricular beat ecg wave form by intracardiac electric stimulus inducing.
2. multiple chamber is threshold value MET(Multiple Extrasystoles Threshold early): this is meant the minimal stimulation current value that induces multiple ventricular premature contraction ecg wave form by heart electric stimulating; Also it can be defined as non-standing chamber speed threshold value NSTT(Nonsustained Tachycardia Threshold according to clinical practice): be meant the minimal stimulation current value that induces 3-9 ventricular premature contraction ecg wave form.
The ventricular tachycardia threshold value or be chamber speed threshold value VTT(Ventricular Tachycardia Threshold): this is meant the minimal stimulation current value that induces the ventricular tachycardia ecg wave form more than 10 or 10 by heart electric stimulating.
In original application, the inventor at first proposes, the ventricular fibrillation threshold in prior art (VFT), the chamber early the multiple chamber of threshold value PVCT early threshold value MET(or be non-standing chamber speed threshold value NSTT) and the fast threshold value VTT in chamber also can the quantitative description ecg stability.Testing result also further shows, above-mentioned each threshold value PVCT, and MET(NSTT), 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 proves, measure PVCT by handy and safe ground, MET(NSTT) and VTT, can replace VFT extremely dangerous in the prior art measures, and with this ecg stability is described quantitatively and reliably, simultaneously can be according to the PVCT that measures, MET(NSTT) or VTT extrapolate the VFT of testee.
For safety with measure PVCT exactly, MET(NSTT) and VTT, the stimulating pulsatile series of specific coding is provided in the original application, 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, use the generation of electrocardio and monitoring of blood pressure chamber morning and chamber speed simultaneously, can accurately and safely identify the PVCT of tested heart, MET(NSTT) and VTT.
The measurement result of describing in the original application also shows, when heartbeat in the cycle generation chamber early, when quiver in chamber speed or chamber, the diastolic blood pressure values when the real-time pressure value of testee promptly is lower than normal heartbeat; The chamber is early, chamber speed or chamber time of quivering is long more, and it is also long more that pressure value is lower than time of diastolic pressure in real time, 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 the sum of errors signal disturbs when the ecg analysis with this by ecg analysis identification chamber.
Disclosed cardiac function checkout gear comprises in the original application: a plurality of electrocardio detecting electrodes, can adopt the electrode of any conventional structure; A pressure transducer can adopt ductus arteriosus pick off, doppler blood pressure sensor or other blood pressure to be converted to 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, with this above-mentioned cardiac stimulation pulse sequence is exported to heart; With an output device, be used for the result of shows signal processing unit output; 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 is carried out Real time identification by signal processing unit, send the result that the instruction that stops to stimulate will discern simultaneously by signal processing unit to the stimulus signal generating unit in the chamber of identifying early or during the speed signal of chamber and show by output device.Can measure PVCT, MET(NSTT safely, automatically, exactly thus), VTT and extrapolate the VFT of testee, use for clinical and scientific research.
Disclosed cardiac function detection method may further comprise the steps in the original application:
A. detect the electrocardiogram of heart and the waveform that the arterial pressure amplitude changes by conventional electrocardio detecting electrode and pressure transducer;
B. calculate real-time heart rate according to the electrocardiosignal that detects;
C. the electrocardio that is higher than heart rate according to the real-time heart rate generation frequency that has calculated is transferred the signal sequence of fighting, and the pulse-induced that on position moves successively and amplitude progressively increases progressively in this sequence, forms the cardiac stimulation pulse sequence with this;
D. the signal sequence of above-mentioned accent being fought input atrium is with above-mentioned cardiac stimulation pulse sequence input ventricle;
E. detect in real time the variation of electrocardio and blood pressure signal under above-mentioned stimulus signal effect;
F. electrocardio and blood pressure signal are carried out real-time analysis with the chamber of identifying morning and/or chamber speed waveform;
G. according to the chamber identified early and/or chamber speed waveform stop to apply the process of electrical stimulation signal to heart; With
H. show chamber morning and/or chamber speed waveform, its corresponding blood pressure waveform that identifies and the amplitude of the electric stimulation pulse that induces above-mentioned waveform and the ventricular fibrillation threshold of extrapolating thus through output device.
Disclosed apparatus and method improve the accuracy of measurement result and comparability by measuring the electrocardiosignal of reflecting myocardium electricity physiological process and the blood pressure signal of reflection cardiovascular system hemodynamics process simultaneously to the intracardiac electrical stimulation signal that applies greatly in the original application.Since the reflection of two kinds of signals be different physiological process and measurement be different physical quantitys, the mutual interferential probability of this measuring process is minimum, so its measurement result is reliable, quantitatively accurately.
But, find that by a large amount of clinical trials disclosed apparatus and method exist following problem in the original application.
1. owing to the apparatus and method of original application will be carried out intracardiac electricity irritation simultaneously and be measured electrocardio and arterial blood pressure signal, therefore will be respectively stimulating electrode be introduced right atrium and right ventricle and will the arterial pressure detecting electrode be introduced with conduit among the tremulous pulse through vein, this metering system that carries out artery and vein puncture simultaneously is bigger to the misery that patient causes, operation to the doctor also requires very high, and also has certain danger, therefore in the middle of clinical practice, particularly when generally investigating on a large scale, be difficult for being accepted by the experimenter.
2. the diastolic pressure BP in the time of when utilizing real-time blood pressure to detect, need utilizing the normal heartbeat of experimenter
0As with reference to value (referring to Fig. 3 A in the original application to 3D and explanation thereof).Yet, when actual measurement, the BP that measures by real-time blood pressure detecting electrode
0Be a unsettled value, it is easy to be subjected to the influence (as anxiety, the worry of testee, or too excited or the like) of the psychological factor of multiple factor, particularly experimenter.Therefore in measuring process, need the doctor rule of thumb to BP
0Value is carried out suitable judgement.In addition, make BP for the emotion of stablizing the experimenter
0Stablizing often needs the doctor to make a lot of effort, and this also causes whole measuring process to be spun out, and this all is totally unfavorable to mass heart survey and emergency call salving.
3. according to disclosed apparatus and method in the original application, the different situations that will distinguish normal myocardium and ischemic myocardium in the process of electrocardio threshold value determination and reckoning are by different formula convert (referring to the relevant explanation of original application Fig. 2 A to 2F and table 1).At first to carry out routine electrocardiogram detection and differentiation in this manner, could on the basis that routine electrocardiogram is differentiated, carry out the electricity irritation testing process then.This has prolonged detection time on the one hand, on the other hand, some atypical situation is difficult for judging rapidly, and this did not have HDH may cause erroneous judgement without any the experimenter of subjective symptoms for some in the past yet.
4. utilize when disclosed apparatus and method are carried out the cardiac function measurement in the original application, in order to guarantee experimenter's safety, scanning and the increasing progressively all of pulse-induced of electrocardio vulnerable period will progressively carry out, this just makes whole measuring process longer, the requirement of various operations (as artery and vein puncture etc.) is all very high, therefore be unfavorable for rescuing critical patient, also be unfavorable in mass heart survey, promoting the use of.
At the problems referred to above and the shortcoming that exist in the disclosed apparatus and method of original application, the present invention proposes a kind of improved apparatus and method that detect cardiac function by electricity irritation.
In apparatus and method of the present invention, by adopting floating ground circuit to solve influencing each other between heart electric stimulating signal and the electrocardiosignal that produces at cardiac muscle under this stimulus signal effect, the mutual interference mutually between the Circuits System that has overcome the generation stimulus signal and the electrocardiosignal detection system.Therefore, in apparatus and method of the present invention, need not detect real-time blood pressure signal, only can the chamber of identifying from the electrocardiosignal that cardiac muscle under the stimulus signal effect produces early and/or the ecg wave form of chamber speed, thereby obtain every electrocardio threshold value of reflection cardiac function.So just need not adopt the blood arterial pressure waveform of wound to detect, also avoid normal diastolic pressure BP
0Fluctuation to the influence of testing result.In addition, heart electric stimulating process of the present invention can utilize stimulating electrode through esophagus atrium and chamber part to be stimulated under the help of B ultrasonic or X line perspective, has so just avoided the wound to the experimenter fully, makes the simpler and easy and safety of whole testing process.
In apparatus and method of the present invention, with the electrocardio threshold value regression equation that ischemic myocardium all is suitable for the testing result of various different testees is all calculated normal myocardium by setting up according to same equation, therefore need not before carrying out electricity irritation, carry out the routine electrocardiogram detection and Identification earlier, this has just simplified testing process, shortened detection time, avoided selecting the improper error that causes because of computing formula.
The present invention is by improving the mode of carrying out heart program stimulating in the original application, the pulse of waveform PVC early carrying out electrocardio vulnerable period location, chamber is brought out in utilization, sweep limits is dwindled greatly, thereby quickened scanning process, further simplify testing process, shortened the used time of whole detection.
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 preamplifier is used for the electrocardiosignal that the electrocardio detecting electrode detects is amplified and exported; Floating ground of a preamplifier circuit makes the not interference of irriate signal of testing process; An analog-digital converter is used for above-mentioned electrocardio output is converted to digital signal; A signal processing unit is used for above-mentioned digital signal is handled to produce the cardiac stimulation control signal; A D-A converter is used for this control signal is converted into analog form from digital form; A stimulus signal buffer circuit makes the not work of Interference Detection system of stimulating course; A stimulus signal generating unit, this unit produces the cardiac stimulation pulse sequence under the analog control signal control of above-mentioned D-A converter output; A heart stimulating electrode, this electrode can be introduced in the chambers of the heart by cardiac catheter and also can introduce in the esophagus by esophagoscope, so that above-mentioned cardiac stimulation pulse sequence is exported to heart; With an output device, be used for the result of shows signal processing unit output; Wherein working as heart is subjected to doing the time spent through the cardiac catheter input or through the boost pulse of esophagus input, above-mentioned a plurality of electrocardio detecting electrode is monitored the variation that electrocardiosignal takes place under the boost pulse effect, and the electrocardiosignal that monitors is carried out Real time identification by signal processing unit, early boost pulse is dwindled the sweep limits of electrocardio vulnerable period during signal in the chamber of identifying, continue to strengthen the amplitude of boost pulse then, until inducing multiple chamber early or chamber speed waveform, send the result that the instruction that stops to stimulate will discern simultaneously by signal processing unit to the stimulus signal generating unit again and show by output device.Utilize cardiac function checkout gear of the present invention need not measure blood pressure waveform and can comparatively promptly measure PVCT, MET(NSTT), VTT, and extrapolate VFT.
Cardiac function detection method according to the present invention may further comprise the steps:
A. detect ecg wave form by conventional electrocardio detecting electrode;
B. calculate real-time heart rate according to the electrocardiosignal that detects;
C. produce the heart tone signal sequence that frequency is higher than heart rate according to the real-time heart rate that has calculated, and relevant position that should sequence is determined the position and the amplitude of pulse-induced to form the cardiac stimulation pulse sequence with this;
D. the signal sequence of above-mentioned accent being fought acts on the atrium and with above-mentioned heart pulse-induced sequence and acts on the ventricle;
E. detect the chamber that under above-mentioned stimulus signal effect, produces in electrocardiosignal waveform early, and early limit the electrocardio vulnerable period in the position of the pulse-induced of waveform, in this vulnerable period, continue to increase the amplitude of pulse-induced then according to the chamber of inducing;
F. electrocardiosignal is carried out real-time analysis to identify multiple chamber morning and/or chamber speed waveform;
G. according to the multiple chamber of identifying early and/or chamber speed waveform stop to apply the process of electrical stimulation signal to heart; With
H. show the amplitude of multiple chamber morning and/or chamber speed waveform that identifies and the pulse-induced that induces above-mentioned waveform and extrapolate ventricular fibrillation threshold thus through output device.
Because apparatus and method of the present invention are carrying out need not measuring blood pressure waveform when cardiac function is measured, therefore needn't carry out arterypuncture, and this has just alleviated the painful of experimenter and has simplified medical worker's operation and avoided traumatic infringement and danger to the experimenter can to stimulate the intracardiac stimulation of the cardiac catheter that replaces venipuncture by esophagus.
Because apparatus and method of the present invention are carrying out having used unified formula when threshold value is calculated, need not distinguish whether there is myocardial ischemia to testee, this has just omitted before the electricity irritation the detection of myocardial ischemia situation and has judged and also avoided the detection error that caused by error in judgement.
Because apparatus and method of the present invention have adopted new cardiac stimulation pulse to the electrocardio scan mode of vulnerable period, checking process is accelerated and guaranteed the accuracy that detects simultaneously.
Above factors make apparatus and method of the present invention can avoid experimenter's wound fully, operator's the requirement and the difficulty of operation are all reduced greatly, and shortened the time of carrying out the cardiac function detection greatly, also guaranteed the accuracy that detects simultaneously, therefore it makes the simpler and easy and safety of the present invention, and be applicable to large-scale cardiac function generaI investigation and in case of emergency be used to rescue the emergency case, make apparatus and method of the present invention can in clinical practice and scientific research, be easy to penetration and promotion more.
The present invention above-mentioned and other purpose, feature, advantage and purposes will in the present invention of doing below in conjunction with accompanying drawing describes in detail, more clearly embody.
Fig. 1 illustrates the schematic block diagram of the improved cardiac function checkout gear of the present invention.
Fig. 2 A illustrates each threshold value statistical Butut of institute of the present invention foundation to 2C.
Fig. 3 A illustrates the multiple chamber of measuring with the improved apparatus and method of the present invention ecg wave form figure that quivers of (non-standing chamber speed), chamber speed and chamber early to 3C.
Fig. 4 illustrates the flow chart of morning/chamber, morning/multiple chamber, the chamber speed ecg wave form recognizer that recognition unit 505 is carried out among Fig. 1.
Fig. 5 A to 5C illustrate the present invention improved by the chamber early waveform recognition limit the electrocardio method of vulnerable period.
Fig. 6 is a pre-amplification circuit 30 and the theory diagram that floats ground circuit 90 among Fig. 1.
Referring to Fig. 1, be depicted as the schematic block diagram of the improved cardiac function checkout gear of the present invention.Among Fig. 1, reference number 10 is represented conventional electrocardio detecting electrode, and detecting electrode of the present invention can carry out conventional electrocardio and detect.Reference number 30 is represented a pre-amplification circuit, and it can amplify electrocardiosignal, to produce electrocardio output.Reference number 40 is an A/D converter, and it is a digital signal with the analog electrocardiogram conversion of signals of pre-amplification circuit 30 outputs.Above electrocardio detecting electrode 10, pre-amplification circuit 30, the A/D converter 40 common test sections that constitute apparatus of the present invention, this part is identical with counterpart structure in the original application device, so is not described further.Increased a floating ground circuit 90 in circuit of the present invention, it keeps apart the other parts of testing circuit and apparatus of the present invention, thereby is not vulnerable to other parts to its circuit that causes interference, and this has just guaranteed the stability of detected ecg wave form.Frame of broken lines 50 is represented a signal processing unit, comprising the memory element 501 that is used to store digitized detection data; Electrocardiosignal measuring unit 502, this unit extracts electrocardiogram (ECG) data from memory element 501, and to R-R same period of electrocardiogram (ECG) data, and parameters such as Q-T interval are measured to produce the electrocardio measuring-signal; Arithmetic element 504, this unit is exported as the cardiac stimulation control signal according to the parameters that the electrocardio measuring-signal of measuring unit 502 output calculates the stimulus signal that the reply heart applies, the flow chart of this stimulation programs can be referring to Fig. 9 recognition unit 505 of original application, this unit is from electrocardiosignal measuring unit 502 input electrocardio measuring-signals, at first this signal is carried out the identification of chamber morning and chamber speed, the situation of getting rid of experimenter's existing ventricular rhythm when not accepting stimulus signal, normal person sends stimulation instructions to the rhythm of the heart, then in the variation chamber of identifying of the ecg wave form that produces under the effect of electrical stimulation signal early or chamber speed waveform and when identifying unusual heartbeat waveform, send the instruction that stops to stimulate to arithmetic element 504 to heart, the boost pulse amplitude that unusual heartbeat waveform is brought out in 504 inputs from the unit, the waveform of output abnormality heartbeat and measurement and every threshold value of extrapolating then simultaneously; The working procedure flow chart that recognition unit 505 is carried out can be referring to Fig. 4.Reference number 60 is that a stimulus signal generation circuit reference number 70 is a heart stimulating electrode, and it can adopt conventional two-way cardiac catheter electrode to carry out intracardiac stimulation, also can carry out AT stimulation to the corresponding site of atrium and ventricle through esophagus.Circuit 60 and the electrode 70 common cardiac stimulation parts that constitute apparatus of the present invention, the similar of appropriate section in they and the original application, can be referring to Figure 10 in the original application and explanation thereof, device of the present invention by adopt floating ground circuit 90 with test section 10 and 30, cardiac stimulation part 60 and 70 and signal processing 50 separate, make the signal of three parts can not produce the phase mutual interference in the course of the work like this, guarantee the accuracy of testing result with this.The detailed structure of floating ground circuit 90 can be referring to Fig. 6.Reference number 80 is an input-output equipment, the amplitude that is used to export the chamber morning or the chamber speed waveshape signal of recognition unit 505 and produces the pulse-induced of this waveform, and every electrocardio threshold value of extrapolating in view of the above, and be used to import various operation instruction signals and for information about.
Referring to Fig. 2 A to 2C, the statistical Butut that is depicted as normal myocardium, ischemic myocardium and cardiomyopathy and the threshold value determination that the sudden death history carries out through the patient of rescue recovery is arranged, the corresponding relation of two different threshold values that every bit representative is measured by the normal same experimenter of blood supply of cardiac muscle among the figure, the corresponding relation of two different threshold values that each small circle representative is gone out by the same body examination of myocardial ischemia among the figure.Fig. 2 A illustrates the MET(NSTT that 91 routine normal myocardiums and 20 routine ischemic myocardiums are measured) than the statistical distribution of VTT, Fig. 2 B illustrates the MET(NSTT that has the patient of sudden death history to measure to 164 routine normal myocardiums and 31 routine ischemic myocardium 6 routine cardiomyopathys, 6 examples) than the statistical distribution of VFT, Fig. 2 C illustrates has VTT that the patient of sudden death history the measures statistical distribution than VFT to 102 routine normal myocardiums and 17 routine ischemic myocardium 6 routine cardiomyopathys, 6 examples.Statistical procedures to above statistics shows, no matter in normal myocardium still is ischemic myocardium, and electrocardio threshold value MET(NSTT), all are height cross-correlation (correlation coefficient r: 0.72-0.99, P＜0.01) between VTT and the VFT three.By above statistics as can be seen, though that every threshold value of normal myocardium and ischemic myocardium distributes in the drawings is regional different, they all meet the regression equation that provides in the table 1.
Table 1
The threshold value regression equation
MET＝0.2375+0.6512VTT
MET/VTT
VTT＝1.2936+0.9981MET
MET＝0.3543+0.5489VFT
MET/VFT
VFT＝1.7932+1.0816MFT
VTT＝0.6673+0.7060VFT
VTT/VFT
VFT＝0.1349+1.1608VTT
As shown in table 1, utilize the above formula can be by experimenter's MET(NSTT) or VTT extrapolate VFT, avoid carrying out dangerous very big VFT with this and directly measure.
, be depicted as and utilize multiple chamber that the improved apparatus and method of the present invention measure respectively ME(non-standing chamber speed NST early to Fig. 3 C referring to Fig. 3 A), chamber speed VT and the chamber electrocardiosignal oscillogram of VF when taking place of quivering.In Fig. 3 A, transverse axis is the time, and the longitudinal axis is the amplitude of electrocardiosignal.The S that marks among the figure
0The electrotherapy pulse that expression applies to the atrium by heart stimulating electrode, it forms with T heartthrob
SOThe all neat artificial rhythm of the heart for the cycle.S
1The pulse-induced that expression applies to ventricle by another road heart stimulating electrode by adjusting its site of action successively and increasing its amplitude gradually, can induce unusual heartbeat (referring to the Fig. 7 and the explanation thereof of original application) at electrocardio in vulnerable period.At electrotherapy pulse S
0Effect under the rhythm of the heart neat, the R-R interval of this moment, equal S
0Period T
SO, see the 1st R-R interval among Fig. 3 A.As pulse-induced S
1When inducing chamber property heartbeat, the R-R interval of this unusual chamber property heartbeat, is less than T
SO, see 2-4 R-R interval among Fig. 3 A.Apply electrotherapy pulse S if at this moment stop to heart
0With pulse-induced S
1, heart can automatically restore to the normal rhythm of the heart, sees among Fig. 3 A 6-9 interval of the 5th R-R normal heartbeat waveform after interval, and these normal R-R interval, is greater than the accent period T of fighting
SOAt pulse-induced S
1The number n of the continuous chamber property heartbeat that produces down of effect satisfy condition: n＜3 o'clock (are that the R-R interval is less than T
SOThe number of continuous unusual waveforms less than 3 o'clock).Be called ventricular premature contraction (chamber of abbreviating as early, i.e. PVC).If 3≤n≤9 would be called multiple chamber early ME(also can be called non-standing chamber speed MST), as shown in Fig. 3 A.If chamber speed VT then is called in n 〉=10, as shown in Fig. 3 B, wherein the 1st R-R interval, equal T
SO, 2-12 R-R interval, is less than T
SOAs pulse-induced S
1Amplitude when meeting or exceeding ventricular fibrillation threshold, the R-R interval of the abnormal electrocardiogram waveform that it brings out, wait anything but, and heart rate surpassed 250 times/minute, quiver in the chamber of being called.Shown in Fig. 3 C, the waveform irregular that become that quivers of chamber wherein can't therefrom identify the R-R interval, and this situation is not if prevent the life that will jeopardize the experimenter rapidly, and device of the present invention will be avoided bringing out the chamber exactly in measuring process and quiver.
Fig. 4 illustrates the flow chart of morning/chamber, morning/multiple chamber, the chamber speed ecg wave form recognizer that recognition unit 505 is carried out among Fig. 1.Should be understood that, the label of a lot of steps among the figure is identical with the corresponding steps of Fig. 6 in effect and the original application, the main distinction of these two programs is, the program of original application is to differentiate whether induce unusual heartbeat according to the situation that arterial pressure descends, and program of the present invention then is to differentiate according to the variation of ecg wave form whether unusual heartbeat takes place.Program of the present invention below is described.At first, measurement data at step 90 input ecg signal, differentiate the chamber of having or not morning and chamber speed waveform in step 100 then, at this moment the experimenter does not accept electrical stimulation signal as yet, if distinguish that unusual waveforms is arranged, illustrates that experimenter's heart condition is very poor, change step 112 over to, do not carry out electricity irritation, if no abnormal waveform enters step 101.Step 101 is sent the instruction that begins to carry out cardiac stimulation to arithmetic element, and the specific procedure of carrying out cardiac stimulation can be referring to the Fig. 9 and the explanation thereof of original application.Step 102 is from the relevant data of electrocardiosignal measuring unit 502 and arithmetic element 504 input electrocardio measuring-signals and cardiac stimulation signal (width of R-R interval, T
SO, the S of R-R correspondence in interval
1The position, S
1Amplitude); Judge whether the order of having stopped paying out boost pulse in step 103 then to 60 outputs of stimulus signal generating unit, and if not would enter step 104 ', the abnormal electrocardiogram waveform that stimulus signal brings out is counted.Should be pointed out that for the pulse S that when discerning the abnormal electrocardiogram waveform, avoids being upset
0And S
1Interference, can filter the waveform of width to the electrocardiosignal that detects earlier, because S less than 10ms
0And S
1Width be (referring to Fig. 7 of original application) about 1ms, they are all filtered through after the filtering, the waveform of seeking fundamental frequency then and be 17Hz in filtered electrocardiosignal can be avoided the erroneous judgement to interfering signal that may cause by amplitude identification R ripple like this to identify the QRS wave group.The QRS wave group can be finished the measurement of interval to R-R after identifying, by with R-R interval and T
SOCompare and to identify the abnormal electrocardiogram waveform (the R-R interval is less than T
SO) number C
0Then at step 105 ' judgement C
0Whether be zero, if yes, then explanation, return step 102 through step 108 and continue new detection data sampling, until at step 105 ' determine C if not inducing unusual heartbeat
0Non-vanishing, enter then step 106 '.Because the amplitude of pulse-induced is to increase step by step, thus the unusual heartbeat that induces at first generally the chamber of being early, 0＜C at this moment should satisfy condition
0＜3.Distinguish the number of this unusual waveforms when step 106 and be not more than when equaling 3, enter step 107 ', in this step to the chamber of inducing early the pulse-induced of PVC waveform position owing to induced the chamber early, S at this moment is described
1Be in electrocardio vulnerable period scope, can limit the position of electrocardio vulnerable period thus and this information is delivered in the cardiac stimulation subprogram of being carried out by arithmetic element 504.Be reduced into the interval of a 20ms to the interval of about 200ms of T crest value from original T ripple starting point by the sweep limits of step 107 ' make electrocardio vulnerable period, this makes later vulnerable period scanning more accurately also rapider, induces the stimulating course of multiple chamber morning and chamber speed waveform after this has just accelerated greatly.Step 107 is finished the back by step 108 display room waveform morning and to C
0Return step 102 after the zero clearing and continue electrocardiosignal is sampled, until at step 106 ' distinguish C
0More than or equal to 3, this explanation has induced multiple chamber morning or chamber speed waveform, enters step 109 then and sends the instruction that stops electricity irritation to stimulus signal generating unit 60.Pass through step 110 to 114 then, enough data points of multiple chamber morning that taking-up has identified or chamber speed waveform show these unusual waveforms and every electrocardio threshold value MET, VTT and the VFT that detect and calculate on output device.
Fig. 5 A to Fig. 5 C illustrate the present invention improved by the identification chamber early the PVC waveform limit the electrocardio method of vulnerable period.Fig. 5 A illustrate electrocardio in original application vulnerable period sweep interval it be from T ripple starting point to the T crest value, generally this interval width is 200ms.It is the vulnerable period of 20～40ms that a width is arranged in this interval, because experimenter's the individual variation and the undulatory property of electrocardiosignal itself, the definite position of each concrete experimenter's electrocardio vulnerable period is unascertainable carrying out between the electricity irritation, in order to find out this vulnerable period, the sequential method in the original application is every N S
0In this sweep interval, apply a S
1Pulse is at every turn with this S
1Move 5ms after the pulse successively, finish the scanning in whole interval through about 40 circulations (200ms/5ms) like this, then with S
1Repeat this scanning process again behind the increment 0.1mA, until inducing multiple chamber early ME or chamber speed VT.Fig. 5 B illustrates the improved mode of the present invention, wherein the 1st S of R-R in interval
1Fail to induce unusual R ripple and the 2nd S of R-R in interval
1Then induce the chamber waveform of PVC early, this S is described
1Be positioned at the electrocardio vulnerable period.Mode of the present invention is not to induce multiple chamber early ME or chamber speed VT by the time, but is inducing one or two chamber early during waveform PVC, promptly according to S at that time
1The electrocardio scope of vulnerable period is determined in the position at place, with S
1Each 10ms was as new sweep interval before and after the position at place at that time, and later like this sweep interval promptly becomes 20ms by original wide about 200ms.Owing to bring out the S of PVC
1Amplitude than the S that brings out ME or VT
1Amplitude much smaller, so just can find out the definite position of vulnerable period earlier, subsequently only in the vulnerable period of having found out by portion with S
1Increment until inducing multiple chamber early ME or chamber speed VT, utilizes this method can accelerate the speed that detects greatly, reduces the blindness of vulnerable period scanning.The position of the vulnerable period that identification is determined according to PVC in electricity irritation process subsequently shown in Fig. 5 C, later S
1Only act in this very narrow scope until inducing multiple chamber early ME or chamber speed VT.
Referring to Fig. 6, be depicted as pre-amplification circuit 30 and the theory diagram that floats ground circuit 90 among Fig. 1.Among Fig. 6, frame of broken lines 30 is a preamplifier, and comprising high input impedance amplifier 301, its resistance to earth is greater than 1000M Ω leakage current＜1 μ A; Gain-controlled amplifier 302, it is controlled at the output of amplifier 301 in the suitable gain ranging, and frame of broken lines 90 is for floating ground circuit, comprising buffer stage 901; Buffer circuit 902, this circuit have adopted photoelectricity coupling buffer circuit, another buffer stage 903, it and 901 all be to be used for carrying out impedance matching with buffer circuit 902, gain-controlled amplifier 904 is used to control the gain ranging of buffer circuit output signal; With low output impedance amplifier 905, its output impedance is less than 100 Ω, to avoid being subjected to the interference of load.Because device of the present invention has adopted buffer circuit 902 to realize the floating ground of detection system, it with stimulus signal generation circuit 60 in buffer circuit 604(referring to Figure 10 of original application) match, avoided detection system and mutual interference mutually between the stimulating system can guarantee simultaneously experimenter's safety well.For providing, signal processing unit 50 disturbs very little electrocardio detection signal.For from the anomalous ecg waveform, discerning PVC later on, ME, VT has created good condition.
Apparatus and method of the present invention have been carried out exemplary illustration above by accompanying drawing; those skilled in the art need not deviate from essence of the present invention and principle can be to its modification and replacement of carrying out various ways, and protection scope of the present invention only depends on claims of the application.
Claims (7)
1, a kind of device by electricity irritation detection cardiac function comprises:
A plurality of electrocardio testing circuits;
A pre-amplification circuit, its input link to each other with above-mentioned a plurality of electrocardio detecting electrodes respectively and form the output of electrocardiosignal;
An analog-digital converter, its input links to each other with the output of following floating ground circuit, so that its mimic electrocardiosignal is converted to digital signal;
An input-output equipment, this device link to each other with following signal processing unit with to its input operation instruction and information and export its result and identification waveform;
It is characterized in that this device also comprises:
Stimulus signal generating unit and the two-way heart stimulating electrode that is connected with this unit;
A floating ground circuit, it comprises first buffer stage that is connected with above-mentioned pre-amplification circuit output, one buffer circuit, one second buffer stage is in order to carry out impedance matching with the output of buffer circuit, a gain controller, in order to control buffer circuit output gain signal scope, and low output impedance amplifier, described floating ground circuit is connected between above-mentioned pre-amplification circuit and the analog-digital converter, makes the stimulus signal generating unit not produce electrical interference to the electrocardiosignal that pre-amplification circuit detects in the process that applies boost pulse to heart; And
A signal processing unit, its input links to each other with the numeral output of above-mentioned analog-digital converter and the data of its output is handled, this signal processing unit comprises: a memory element, and its input links to each other with the outfan of described analog-digital converter, is used to store digitized electrocardiosignal; An electrocardiosignal measuring unit is used for measuring from said memory cells taking-up electrocardiosignal and to its characteristic parameter; A recognition unit is used for discerning from the electrocardiogram (ECG) data of electrocardiosignal measuring unit input; With an arithmetic element, the characteristic parameter that above-mentioned electrocardiosignal measuring unit is imported in this unit is an initial value, and produces the heart electric stimulating control signal and it is sent to described stimulus signal generating unit under above-mentioned recognition unit control;
Wherein, above-mentioned signal processing unit is at first handled the detected electrocardiosignal of electrocardio detecting electrode, 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 certain pulses structure and it is applied to atrium and ventricle respectively by heart stimulating electrode according to the information in the instruction by the stimulus signal generating unit, by above-mentioned signal processing unit the variation of electrocardiosignal under the electrical stimulation signal effect is carried out the identification of chamber morning and chamber speed waveform simultaneously, and send the instruction that stops to stimulate according to recognition result to the stimulus signal generating unit, simultaneously by input-output equipment with waveform that identifies and the stimulus signal amplitude output of bringing out this waveform.
2, the device of claim 1, 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 the electrotherapy pulse sequence that is applied to the atrium, its period T
SOLess than the electrocardio R-R interval before the electricity irritation, another road is the pulse-induced sequence that is applied to ventricle, by adjusting chamber morning and/or the chamber speed waveform that pulse-induced can bring out electrocardiosignal with respect to the time location and the amplitude of electrotherapy pulse;
Accept the ecg wave form measured value that produces after the electricity irritation by described recognition unit from described electrocardiosignal measuring unit input heart, and measure the R-R interval less than the above-mentioned accent period T of fighting
SOThe continuously number of unusual heartbeat, the continuous number chamber of determining morning or chamber speed according to this unusual heartbeat are sent the instruction that stops electricity irritation to described arithmetic element simultaneously, and from this unit, extract the boost pulse amplitude signal that brings out this unusual waveforms, show unusual waveforms that identifies and the ventricular stimulation pulse-induced amplitude of bringing out this waveform through described input-output equipment then.
3, according to the device of claim 2, it is further characterized in that:
Discern by the number that described recognition unit accepts to produce after the electricity irritation successive unusual waveforms to heart;
When in the scope of number at 3-9 of unusual waveforms (comprising 3 and 9), with its be judged to multiple chamber early ME(or cry the non-standing chamber fast NST), the amplitude of its pulse-induced is obtained ventricular fibrillation threshold VFT as follows as MET;
VFT＝1.7932+1.0816MET;
When the number of unusual waveforms more than or equal to 10 the time, it is judged to chamber speed VT, the amplitude of its pulse-induced is obtained ventricular fibrillation threshold VFT as follows as VTT;
VFT＝0.1349+1.1608VTT;
The ventricular fibrillation threshold that calculates is exported by input-output equipment.
4, a kind of method by electricity irritation detection cardiac function is characterized in that may further comprise the steps:
A. detect the electrocardiographic wave signal by conventional electrocardio detecting electrode;
B. the electrocardiosignal that detects is measured R-R interval and Q-T interval;
C. apply an electrotherapy pulse sequence, the period T of this pulse train by one road heart stimulating electrode to the atrium
SOBe the R-R interval of 50-80%, amplitude is 1-20mA;
D. apply a pulse-induced sequence by another road heart stimulating electrode to ventricle, to induce electrocardiosignal by adjusting the time location and the chamber morning and/or the chamber speed waveform of amplitude of pulse-induced with respect to electrotherapy pulse;
E. detect and under the pulse-induced effect, whether occur the R-R interval in the electrocardiosignal less than the accent period T of fighting
SOUnusual heartbeat, and repeat steps d, until inducing unusual heartbeat;
F. after detecting unusual heartbeat, stop pulse-induced that the atrium being applied electrotherapy pulse and ventricle is applied, the waveform of unusual heartbeat and the amplitude signal that induces the ventricular stimulation pulse of this waveform are shown through output device.
5, the method for claim 4, it is further characterized in that following steps:
G. the electrocardiographic wave of step f output is measured, if the R-R interval is less than the accent period T of fighting
SOThe continuous number of unusual heartbeat be that 3-9(comprises 3 and 9), then be judged to multiple chamber early ME(or cry the non-standing chamber fast NST), the amplitude of its pulse-induced as MET, is obtained ventricular fibrillation threshold VFT as follows:
VFT＝1.7932+1.0816MET;
If the continuous number of unusual heartbeat more than or equal to 10 o'clock, is judged to chamber speed VT with it, the amplitude of its pulse-induced is obtained ventricular fibrillation threshold VFT as follows as VTT:
VFT＝0.1349+1.1608VTT;
Then the VFT value is exported.
6, the method for claim 5, it is further characterized in that:
In described step g, when the number of the unusual heartbeat that detects was 1 or 2, then the chamber of being judged to PVC morning was the electrocardio vulnerable period that a 20ms is determined at the center with the stimulation sites that produces the pulse-induced of PVC;
Return described steps d then, adjust pulse-induced above-mentioned electrocardio in vulnerable period time location and amplitude until inducing multiple chamber early ME or chamber speed VT.
7, the method for claim 4, it is further characterized in that:
Recognition method to unusual heartbeat among the described step e is as follows:
e
1Detected electrocardiosignal is carried out filtering, remove the waveform of width less than 10ms;
e
2It is the waveform of 17Hz that filtered electrocardiosignal is sought fundamental frequency, thereby identifies each QRS wave group;
e
3The QRS wave group that identifies is carried out the R-R measurement of interval, with the R-R interval less than the accent period T of fighting
SOWaveform as unusual heartbeat.
Priority Applications (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN88101253.XA CN1026752C (en) | 1988-03-12 | 1988-03-12 | Device and method for detecting heart function by using electrical stimulation |
| 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 |
|---|---|---|---|
| CN88101253.XA CN1026752C (en) | 1988-03-12 | 1988-03-12 | Device and method for detecting heart function by using electrical stimulation |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN1035613A CN1035613A (en) | 1989-09-20 |
| CN1026752C true CN1026752C (en) | 1994-11-30 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN88101253.XA Expired - Fee Related CN1026752C (en) | 1987-09-30 | 1988-03-12 | Device and method for detecting heart function by using electrical stimulation |
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| Country | Link |
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| CN (1) | CN1026752C (en) |
Families Citing this family (3)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN102284138B (en) * | 2011-08-03 | 2014-03-05 | 复旦大学 | In-vitro defibrillator for distinguishing ventricular tachycardia and ventricular fibrillation automatically on basis of symbol sequence entropy of second derivative codes |
| KR101809635B1 (en) * | 2015-10-07 | 2017-12-15 | 각꼬호우진 구루메 다이가쿠 | Heartbeat synchronous blood circulation assisting system, control method and heartbeat synchronous electrical stimulating device |
| CN109106361A (en) * | 2017-06-23 | 2019-01-01 | 周厚荣 | A kind of monitoring device inducing animal ventricular fibrillation |
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1988
- 1988-03-12 CN CN88101253.XA patent/CN1026752C/en not_active Expired - Fee Related
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| Publication number | Publication date |
|---|---|
| CN1035613A (en) | 1989-09-20 |
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