CN103976722B - A kind of esophageal variceal vein non-invasivetesting method - Google Patents
A kind of esophageal variceal vein non-invasivetesting method Download PDFInfo
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Abstract
The invention belongs to medical detecting method field, it is specifically related to a kind of esophageal variceal vein non-invasivetesting method, the method produces air-flow first by the air pump of scalable air pressure and is delivered in gas pipeline, and gas pipeline arrives near esophageal variceal vein through the biopsy channel of gastroscope.In at intervals position, by the air-flow vertical impact of the gas pipeline vein surface in varicose, and it is gradually increased impact air pressure.In the moment that blood vessel wall is just driven plain, the tension force vector of blood vessel wall is parallel to blood vessel wall, and now gas shock power is equal to vein pressure.Blood vessel is oppressed by the method by air-flow, belongs to untouchable detection, it is achieved that non-invasivetesting truly.This method efficiently avoid the interference that the cirso-come in every shape causes to pressure measurement, is tested and zoopery by bionical checking, show that the method accuracy of the present invention is high, has Clinical practice and be worth.
Description
Technical field
The invention belongs to medical detecting method field, be specifically related to a kind of esophageal variceal vein non-invasivetesting method.
Background technology
Esophageal varicosis (EV) is a kind of common complication of patient with liver cirrhosis, and the liver cirrhosis patient about half is existing esophageal varicosis when making a definite diagnosis liver cirrhosis.The cardinal symptom of EV is Rupture haemorrhag, and the more high patient of liver function grade, and its EV Rupture haemorrhag mortality rate is more high.Therefore for liver cirrhosis patient, how finding the hemorrhage high-risk group of EV in time, look-ahead bleeding tendency is also formulated rational therapeutic scheme and is just particularly important.
Since the fifties in last century, the numerous researchs about esophageal variceal vein pressure show that too high esophageal variceal vein pressure is the principal element causing rupture of esophageal varices hemorrhage.Scholars generally believes that esophageal variceal vein pressure is to predict hemorrhage independent factor and gold index.This pressure can reflect the hemodynamic situation of cirso-, and is proportionate with antiotasis and azygos vein blood flow, and almost unrelated with portal venous pressure.Utilize the result that respiratory pressure measuring principle carries out the adherent Manometric Studies of EV to show, when esophageal variceal vein pressure>14mmHg time bleeding event more than 39%,<there is Esophagus venous bleeding in the patient only having 9% during 14mmHg to pressure.
There are two big class technology and all carry out under scope, i.e. intravenous pressure measurement and vein measuring pressure from outside in current human body esophageal variceal vein piezometry.The former measures pressure, the standard pressure testing method being well recognized as by fine needle aspiration cirso-, first reports by Palmer in nineteen fifty-one.But the method has the weakness that it is fatal in scientific research and clinical practice: first is to repeat pressure measurement；Second has the patient of 1/3 to be likely to because puncture causes massive hemorrhage；3rd is that puncture pressure measuring can cause antibacterial to infect.So the method seldom adopts at present.Manometric technique outside vein is then the focus of research at present[i].Nineteen eighty-two, Switzerland scholar Mosimann utilized respiratory pressure principle to invent the technology of the adherent pressure measurement of esophageal variceal vein, and its principle is: owing to varicose vein wall is very thin, and do not have peripheral tissues to support, therefore oppressing the pressure of vein, to be equal to vein intrinsic pressure.Afterwards, scholars is devoted to the clinical application research of this technology and updates this technology, changes the air inputted in gas return path into nitrogen to prevent water steam from solidifying on the one hand, does less and less by probe on the other hand[ii].Within 1987, Switzerland scholar is according to cuff pressure measuring principle, and after utilizing transparent gasbag compressing esophageal variceal vein to subside to blood vessel, detection air bag is intrinsic pressure, utilizes this mode to detect the pressure of esophageal variceal vein.Although both approaches has Non-Invasive feature, but still has respective defect.
There are two big class technology and all carry out under scope, i.e. intravenous pressure measurement and vein measuring pressure from outside in current human body esophageal variceal vein piezometry.Intravenous pressure measurement and puncture pressure measuring, the standard pressure testing method being well recognized as, but the method existence can not repeat pressure measurement, puncture easily causes the shortcoming such as massive hemorrhage or antibacterial infection.Vein measuring pressure from outside technology is then current study hotspot.Include two big classes at present: one is the technology of the adherent pressure measurement of esophageal variceal vein, and another kind is air bag manometry.
In the pressure testing method that presently, there are, though having Non-Invasive feature, but current existing method still has following deficiency:
Although a) adherent pressure measurement noinvasive, but belong to contact type measurement, pressure measurement process includes ejecting air bag, inflation wall contact, pressurising measurement, receiving the processes such as capsule, has the intrinsic inconvenience of contact type measurement mode, as test process length, air bag and blood vessel wall friction cause Rupture haemorrhag etc.；
B) pass through video image during air bag pressure measurement it is seen that air bag inwall, even if air bag is transparent, there is also reflective, the problems such as absorption spectrum is inconsistent, can't see real biological endoscopic picture, be not easy to doctor's visual Diagnosis；
C) during air bag pressure measurement, tested vein is not only close to by air bag, also oppresses whole esophagus inner chamber, and total force is big, causes tested vein blood vessel to move integrally, and state changes, and causes measurement error；
D) video image is relied on to judge the state of vein " just subsiding " during air bag pressure measurement, owing to pick-up lens is uncertain to the visible sensation distance at vein collapse place, cause that the amplification of image is inconsistent, no matter be judge that the state of " just subsiding " all exists uncertain error by people or Software of Computer Vision；
E) existing method visual field is all relatively big, to tiny cirso-pressure measurement difficulty.
F) esophageal peristalsis impact is measured: the many Based PC of existing method processes video data, and processing procedure is long, that have or even process afterwards, when finding that esophageal peristalsis affects measurement data, has little time again to measure；
Esophageal variceal vein pressure predicts hemorrhage golden index as what current scholar generally acknowledged, and the measuring method of its pressure is of crucial importance.Make a general survey of existing esophageal variceal vein pressure testing method and be both needed to the venous blood tube wall of contact varicose, it is possible to cause Rupture haemorrhag when detection with blood vessel wall friction.And these methods carry out pressure measurement when being all subsided by perstriction, its theoretical premise is to be assumed to the vessel wall thickness of cirso-to level off to infinitely thin idealized state, so just can ignore the vessel wall elasticity impact on pressure measurement.It practice, the thickness of varicose vein wall and blood vessel diameter vary, there's almost no perfect condition, so pressure measurement result is difficult to convincing.Therefore, in order to better predict that EV is hemorrhage, it is necessary to find a kind of safer, accurate, reproducible endoscopic approach for measuring the pressure of EV.
Symbol description
Summary of the invention
For the deficiencies in the prior art, it is desirable to provide a kind of esophageal variceal vein non-invasivetesting method, blood vessel is oppressed by the method by air-flow, belongs to untouchable detection, it is achieved that non-invasivetesting truly.This method efficiently avoid the interference that the cirso-come in every shape causes to pressure measurement simultaneously, is tested and zoopery by bionical checking, show that the method accuracy of the present invention is high, has Clinical practice and be worth.
For solving above-mentioned technical problem, the technical solution adopted in the present invention is:
A kind of esophageal variceal vein non-invasivetesting method, concretely comprises the following steps:
(1) being placed near esophageal variceal vein by one end of gas pipeline through gastroscope passage, keep gas pipeline gas outlet constant with the distance s of esophageal variceal vein tube wall, described distance s is in the scope of 7mm-15mm；The internal diameter d of described gas pipeline is in the scope of 1.5mm-3mm；
(2) passing into air-flow by scalable air pump in gas pipeline, the operating current FREQUENCY CONTROL of scalable air pump is in 2.0KHz-30KHz；
(3) during actual pressure measurement, s takes certain value in the scope of 7mm-15mm, gas pipeline internal diameter d takes certain value in the scope of 1.5mm-3mm, by controlling air-flow change, this air-flow is as the vertical vascular compression of finger pressure air-flow, and by gastroscope system synchronous monitoring blood vessel strain image, the stream pressure P1 of gas pipeline air intake when record blood vessel wall deforms upon；
(4) asking the pressure P 2 impacting blood vessel wall, described P2=kP1+b, described for step (3) P1 is substituted into formula and can obtain P2, wherein the value of k and b is different and different with the value of s and d；
Described formula P2=kP1+b is got by following methods: breather line and measuring cell are placed in the container of an airless impact, it is respectively provided with pressure transducer in the position of gas pipeline air intake end and Distance Gas Pipeline gas outlet s point, s with the value of gas pipeline internal diameter with actual pressure measurement time consistent, regulate the operating current frequency shift stream pressure of air pump, record the stream pressure P1 of not gas pipeline air intake in the same time and the pressure of Distance Gas Pipeline gas outlet s point, namely impact the pressure P 2 of blood vessel wall, draw relational expression P2=kP1+b between the two, wherein the value of k and b is different and different with the value of s and d；
(5) the pressure value P 4=P2 when blood vessel wall deforms upon, in esophageal variceal vein.
Preferred version: in step (3), described blood vessel wall is deformed upon and can be judged by following two method:
Method 1: by time on radiating laser beams to the blood vessel wall detect region, the blood vessel wall surface in this region will form a curve, utilize gastroscope figure acquisition system to carry out dynamic collection blood vessel wall surface image, when arc positions changes, be blood vessel wall and deform upon the moment；
Method 2: detect the amount of recess Δ h of blood vessel wall with laser range finder, as 0 < Δ h < Δ h0Time be that blood vessel wall deforms upon the moment, wherein Δ h0Numerical value be 0.1mm.
The amount of recess Δ h measuring method of blood vessel wall described in method 2 is preferably: is measured by laser range finder and obtains the flare diameter d that blood vessel wall deforms upon1, amount of recess Δ h and reflection laser spot diameter d1Proportional, Δ h=1.02-1.12d1, real-time amount of recess Δ h can be obtained by detecting spot diameter d in real time.
Preferred version: in step (4), when s is fixed as 10mm, and gas pipeline internal diameter is fixed as 2mm, P2=0.0685P1-273.231.
It is preferred that scheme: in step (4), when gas pipeline internal diameter d is fixed as 2mm, the operating current frequency of air pump is fixed as 10KHz, changes the value of s in the scope of 7mm-15mm, pressure value P 2 during record difference s point, obtains P2=44328.8835/s-1184.8515.
Below the present invention it is further explained and illustrates
Principles of the invention is: utilize the gas shock esophageal variceal vein of atmospheric pressure value controllable adjustable, detects the deformation process of esophageal variceal vein simultaneously, and pressure data during record blood vessel deformation, thus drawing the pressure of internal blood vessel.Air pump first by scalable air pressure produces air-flow and is delivered in gas pipeline, and gas pipeline arrives near esophageal variceal vein through the biopsy channel of gastroscope.In at intervals position, by the air-flow vertical impact of the gas pipeline vein surface in varicose, and it is gradually increased impact air pressure.In the detection region of cirso-, gravity impact is small to be negligible, and on vertical blood vessel wall direction, there is the tension force of gas shock power, intravascular pressure and blood vessel self.In the moment that blood vessel wall is just driven plain, the tension force vector of blood vessel wall is parallel to blood vessel wall, and now no matter what type of blood vessel is in the vertical direction all without active force.According to mechanical balance principle, now gas shock power is equal to vein pressure.In whole measurement process, utilize PaintShop Tong Bu with air flow system, catch the stream pressure in the moment that blood vessel deforms upon.
Equipment preferred for this invention and the theoretical basis of pressure testing method are as follows:
As shown in Figure 8, the non-invasivetesting system that present invention preferably employs carries out pressure measurement, and this system includes gastroscope, also includes finger pressure air-flow probe system, laser range finder；The gas outlet tube of described finger pressure air-flow probe system is stretched in described gastroscope by gastroscope movable detecting hole to be peeped in pipe；The arrival end of described gas outlet tube is provided with the first pressure transducer；The image transmission optical fibre of described laser range finder is stretched in described gastroscope by described gastroscope movable detecting hole and peeps in pipe；The distance peeped between the imageing sensor of end surfaces and esophageal veins to be measured in the described gas outlet tube port of export, image-carrying fiber bundle end face, described gastroscope is 7～15mm；Described gastroscope, finger pressure air-flow probe system, laser range finder all electrically connect with described central processing unit.
The gas outlet tube 1 of described finger pressure air-flow probe system is stretched in described gastroscope by gastroscope movable detecting hole 2 and peeps in pipe 3；The arrival end of described gas outlet tube 1 is provided with the first pressure transducer 4；Described laser range finder 5 obtains the flare of esophageal veins wall film under described finger pressure air-flow probe system effect by image transmission optical fibre 6, described image transmission optical fibre 6 through described gastroscope movable detecting hole 2 stretch into described in peep in pipe 3；The esophageal veins image that described imageing sensor gathers is sent in central processing unit 8.
The finger pressure air-flow probe system of the present invention includes the gas bomb 10 that inflator pump 9 connects with described inflator pump with arrival end, described gas bomb 10 port of export is connected with described gas outlet tube 1 arrival end by pipeline, and the pipeline between described gas bomb 10 port of export and described gas outlet tube 1 arrival end is provided with control damper 11；The second pressure transducer 12 it is provided with in described gas bomb 10；Described second pressure transducer 12, inflator pump 9 all electrically connect with described central processing unit 8.
Second pressure transducer detects gas bomb internal gas pressure P in real time0, work as P0During less than setting value, central processing unit starts inflator pump inflation, to ensure that gas bomb has enough tolerance and air pressure；Controlling control damper during measurement and produce triangular wave pulse pneumatic with some cycles, thus forming periodically pulsing air pressure, forming finger pressure airflow function in vein blood vessel through gas outlet tube.Gas outlet tube diameter only small (< φ 3mm), acts on venous blood tube wall close (less than 15mm), the gross pressure of finger pressure probe vasoactive wall little (< 15g), thus without interference with measurand.The operation principle of finger pressure air-flow probe system is: by scalable air pump, produce the air flow stream of pressure adjustable joint, blood vessel wall is produced active force by the impulsive force of air flow stream, simultaneously, functional relationship according to the stream pressure at diverse location, finger pressure air-flow probe system gathers the stream pressure of a certain position, such that it is able to calculate the stream pressure value of other positions.
In the present invention, air reservoir capacity is 3L, and adopting thickness is that the steel plate of 3MM is made, surface through paint baking, safe air pressure 15KG.Air reservoir has four fixed supports, is furnished with rubber buffering mounting seat.With relief valve on air reservoir, drain valve, air reservoir gas outlet is with oil water separator.Drain valve and oil water separator need regularly to do draining blowdown to be safeguarded.
If finger pressure air-flow probe effect vein blood vessel wall pressure force value is P2, we require pulsation air pressure P2Big minor control field meets following formula:
0<P2<MaxP2(1)
MaxP in formula2It is make blood vessel wall film amount of recess more than depressions in features degree of depth correspondence air pressure.
The first real-time detected air pressure P of pressure transducer simultaneously1, by finger pressure probe structure and Hydrodynamics Theory, it is known that
P2=f (P1, h, φ) (2)
Namely the air pressure P on vein blood vessel is imposed on2Not only active air pressure P1Relevant, also relevant with pressure distance h and pressure relative area size φ.In this programme, gas outlet tube diameter is less than 3mm, and tracheal diameter impact can be ignored, and ensures that initial pressure distance h is for determining constant value (=10mm) by laser fiber distance measuring sensor, so that (3-5) formula is converted into simultaneously:
P2=f1(P1)(3)
Under the pressure measurement operating condition determined, it is possible to by the mode that measured test is demarcated, it is thus achieved that (3) formula expressed in a tabular form；So in test in the future, we can be detected to obtain air pressure P by load cell-11Value, then look into (3) formula form, obtain pressure valve P on vein blood vessel2。
Investigating venous blood tube wall part of the force, venous blood tube wall quality and acceleration are all only small, negligible, and we can obtain equilibrium equation:
P4=P2+P3(4)
Wherein:
P4: for pressure in cirso-, the present invention finally measures object；
P2: act on the air pressure in cirso-blood vessel wall for finger pressure air-flow probe,
P is recorded by the first pressure transducer1After table look-up and obtain；
P3: for cirso-blood vessel wall layer tension, as the moment P that blood vessel wall deforms upon3It is zero, or is zero when wall film depression and amount of recess are less than depressions in features degree of depth 0.1mm.
Owing to being adopt pulse pneumatic, in formula (4), each power size is all time dependent, and we should be specifically noted that cirso-blood vessel wall layer tension P3Direction can just can be born, and P4、P2Direction be constant.
When active flow pressure is 0, blood vessel wall film constraint Ink vessel transfusing blood flow, P3For just；When active finger pressure stream pressure is gradually increased, P3For just and taper into, until being zero；Now cirso-blood vessel wall film starts depression, when reaching depressions in features depth delta h0Time, P3It is still zero；Afterwards, actively finger pressure stream pressure continues to increase gradually to MaxP2, P3Striding across zero point, direction is reversed negative, and value becomes larger.
We detect cirso-blood vessel wall film cup depth in real time by laser fiber distance measuring sensor, when cup depth more than zero less than Δ h0Time, have:
P3=0 (5)
P4=P2(6)
The record P that the first pressure transducer is measured this moment1Value, then table look-up and namely record P2, (6) formula namely obtain cirso-pressure value P4。
The central processing unit of the present invention adopts OMAP-4430-1GHz double-core Cortex-A9 processor.
Compare with wall-attaching type pressure testing method medically used at present and air bag pressure testing method with the non-invasivetesting new method adopted, present invention have the advantage that
(1) although traditional adherent pressure testing method noinvasive, but belong to contact type measurement, pressure measurement process includes ejecting air bag, inflation wall contact, pressurising measurement, receiving the processes such as capsule, there is the intrinsic inconvenience of contact type measurement mode, as test process length, air bag and blood vessel wall friction cause Rupture haemorrhag etc.；And in the non-invasivetesting new method used by the present invention, utilization is that blood vessel wall is oppressed by the impulsive force of air-flow, there is certain distance, it is achieved that non-contact measurement truly between pressure measurement instrument and the blood vessel of measurement.
(2) in air bag pressure testing method by video image it is seen that air bag inwall, even if air bag is transparent, there is also reflective, the problems such as absorption spectrum is inconsistent, can't see real biological endoscopic picture, are not easy to doctor's visual Diagnosis, and follow-up have researcher to carry out method improvement on this basis, make use of image processing system, rely on instrument to judge image conditions, but be still under air bag interference；And in the present invention, and it is absent from air bag interference, and the optical signalling that the laser emitting rays in studying produces in blood vessel wall is relatively strong, even if pick-up lens touches moistening gas and produces lens blur, still obvious laser optics signal, strong interference immunity can be captured.
(3) during air bag pressure measurement, tested vein is not only close to by air bag, also oppresses whole esophagus inner chamber, and total force is big, causes the cirso-mobile depression of overall rearward tissue that tested vein blood vessel is especially tiny, and state changes, and causes measurement error；And in pressure testing method of the present invention, air flow stream is less, and produced dominating impact power only acts on the local smaller range of blood vessel wall, and blood vessel wall entirety will not be caused to deform upon, because of without causing measurement blood vessel entirety to be absorbed in tissue, thus avoiding the error that vascular pressure is measured.
(4) video image is relied on to judge the state of vein " just subsiding " during air bag pressure measurement, owing to vascular compression scope is bigger, cause that the position of blood vessel " just subsiding " is uncertain, the visible sensation distance that pick-up lens arrives vein collapse place is made to there is uncertainty, cause that the amplification of image is inconsistent, no matter be judge that the state of " just subsiding " all exists uncertain error by people or Software of Computer Vision；And pressure testing method of the present invention, it is carry out pressure measurement under endoscopic probe is looked at straight, the vessel position of measurement is clear and definite, thus eliminating the uncertain this kind of interference of blood vessel collapse position.
(5) no matter it is adherent manometry or air bag manometry, all inevitably the blood vessel of measuring point is contacted, stimulate owing to the blood vessel in organism and its perienchyma are subject to extraneous foreign body, very possible there is irritable contraction after contact instrument, thus causing measurement error；And measuring method used by the present invention, there is certain distance with blood vessel and perienchyma, not the blood vessel of contact measurement position, thus eliminating the instrument irritant reaction to blood vessel.
(6) the pressure testing method repeatability of the present invention better, can repeatedly measure at short notice, and we also can wait blood vessel to carry out quickly measurement repeatedly when recovering comparatively resting state, also can significantly avoid measurement error.
Accompanying drawing explanation
Fig. 1 is the instrument order of connection and each point air flow pressure instrumentation plan；
Fig. 2 is the instrument order of connection and each point air flow pressure measurement position view；
Fig. 3 is the scatter plot of data of d point air pressure and 1/S；
Fig. 4 is the correlation analysis figure of d point air pressure and 1/S；
Fig. 5 is non-invasivetesting instrument force value and bionical blood vessel actual pressure value correlation analysis figure；
Fig. 6 is non-invasivetesting instrument force value and myocardium vessel actual pressure value correlation analysis figure；
Fig. 7 is non-invasivetesting instrument force value and BL-410 biological functional system measured value correlation analysis figure.
Fig. 8 is the non-invasivetesting system structure schematic diagram adopted in the embodiment of the present invention.
Detailed description of the invention
Below in conjunction with embodiment, the present invention is described further.
Embodiment 1 basic research, draws the relation between the pressure P 2 and the gas pipeline air intake end pressure P1 that impact blood vessel wall；Drawing the relation of the pressure P 2 and s impacting blood vessel wall, described s is the distance between gas pipeline gas outlet and blood vessel wall.
1, air-flow is by the experiment of pressure change after pipeline
1.1 foundations: breather line and measuring cell are placed in the container of an airless impact, it is respectively provided with pressure transducer in the position of gas pipeline air intake end and Distance Gas Pipeline gas outlet s point, s with the value of gas pipeline internal diameter d with actual pressure measurement time consistent, regulate the operating current frequency shift stream pressure of air pump, record the stream pressure P1 of not gas pipeline air intake in the same time and the pressure of Distance Gas Pipeline gas outlet s point, namely impact the pressure P 2 of blood vessel wall, draw relational expression P2=kP1+b between the two, wherein the value of k and b is different and change with the value of s and d.
1.2 research materials and method
1.2.2 experimental technique
(1) experimental apparatus is installed: each scalable air pump and air-flow output channel are connected (see Fig. 1), it is ensured that the air-tightness of air-flow output channel；Bonding pressure sensor and the system of reception；
(2) demarcate: utilize marking apparatus, the parameter of nominal pressure sensor；
(3) two pressure transducers are individually positioned in a point and b point, open air pump, the operating current frequency of air pump is gradually increased, from 2.0kHz to 20kHz, increase 2.0kHz, the situation of change of record 2 air pressure of a, b every time, measure 5 times continuously；
(4) two pressure transducers are individually positioned in a point and c point, open air pump, the operating current frequency of air pump is gradually increased, from 2.0kHz to 20kHz, increase 2.0kHz, the situation of change of record 2 air pressure of a, c every time, measure 5 times continuously；
(5) disposal data, draws scatterplot, calculates a point respectively and b presses the linear regression equation that force value, a point and c press between force value, carry out linear correlation analysis.
1.2.3 statistical method
Adopting IBMSPSSStatistics19 to carry out data management and statistical analysis, measurement data represents with mean ± standard deviation (X ± SD), uses linear regression analysis between two variablees.
1.3 results and analysis
1.3.1 result:
Table 1-1 air pump operating frequency, a point and b point barometric information table
Table 1-2 air pump operating frequency, a point and c point barometric information table
1.3.2 analyze:
Owing to instrument is in holding state under the output state of 2kHz, so when being calculated, the data in 2kHz situation being got rid of.
According to table 1-1, calculating linear regression equation: Y=0.3115X-288.461 (P < 0.0005), two groups of data are in line relevant.Can drawing from linear regression equation, b point atmospheric pressure value is subject to the impact of a point atmospheric pressure value, in linear function relation.
According to table 1-2, calculating linear regression equation: Y=0.0685X-273.231 (P < 0.0005), two groups of data are in line relevant.Can drawing from linear regression equation, c point atmospheric pressure value is subject to the impact of a point atmospheric pressure value, in linear function relation.
2 and gas outlet positional distance change time pressure change experiment
2.1 research backgrounds and principle
This experimentation is when a point air pressure homeostasis, during distance S change, and d point air pressure change situation, specify the functional relationship of d point air pressure and distance s, specifying air-flow after the outflow of gas outlet, the change of air pressure weakens situation, selects standardized measurement apart from offer experimental basis for subsequent experimental.
2.2 materials and methods
2.2.2 experimental technique
(1). connecting air pump and breather line, be fixed in gas outlet and baroceptor on distance adjusting apparatus, both initial distances are set as 1mm (Fig. 2)
(2). open air pump, by stable for air pump operating frequency at 5kHz, after air pump working stability, command range adjusting apparatus, change distance s, increase 2.0mm every time, gathered the air pressure numerical value of d point by pressure transducer, measure 5 times continuously；
(3). regulate air pump, air pump operating frequency is changed to 10,15,20kHz, other steps are ibid
(4). disposal data, draw scatterplot, d is pressed force value and carries out correlation analysis with 1/s
2.2.3 statistical method
Adopting IBMSPSSStatistics19 to carry out data management and statistical analysis, measurement data represents with mean ± standard deviation (X ± SD), to atmospheric pressure value PdLinear regression analysis is used with 1/s.
2.3 results and analysis
2.3.1 result
Table 1-3 distance s and d puts barometric information information slip
2.3.2 analyze
Draw with 1/s for X-axis, d point pressure is the scatter plot of data of Y-axis, as shown in Figure 3, can analyze from the figure line of Fig. 3 is out of shape, when air pump power is certain (namely gas outlet air velocity is fixed value), along with 1/s numerical value increasing (i.e. d point increasingly level off to position, gas outlet), air pressure is more and more stronger, but in this site of 1/s=0.14, atmospheric pressure value change tends towards stability gradually.Analyzing and consider, this situation is likely to there is following several situation:
(1) along with measurement point moves closer to gas outlet, owing to pressure transducer gets too close to gas outlet, disturbing the circulation of gas so that in gas flowing path, resistance increases, air pressure increases slowly
(2) measuring in distance whole, any one force value measuring point all less than gas outlet, can level off to gas outlet along with measuring point, and its force value of this segment distance has leveled off to position, gas outlet air pressure, it is impossible to have obvious increase.
We intercept the data of turning point leading portion and are analyzed, (namely during 7mm s 15mm), take air pump power when being 10kHz, atmospheric pressure value and 1/s are carried out correlation analysis, see Fig. 4, calculating linear regression equation: Y=44328.8835X-1184.8515 (P < 0.0005), two groups of data are in line relevant.Can drawing from linear regression equation, when 7mm s 15mm, d point atmospheric pressure value is subject to the impact of distance s, is linear function relation with 1/s.
3 discuss
1 obtained data and correlation analysis by experiment, it is possible to clear and definite air-flow is at the airflow line certain through internal diameter, and position, gas outlet air pressure is subject to air intake position effects of air pressure, and both are linear, and linear regression equation is Y=0.3115X-288.461；Distance 1cm position, gas outlet air pressure is similarly subjected to air intake position effects of air pressure, and both are linear, and linear regression equation is Y=0.0685X-273.231.
2 obtained data and correlation analysis by experiment, it is possible to clearly in certain interval range (7mm s 15mm), atmospheric pressure value is subject to the impact of distance s, is linear function relation with 1/s.This indicates that when air pump power is constant, and when stable distance, air-flow produces atmospheric pressure value will not be changed.
Non-invasivetesting method used by the present invention, what the blood vessel wall measured was implemented is non-contact measurement, this means that the atmospheric pressure value that pressure transducer cannot directly be measured in blood vessel wall, and this section experiments show that in the airflow line measuring instrument, there is dependency in the pressure that the air-flow of diverse location produces, it means that the functional relationship of air-flow between each position can be utilized, by measuring the stream pressure value of certain point position, and then calculate the atmospheric pressure value of other positions.
4 conclusions
Tested by this section, it was shown that non-invasivetesting method used by the present invention according to the functional relationship of air-flow between each position, by measuring the stream pressure value of certain point position, and then can calculate the atmospheric pressure value of other positions.
The external bionical blood vessel experiment of embodiment 2 and extracorporeal blood vessel experiment
1 external bionical blood vessel experiment
1.1 materials and methods
1.1.2 experimental technique
(1) simulated blood vessel instrument is positioned over horizontal level, then the bionical blood vessel of plastic cement material is connected to the pipeline broken ends of fractured bone place that simulated blood vessel instrument is reserved, confirm the tight ne-leakage in coupling part.((note standby: simulated blood vessel instrument constitutes making one and marks graduated glass tubing, and it is fixed on a fixed mount, glass tubing hypomere connects the plastic pipe of a horizontal positioned, the plastic pipe other end connects a tee T, blocking a section in the middle of plastic pipe, broken ends of fractured bone part is in order to connect simulated blood vessel)
(2) three-way valve of simulated blood vessel instrument one end is opened, from glass tubing upper end saline injection, three-way valve is closed after being drained by air in simulated blood vessel instrument, now bionical Ink vessel transfusing is hydraulically full and expand, its internal pressure regulates and can realize by changing liquid level in glass tubing, and bionical endovascular force value can read scale residing for glass tubing liquid level and draws.
(3) probe of non-invasivetesting system is placed in the surface of bionical blood vessel, and probe gas outlet is apart from bionical blood vessel wall 10mm position.Glass tubing liquid level is regulated to 5.0cm, opens non-invasivetesting system, the bionical intravascular pressure force value that grapher is measured.
(4) according to step (3) method, regulate glass tubing liquid level, increase 5.0cm every time, until 45.0cm, record the bionical intravascular pressure force value measured by each non-invasivetesting system simultaneously.
(5) repeat experiment 5 times, paint scatterplot, calculate linear regression equation, carry out Liner correlation.
1.1.3 statistical method
Adopting IBMSPSSStatistics19 to carry out data management and statistical analysis, measurement data represents with mean ± standard deviation (X ± SD), uses linear regression analysis between two variablees.
2.2 results and analysis
(1) result:
Table 2-1 bionical blood vessel liquid level and measured pressure value information slip of the present invention
(2) analyze:
According to conversion pressure formula: 10mmH20=98.1Pa, after the altitude conversion of liquid level is become pressure, can draw bionical endovascular force value, the Comparative result drawn (table 2-2)
The bionical intravascular pressure of table 2-2 and measured pressure value information slip of the present invention
Non-invasivetesting instrument force value and bionical blood vessel actual pressure value correlation analysis, be shown in Fig. 5, calculates linear regression equation: Y=1.001X+6.036 (P < 0.0005), and two groups of data are in line relevant.
2 extracorporeal blood vessel experiments
2.1 materials and methods
2.1.2 experimental technique
(1) simulated blood vessel instrument is positioned over horizontal level, then in vitro great saphenous vein blood vessel is connected to the pipeline broken ends of fractured bone place that simulated blood vessel instrument is reserved, confirm the tight ne-leakage in coupling part.
(2) opening the three-way valve of simulated blood vessel instrument one end, from glass tubing upper end saline injection, close three-way valve after being drained by the air in simulated blood vessel instrument, now in vitro great saphenous vein Ink vessel transfusing is hydraulically full and expand.
(3) probe of non-invasivetesting system is placed in the surface of in vitro great saphenous vein blood vessel, distance great saphenous vein blood vessel wall 10mm position, probe gas outlet.Glass tubing liquid level is regulated to 5.0cm, opens non-invasivetesting system, the in vitro great saphenous vein intravascular pressure force value that grapher is measured.
(4) according to step (3) method, regulate glass tubing liquid level, increase 5.0cm every time, until 45.0cm, record the in vitro great saphenous vein intravascular pressure force value measured by each non-invasivetesting system simultaneously.
(5) repeat experiment 5 times, paint scatterplot, calculate linear regression equation, carry out Liner correlation
2.1.3 statistical method
Adopting IBMSPSSStatistics19 to carry out data management and statistical analysis, measurement data represents with mean ± standard deviation (X ± SD), uses linear regression analysis between two variablees.
3.2 results and analysis
(1) result:
Table 2-3 myocardium vessel liquid level and measured pressure value information slip of the present invention
(2) analyze:
According to conversion pressure formula: 10mmH20=98.1Pa, after the altitude conversion of liquid level is become pressure, can draw the force value in myocardium vessel, the Comparative result (table 2-4) drawn:
Pressure and measured pressure value information slip of the present invention in table 2-4 myocardium vessel
Measured pressure value of the present invention and myocardium vessel actual pressure value correlation analysis, be shown in Fig. 6, calculates linear regression equation: Y=1.001X+9.703 (P < 0.0005), and two groups of data are in line relevant.
2.4 discuss
In the present embodiment, by utilizing the non-invasivetesting new method of Subject Design, bionical blood vessel and myocardium vessel are carried out non-invasivetesting.Bionical blood vessel experimental result shows, force value measured by non-invasivetesting system and bionical endovascular actual pressure value have good dependency, both are linear: Y=1.001X+8.036 (Y is non-invasivetesting system pressure value, and X is bionical intravascular pressure force value).Meanwhile, extracorporeal blood vessel experimental result shows, force value measured by non-invasivetesting system is same with in vitro great saphenous vein Ink vessel transfusing actual pressure value has good dependency, both are linear: Y=1.001X+10.703 (Y is non-invasivetesting system pressure value, and X is in vitro great saphenous vein intravascular pressure force value).This example demonstrates that, this pressure testing method can accurately measure the pressure in simulated blood vessel, and error is low.
All the time, in pressure testing method existing in medical treatment, though having Non-Invasive feature, but current existing two are big, and class method still has some shortcomings, by the experiment of this section, non-invasivetesting new method of the present invention and these methods are compared by we, it can be seen that some advantages of method therefor of the present invention:
First point: although traditional adherent pressure testing method noinvasive, but belong to contact type measurement, pressure measurement process includes ejecting air bag, inflation wall contact, pressurising measurement, receiving the processes such as capsule, there is the intrinsic inconvenience of contact type measurement mode, as test process length, air bag and blood vessel wall friction cause Rupture haemorrhag etc.；And in the non-invasivetesting new method used by the present invention, utilization is that blood vessel wall is oppressed by the impulsive force of air-flow, there is certain distance, it is achieved that non-contact measurement truly between pressure measurement instrument and the blood vessel of measurement.
Second point: by video image it is seen that air bag inwall in air bag pressure testing method, even if air bag is transparent, there is also reflective, the problems such as absorption spectrum is inconsistent, can't see real biological endoscopic picture, are not easy to doctor's visual Diagnosis, and follow-up have researcher to carry out method improvement on this basis, make use of image processing system, rely on instrument to judge image conditions, but be still under air bag interference；And in the present invention, and it is absent from air bag interference, and the optical signalling that the laser emitting rays in studying produces in blood vessel wall is relatively strong, even if pick-up lens touches moistening gas and produces lens blur, still obvious laser optics signal, strong interference immunity can be captured.
Thirdly: during air bag pressure measurement, tested vein is not only close to by air bag, also oppresses whole esophagus inner chamber, and total force is big, causes the cirso-mobile depression of overall rearward tissue that tested vein blood vessel is especially tiny, and state changes, and causes measurement error；And in pressure testing method of the present invention, air flow stream is less, and produced dominating impact power only acts on the local smaller range of blood vessel wall, and blood vessel wall entirety will not be caused to deform upon, because of without causing measurement blood vessel entirety to be absorbed in tissue, thus avoiding the error that vascular pressure is measured.
4th point: rely on video image to judge the state of vein " just subsiding " during air bag pressure measurement, owing to vascular compression scope is bigger, cause that the position of blood vessel " just subsiding " is uncertain, the visible sensation distance that pick-up lens arrives vein collapse place is made to there is uncertainty, cause that the amplification of image is inconsistent, no matter be judge that the state of " just subsiding " all exists uncertain error by people or Software of Computer Vision；And pressure testing method of the present invention, it is carry out pressure measurement under endoscopic probe is looked at straight, the vessel position of measurement is clear and definite, thus eliminating the uncertain this kind of interference of blood vessel collapse position.
Embodiment 3 animal blood vessels is tested
1 research background
The vein measuring pressure from outside of current esophageal variceal vein has two big classes, and one is the adherent manometry of esophageal variceal vein, and another kind is the air bag manometry according to the design of cuff pressure measuring principle.Although the outer non-invasive pressure testing method of this two big class vein all has the relevant report of many experiment in vitro, zoopery and clinical trial, it was demonstrated that both pressure testing methods have clinical meaning and feasibility.But, the factors such as the inevitable esophagus peristaltic contraction of both, cough, nauseating, belch cause the impact on measurement result, it is difficult to reduce interference and improves accuracy and the current measured deviation not yet having pertinent literature and research report how to overcome this series factor to cause.And of the present invention group based on air-flow and laser measuring technology new method, for non-contact type pressure testing, contact with blood vessel wall, is affected by esophageal motility little, by further exploitation with improve, be expected to break through the difficult problems such as esophagus movement interference.
Biological characteristics according to esophageal variceal vein, and the multifactor impact environment of esophagus residing for it, we utilize and carry out postcava pressure measurement in animal body, are used as the experiment of simulation esophageal veins pressure measurement.In animal model, postcava is big vein important in blood circulation, with relatively multi viscera and organize back painstaking effort stream to pass through postcava, make the blood flow that this vein passes through big, in living animal, folder closes the nearly heart section of its postcava, due to blood backflow obstacle, postcava blood pressure rapid increase can be made.Thus can be refluxed by the postcava of Control release animal, quickly changing inferior caval pressure value, and postcava caliber is thick, tube wall relatively other blood vessels are thick, not cracky, are conducive to carrying out the experiment under higher blood pressure numerical value.And in testing in animal body, compare with experiment in vitro, postcava is subject to the multifactor impact such as blood flow, internal organs wriggling, is not in resting state, and there will be activity by a small margin, similar with the esophageal variceal vein in wriggling esophagus.
By previous section to the design of new pressure testing method system and preliminary debugging, and extracorporeal blood vessel experiment, it was shown that in the measurement of the method blood vessel in vitro, there is higher accuracy.In the present embodiment, intend by the postcava blood vessel in animal body is carried out pressure measurement contrast, utilize the pressure measurement new method of the present invention, contrast traditional vascular puncture pressure testing method, specify the dependency of measuring cell and puncture pressure measuring method, and understand the pressure testing method of the present invention accuracy to the vessel measurement under nonstatic state, for from now on further animal esophagus blood vessel pressure measurement experiment necessary experimental data and basis are provided.
2 materials and methods
2.2 laboratory animals
The laboratory animal instruction policy formulated in accordance with Ethics Committee of Central South University is tested.Rabbit 6, body weight 2.6 ± 0.4kg, The Third Xiangya Hospital of Central South University's animal center provide.
2.3 experimental techniques
(1) anesthesia: in rabbit auricular vein indwelling venous detaining needle, injects procaine, 2mg/kg
(2) after anesthesia, rabbit is fixed on dissecting table, in its abdominal part sterilization preserved skin, does abdominal part median incision, after cutting skin, blunt separation subcutaneous fat, Musclar layer, enter abdominal cavity
(3) rabbit intraperitoneal intestinal tube is moved to left side, expose its caval vein, and at caval vein one bifurcation row puncture pressure measuring, place venipuncture indwelling tube, indwelling tube is connected with BL-410 biological functional system
(4) in the caval vein proximal part position come out, making a call to a line knot with surgical thread around caval vein, now line knot can affect the backflow of venacaval blood, ties degree of tightness by control line and will change caval vein internal blood pressure
(5) probe of non-invasivetesting system is placed in the surface of the caval vein blood vessel of exposure, distance blood vessel wall 10mm position, probe gas outlet, open non-invasivetesting system, simultaneously record intravascular pressure force value measured by non-invasivetesting system and the vascular puncture force value measured by BL-410 biological functional system
(6) caval vein proximal part line knot degree of tightness is changed, record intravascular pressure force value measured by non-invasivetesting system and the vascular puncture force value measured by BL-410 biological functional system simultaneously, paint scatterplot, calculate linear regression equation, carry out Liner correlation
2.4 statistical methods
Adopt IBMSPSSStatistics19 to carry out data management and statistical analysis, between two variablees, use linear regression analysis.3 results and analysis
(1) result:
Table 3-1BL-410 biological functional system measured pressure value and measured pressure value information slip of the present invention
(2) analyze:
According to conversion pressure formula: 10mmH20=98.1Pa, after the altitude conversion of liquid level is become pressure, the force value in myocardium vessel can be drawn, the Comparative result (table 3-2) drawn:
BL-410 biological functional system measured value and instrument measurements information slip after table 3-2 unit conversion
Non-invasivetesting instrument force value and BL-410 biological functional system measured value correlation analysis, be shown in Fig. 7, calculates linear regression equation: Y=1.001X+10.820 (P < 0.0005), and two groups of data are linear relevant.
4 discuss
In the present embodiment, the non-invasivetesting new method of Subject Design and traditional puncture pressure measuring method are compared.Experimental result shows, the force value that force value measured by non-invasivetesting system is measured with BL-410 biological functional system has good dependency, both are linear: Y=1.001X+10.820 (Y is non-invasivetesting system pressure value, and X is the force value that BL-410 biological functional system is measured).Experiments show that, in non-invasivetesting method movable vessel measurement in animal body, can accurately measure.
By the experiment of this section, non-invasivetesting new method of the present invention is compared by we with presently, there are two big class vein measuring pressure from outside methods, it can be seen that some advantages of method therefor of the present invention:
First point: no matter be adherent manometry or air bag manometry, all inevitably the blood vessel of measuring point is contacted, stimulate owing to the blood vessel in organism and its perienchyma are subject to extraneous foreign body, very possible there is irritable contraction after contact instrument, thus causing measurement error；And measuring method used by the present invention, there is certain distance with blood vessel and perienchyma, not the blood vessel of contact measurement position, thus eliminating the instrument irritant reaction to blood vessel.
Second point: due to factor impacts such as esophagus peristaltic contraction, cough, nauseating, belch, the big class vein measuring pressure from outside method of two presently, there are is difficult to reduce interference raising accuracy；And measuring method used by the present invention, owing to can quickly flutter the moment grasping blood vessel deformation, the stream pressure value of record instantaneous moment, even blood vessel has activity by a small margin, too big on measuring without impact, and this measuring method repeatability is better, can repeatedly measure at short notice, we also can wait blood vessel to carry out quickly measurement repeatedly when recovering comparatively resting state, also can significantly avoid measurement error.
Claims (5)
1. an esophageal variceal vein non-invasivetesting system, this system includes gastroscope, it is characterised in that also include finger pressure air-flow probe system, laser range finder；The gas outlet tube of described finger pressure air-flow probe system is stretched in described gastroscope by gastroscope movable detecting hole to be peeped in pipe；The arrival end of described gas outlet tube is provided with the first pressure transducer；The image transmission optical fibre of described laser range finder is stretched in described gastroscope by described gastroscope movable detecting hole and peeps in pipe；The distance peeped between the imageing sensor of end surfaces and esophageal veins to be measured in the described gas outlet tube port of export, image-carrying fiber bundle end face, described gastroscope is 7～15mm；Described gastroscope, finger pressure air-flow probe system, laser range finder all electrically connect with described central processing unit.
2. esophageal variceal vein non-invasivetesting system according to claim 1, it is characterized in that, described laser range finder obtains the flare of esophageal veins wall film under described finger pressure air-flow probe system effect by image transmission optical fibre, and the esophageal veins image that described imageing sensor gathers is sent in central processing unit.
3. esophageal variceal vein non-invasivetesting system according to claim 1, it is characterized in that, finger pressure air-flow probe system also includes the gas bomb that inflator pump connects with described inflator pump with arrival end, the described gas bomb port of export is connected with described gas outlet tube arrival end by pipeline, and the pipeline between the described gas bomb port of export and described gas outlet tube arrival end is provided with control damper；The second pressure transducer it is provided with in described gas bomb；Described second pressure transducer, inflator pump all electrically connect with described central processing unit.
4. esophageal variceal vein non-invasivetesting system according to claim 3, it is characterised in that the second pressure transducer detects gas bomb internal gas pressure P in real time0, work as P0During less than setting value, central processing unit starts inflator pump inflation；Control control damper during measurement and produce triangular wave pulse pneumatic with some cycles, thus forming periodically pulsing air pressure, finger pressure airflow function is formed in vein blood vessel through gas outlet tube, gas outlet tube diameter < φ 3mm, act on venous blood tube wall less than 15mm, the gross pressure of finger pressure probe vasoactive wall < 15g, thus without interference with measurand.
5. esophageal variceal vein non-invasivetesting system according to claim 3, it is characterised in that the safe air pressure of air reservoir is 15KG.
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| CN105433930B (en) * | 2015-12-31 | 2022-09-27 | 合肥中纳医学仪器有限公司 | Optical fiber pressure measuring device for venous blood pressure measurement |
| CN111543968A (en) * | 2020-04-09 | 2020-08-18 | 四川省人民医院 | Non-invasive gastric and esophageal vein manometry device based on airflow and machine vision technology |
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