CN104519950A - 使aed更快时间进行电击的方法和装置 - Google Patents

使aed更快时间进行电击的方法和装置 Download PDF

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CN104519950A
CN104519950A CN201280074134.7A CN201280074134A CN104519950A CN 104519950 A CN104519950 A CN 104519950A CN 201280074134 A CN201280074134 A CN 201280074134A CN 104519950 A CN104519950 A CN 104519950A
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aed
algorithm
rhythm
cpr
ecg
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CN104519950B (zh
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费查·阿卜丁
林达·萨玛
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Zoll Medical Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3904—External heart defibrillators [EHD]
    • A61N1/39044—External heart defibrillators [EHD] in combination with cardiopulmonary resuscitation [CPR] therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/364—Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3904—External heart defibrillators [EHD]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3987—Heart defibrillators characterised by the timing or triggering of the shock
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3904—External heart defibrillators [EHD]
    • A61N1/39046—User protection from shock
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3925—Monitoring; Protecting

Abstract

除了所公开的其他装置和方法以外，本发明公开了一种用于减少在终止心肺复苏(CPR)和施行除颤电击之间的延迟的自动体外除颤器(AED)及其方法。在一个实施例中，所述AED包括获得与患者的心脏活动相对应的ECG信号的ECG传感器以及提供关于心肺复苏的指令的提示装置。所述AED还具有控制系统，其包括被编程用于在终止CPR的指令后运行两个心率分析算法的微处理器。所述两个心率分析算法分析所述ECG信号的片段以识别可电击心律的存在，其中的一个算法相对于另一个算法具有延迟启动。所述AED还包括治疗生成电路，其用于响应于判断可电击心律的存在的所述控制系统而用除颤脉冲处理所述可电击心律。

Description

使AED更快时间进行电击的方法和装置
技术领域
本发明涉及改进的方法和装置，其涉及自动体外除颤器(AED)和心肺复苏(CPR)的综合使用。具体地，本发明涉及AED和方法，其能快速和可靠地在复苏尝试期间确定在心脏骤停的受害者体内可电击心律的存在，从而使在CPR和传递除颤电击之间的延迟最小化成为可能。
背景技术
心脏骤停被广泛理解为重大的公共健康问题以及在世界上的大部分地区导致死亡的主要原因。每年在美国和加拿大约有350,000人遭遇心脏骤停且接受试图复苏。因此，医学界一直在寻求通过CPR和应用除颤电击以更成功地治疗心脏骤停以使经历该类型事件的人士迅速恢复正常心律的方式。几十年前，首次开发了AED以帮助治疗心脏骤停的事件。自创建以来，AED已在公共区域，如办公室、购物中心、体育场和其他高人流区域中变得流行。AED使市民能在公共场所中在心脏急救期间提供医疗帮助，之前，在这些地方无法得到在心脏突发事件的关键早期阶段的帮助。
能够准确检测室性心律失常和不可电击的室上性心律失常的全自动体外除颤器，如在Payne等的美国专利号5,474,574中描述的那些已被开发出来以治疗无人值守的患者。这些装置治疗遭受室性心律失常的受害者且在实时检测可电击心律失常中具有高敏感性和特异性。进一步地，已开发出AED以作为诊断监控装置，其可自动地在医院环境中提供治疗，如在Lin等的美国专利号6,658,290中所述的。
尽管在AED技术中取得了进步，但当前许多AED在实施当前医学建议的综合CPR和AED的使用中不能够完全发挥作用。当今，大多数可用的AED试图对室性心律进行分类并区分可电击室性心律以及所有其他不可电击的心律。这种室性心律的检测和分析提供了ECG波形的某种实时分析。然而，特定AED的功能、准确性和速度在很大程度上取决于用于分析ECG波形的算法和硬件。在许多实施方案中，在AED中使用的算法取决于心率计算和从ECG波形获得的多种形态特性，如在Payne等的美国专利号5474574和Zhang等的美国专利号6480734中公开的ECG波形因数和不规则性。进一步地，为了提供足够的处理能力，当前的AED通常将算法和控制逻辑嵌入微控制器中。
随着在AED领域中取得的进步，在理解人体生理学以及其是如何与医疗保健相关的方面具有了显著的医学进步。在医学研究中的这些进步已导致在处理身体创伤事件的新协议和标准操作程序中的发展。例如，在用于除颤的公共接入协议中，最近的指南已强调需要同时使用CPR和AED并已建议涉及结合有CPR的除颤的包容性方法。
然而，伴随着优势，结合使用CPR和除颤可对AED的操作产生负面影响，这是因为胸外按压和放松已知会在ECG的记录中引入显著的运动伪影。在CPR期间和其之后，在指导救助者按每分钟约100次的规定速率施加胸外按压和放松的情况下，从患者获得干净的信号数据的能力可能是有挑战性的。
除了难于获得干净的ECG信号外，最近已突出了快速地做这件事的重要性，这是因为当前的AHA指南强调了使在CPR和除颤之间的中断最小化的重要性。指南说明，“如果在胸外按压中的中断(用于心律评估、除颤或高级护理)的保持为最小值，则会改善除颤结果”以及“使在停止胸外按压和传递电击之间的间隔最小化(即，使电击前的停顿最小化)改善了电击成功和患者生存的机会”。见发行2010，122：S678和S641。
过去的一些AED实施一种算法，其在救援期间需要干净的ECG信号数据的延长期以将感测的室性心律分类为可电击的。一些需要干净信号的现有技术的公开也讨论了当进行CPR且在依托CPR中的临时中止以获得并进行ECG分析前进行ECG的初步评估。此外，在该领域中最近的学术研究中的大多数均涉及使用能使ECG的整个分析在CPR进行时发生的工具，从而很少需要或不需要中止CPR。因此，已经提出为了进行ECG信号分析的用于识别和过滤CPR伪影的多种技术。然而，这些方法和分析技术中的许多都具有局限性或增加了与提供适当的护理相关的考虑，特别是在最新的AHA指南中。
因此，需要用于快速地评估可电击心律的改进的方法和装置，其使使在CPR和用AED传递除颤电击之间的任何时间段最小化。
发明内容
本发明的各种实施例能够通过提供一种方法和装置，以快速但却准确地判断和验证可电击心律的存在以使CPR和通过救助者传递除颤电击之间的延迟最小化而克服现有技术的问题。
在一个实施例中，提供了一种自动体外除颤器(AED)。该AED包括获得与患者的心脏活动相对应的ECG信号的ECG传感器以及提供关于心肺复苏(CPR)指令的提示装置。进一步地，该AED还具有控制系统，其包括被编程用于在终止CPR的指令后运行两个心率分析算法的微处理器。这两个心率分析算法分析ECG信号的片段以识别可电击心律的存在。两个心率分析算法中的一个提供了延迟启动的可电击心律验证算法。该AED还包括治疗生成电路，其用于响应于判断可电击心律的存在的控制系统而用除颤脉冲处理可电击心律。
在根据本发明的另一个实施例中，公开了一种AED。AED包括获得与患者的心脏活动相应的ECG信号的ECG传感器。AED还包括用于提供CPR指令的指示装置。AED还包括具有微处理器的控制系统，其中控制系统适于使用第一算法在ECG信号的第一片段中确定可电击心律的存在。控制系统还适于使用第二验证算法在ECG信号的第二片段中确定可电击心律的存在。第一算法和第二验证算法并行运行并分析ECG信号的片段。在该实施例中，第一片段在给出停止CPR的指令时开始。之后，第二片段在短短几秒后开始。该实施例中的AED还包括发电电路，其用于为可用于处理可电击心律的除颤脉冲提供电力；以及脉冲传递电路。
根据本发明的一个实施例，提供了一种用于减少在终止心肺复苏和施行除颤电击之间的延迟的自动体外除颤器。AED包括获得与患者的心脏活动相应的ECG信号的ECG传感器以及处理器。处理器运行多个心律分析算法，其中每个算法基于在心肺复苏后具有不同的启动时间的所述ECG信号的片段而独立地确定可电击心律的存在以验证可电击心律的存在。
根据本发明的另一个实施例包括一种用自动体外除颤器传递除颤电击的方法。该方法包括在心肺复苏(CPR)期间给AED充电；用AED的提示装置提示在CPR的中断；以及用第一算法分析在CPR后立即收到的患者的ECG数据的第一片段以确定ECG数据是否具有初始可电击分类。该方法还包括在初始可电击分类后用第一算法监控ECG数据以验证可电击分类保持一致。该方法还包括在第一算法分析和监控ECG数据以获得独立的心律分类的同时，以第二验证算法分析相对于ECG数据的第一片段具有延迟启动时间的ECG数据的第二片段。该方法还包括使用第二算法的心律分类与第一算法的分类进行比较以提供复苏建议的步骤。
另一个实施例包括一种用AED减少在终止心肺复苏和施行除颤电击之间的延迟的方法。这种方法包括发起CPR、给AED充电、提示CPR的中断以及用第一算法分析在CPR后立即收到的第一组ECG数据以确定ECG数据是否具有可电击心律分类的步骤。该方法还包括分析相对于ECG数据的第一组具有延迟启动而获得的第二组ECG数据以确定ECG数据是否具有可电击心律分类以及将第一组ECG数据的分类与第二组ECG数据进行比较以确定是否应通过AED传递除颤电击的步骤。
附图说明
可通过考虑本发明的各实施例的下列详细描述并结合附图更完全地理解本发明，其中：
图1大致示出根据本发明的一个实施例的用CPR和AED治疗心脏骤停受害者的一个实例。
图2大致示出根据本发明的一个实施例的AED硬件的示意图的一个实例。
图3大概示出根据本发明的一个实施例的AED心律分析的操作步骤的流程图。
图4大致示出说明心律评估和AED操作的实例时间线的图，其具有在基本并行运行的算法中的心律评估的成功匹配。
图5大致示出说明心律评估和AED操作的实例时间线的图，其不包括基本并行算法中的心律评估的成功匹配。
具体实施方式
本发明可在不脱离其的本质属性的前提下以其他具体形式实施，因此，所示的实施例应在所有方面中被认为是说明性的而非限制性的。
在本发明的各实施例中，公开了一种装置和方法以快速和可靠地评价从患者获得的ECG信号，从而可使在CRP和传递除颤电击之间的延迟最小化。图1示出正在经历复苏尝试并正接受AED和CPR治疗的心脏骤停的受害者。
所示的AED 100具有被联接至患者胸部的电极片104和106，且所示的救助者108位于能快速对患者110提供胸外按压的位置中。
AHA当前建议所有的救助者(无论是否接受过训练)都应对所有心脏骤停的受害者提供胸外按压，且胸外按压应是对所有的受害者(不论其年龄如何)的最初采取的CPR行动。通常，CPR通过在心脏和大脑中提供关键的血液循环而提高受害者的存活机会。
通常，单独使用CPR将不足以逆转患者的心跳骤停的情况。在这些情况下，AED 100可用于将高振幅电流的脉冲传递至患者的心脏以将其恢复至正常的心律。然而，有许多不同类型的心律，且其中仅有一些被认为是可电击的。主要的可电击心律为心室颤动(VF)、室性心动过速(VT)和心室扑动。非可电击心律可包括心动过缓、电机械分离、室性自主心律和正常的心律。
为了确定心律是否为可电击的，AED分析ECG数据以对患者正在经历的心律的类型进行分类。特别地，一对AED电极104和106位于患者的胸部上，如在图1中所示以获得ECG信号。接下来，通过AED分析ECG信号且如果心律被认为是可电击的，则将除颤脉冲传递至患者。
依赖于ECG分析的AED可被认为是半自动的或全自动的。通常，半自动除颤器要求用户按下按钮以传递实际的除颤电击，相比较，全自动除颤器能在不具有用户的这种输入的情况下传递治疗。本发明的各实施例能用自动和/或半自动AED工作。
在图1中，所示的AED 100被联接至位于患者胸部110上的一对电极104和106。AED 100配备有的中央室，其具有铰链盖112以当不使用除颤器时容纳电极片104和106。所示的盖112处于图1中的开放配置中且因此已准备开始使用。在一个实施例中，打开这个盖112启动AED 100并开始将提示发送至用户。提示可包括源自扬声器114的语音提示以及源自显示器116的视觉提示。
图2大致示出根据本发明的一个实施例、实施改进的电击算法的AED 200的硬件的方框图。基于数字微处理器的控制系统202用于控制AED 200的整体操作。电气控制系统202还包括用于测试电极204和206的互联性和可操作性的阻抗测量电路。控制系统202包括接口连接至程序存储器210、数据存储器212、事件存储器214和实时时钟216的处理器208。通过处理器208执行的操作程序被存储在程序存储器210中。电力是通过电池218提供的且被连接至发电电路220。
发电电路220还被连接至功率控制单元222、盖开关224、看门狗定时器226、实时时钟216和处理器208。数据通信端口228被联接至处理器208以进行数据传输。在某些实施例中，可利用串行端口、usb端口、火线、无线，如802.11x或3G、无线电等进行数据传输。救援开关230、维护指示器232、诊断显示面板234、语音电路236和声音报警238也被连接至处理器208。语音电路236被连接至扬声器240。在各种实施例中，救援开关灯242和视觉显示器244被连接至处理器208以提供额外的操作信息。
在某些实施例中，AED将具有处理器208和协处理器246。协处理器246可以是在硬件中实施的心律分析算法并通过高速数据总线被可操作性地连接至处理器。在各种实施例中，处理器218和协处理器246在相同的硅片上且可在多核处理器中予以实施。可替代地，处理器208和协处理器可被实现为多处理器甚或联网处理器布置的一部分。在这些实施例中，处理器208将计算中的一些卸至协处理器，从而优化对从电极204和206感测的信号的处理。在其他实施例中，用具体的指令或用于执行计算的优化对处理器208进行优化。因此，处理器210可在更少的时钟周期内执行计算且同时命令更少的硬件资源。在其他的实施例中，控制系统202的逻辑和算法可在逻辑、以ASIC为形式的硬件或以FPGA为形式的组合等中实施。
高电压生成电路248也被连接至处理器208且通过处理器208进行控制。高电压生成电路248可含有半导体开关(未示出)以及多个电容器(未示出)。在各种实施例中，连接器250和252将高电压生成电路248连接至电极204和206。要注意的是，这里的高电压电路是通过电池提供电力的且具有高功率。
阻抗测量电路254被连接至连接器250和实时时钟216。阻抗测量电路254通过模拟-数字(A/D)转换器256被连接至实时时钟。另一个阻抗测量电路258可被连接至连接器250和实时时钟216且通过模拟-数字(A/D)转换器256被连接至处理器208。可选地，CPR装置260可通过连接器252和A/D转换器256而被连接至处理器208和实时时钟216。CPR装置260可以是胸外按压检测装置或手动、自动或半自动机械胸外按压装置。一些AED设计的额外详细的讨论可在美国专利公开号2011/0105930和美国专利号5474574、5645571、5749902、5792190、5797969、5919212、5999493、6083246、6246907、6263238、6289243、6658290和6993386中找到，其中的每一个均以引用方式并入本文。
通过本发明的实施例所利用的方法和系统一般是由心律分析算法300和301的两个实例所组成，两个算法平行操作以在AED或类似的心肺复苏装置(例如，与在图2中所示的相类似的装置)中进行评估和验证，从而改善用于传递治疗的时间。第一心律分析算法300从接收到AED停止CPR的指令后立即以很少的释抑期或不具有释抑期的方式运行。第二算法为验证算法以及默认的治疗推荐算法。第二心律分析验证算法301在延迟启动后运行以作为验证算法。具体地，第二心律分析验证算法301在被设计为减少CPR伪影对心律分析的影响的释抑期后开始运行。如果在初始学习期后，心律分析300的第一实例指示相同的可电击心律自始自终存在且源自第二心律分析验证算法301的心律分类与源自第一心律分析算法300的第一分类相一致时，除颤器则将建议电击。如果心律分类不匹配，第二心律分类验证算法301则被允许完成整个分析和监控期，且第二算法301所产生的分类被用于确定分类以及用于救援的任何后续协议建议。
图3表明了更详细的流程图，其描述了利用心律分析的AED的操作步骤，该心律分析协调针对具有不同启动点的片段的两个算法以分析ECG信号，从而快速得到心律分类并验证可电击状态的评估。
具体地，采用心律分类算法的一个实施例的AED 100的操作为首先在CPR期间用内部电池给AED电容器充电，如数字302所示。该充电可通过各种方式进行触发。在一些实施例中，充电可简单地通过打开其盖子、将其接通或以其他类似的方法启动AED 100的方式而发生。在其他优选实施例中，只有之前的分析已发现可电击心律时才会发生充电，从而不会以实质性的方式因预充电等对电池的使用寿命产生负面影响。接下来，在CPR期间的合适的点上，AED 100提供表示用户108应停止CPR的语音提示，如数字304所示。紧接着语音提示后为瞬时分析的释抑期或一点也没提供释抑期，如306所表示的。在各种实施例中，该初步分析释抑期仅持续约一秒钟。接下来，第一(或一级)心律分析算法(RAA)引擎(第一心律分析算法300引擎)在308开始并在310进行分析。在一些实施例中，用于该算法的分析期可能会持续约4秒钟。第一心律分析算法300在分析期后进行在312的操作，其中达到可电击决策并在很短的时间内对其进行监控。在一些实施例中，该可电击决策和监控阶段持续大约5秒钟。如果在整个监控阶段保持可电击心律的一致分类，则在314进行确定。在进行第一心律分析算法300的同时，第二心律分析验证算法301以平行评估ECG心律数据的方式同时运行。该第二(或二级)心律分析验证算法301开始于随第一心律分析操作310开始而开始的分析释抑期316。接下来，第二心律分析验证算法301在318即释抑期完成时开始。通过延迟启动第二心律分析验证算法301，可能影响信号完整性的数据伪影和干扰或获得干净信号的能力被大大降低，但这并不依赖于对ECG信号的任何过滤。第二心律分析算法301然后进入分析阶段320。例如，在一些实施例中，该分析期320可持续5秒钟。在该期间的最后，在322作出判断该心律为可电击的还是不可电击的。
接下来，如果第二算法301认为心律是可电击的且第一算法300给出在整个监控期指示可电击心律的一致分类，则在步骤324中发出电击。当在整个监控期的第一算法300不是一致地被分类为可电击的或第二算法301分类不是可电击的，第二算法分类则在326继续进行。然后，在328的整个连续的监控和分析期将第二算法分类为可电击的或不可电击的。如果分类为可电击的，则在330发出除颤电击。如果心律未被分类为可电击的，则在332不传递电击且提供进一步的CPR或救援协议提示或建议。
为了本发明的目的，在各种实施例中，第一心律分析算法也可被理解为一级的心律分析算法且第二心律分析验证算法也可被理解为二级心律分析算法或第二心律分析算法。在某些实施例中，心律分析算法中的每一个可被理解为心脏科学公司的软件算法的修改版本。要注意的是，在各种实施例中，该方法可利用在当前AED中现有的心律分析算法或为用于控制AED操作的完全更新的算法的一部分。
与过去的现有技术相比，使用两个独立的心律分析算法以用于可电击评估和验证的过程为有用的和有利的替代。例如，替代的窗口化技术已被用于整个现有技术中，其限制治疗的决策为进一步进行投票过程以加强一致性的相邻窗口的评估。在其他发明中已对该窗口技术稍做修改以使用数据的重叠窗口加快该评估。一种对重叠的窗口进行建模且已知使用几十年的一种信号分析技术被称之为Welch方法，然而其他类似的技术也是存在的。Welch方法主要是使用谱密度估计教导减少噪声信号，如ECG信号。该方法是基于使用作为将信号从时域转换为频域的结果的周期图频谱估计的概念。基本上，信号被分成窗口化的重叠段且使用傅立叶变换操作以提供对频点的功率测量数组。在Welch方法中的该重叠被认为是有用的，这是因为其减少了在窗口之间的边界上的问题但却提供了用于处理加速心律评估的问题并具体地处理有问题的CPR后的信号的不同的计算方法。见美国专利号7,463,922。
本专利未使用这种窗口化技术，反而使用有针对性的评估和验证过程以不同的方式处理该问题。已发现使用当前公开的利用两个完全独立的算法和验证过程的非窗口化的过程允许来更快地评估和验证电击评估。在本申请中所讨论的方法均利用了紧随在CPR之后的期间且还考虑了在该期间中潜在的噪声不准确性，其方式为过去的技术窗口化数据所未考虑的的方式。
图4示出了在替代的时间线格式中的心律分析过程。具体地，图4为说明心律评估和AED操作的实例时间线的图400，该图在大致平行的心律分析算法300和心律分析验证算法301中的心律评估初步匹配。在该实例中，分析ECG信号并在CPR的十秒内传递除颤电击。
第一时间线部分402表示在进行CPR的同时发生的进行充电的十秒时间。第一时间线片段402的结束对应于在404发生的AED的语音提示的开始。在404的该语音提示指导救助者停止CPR且不要触碰受害者。具体地，语音提示表示“不要触碰患者！分析心律。”
停止CPR的提示也与第一心律分析算法300所进行的分析期406的开始相重合。该分析期406可持续5秒，如在图中所示，或持续另外合适的替代时期。该分析期406的第一秒可包括简短的释抑期，如在一些实施例中的一秒延迟。在分析期406内，获得ECG数据并相对于出现的心脏活动数据的可电击性进行分析。紧随其后的是分析和监控期408。该期间开始于ECG数据的心脏状况的评估，其表示存在有可电击或不可电击的心律。然后，在该期间408内继续对该评估进行分析和监控，从而确保在整个该期间内进行了一致的可电击或不可电击的评估。
在该分析期406发生的同时，第二心律分析验证算法301进行初始的释抑期410。例如，在一些实施例中，该释抑期410可持续4至5秒。释抑期410是有用的，这是因为其避免在CPR后立即收到的信号以及任何潜在的数据伪影和干扰对信号完整性的影响或对获得干净信号的能力的影响。在一些实施例中，释抑期410可在很短的学习期间412内结束，其中获得了ECG数据。一旦释抑期410结束，则在分析期414内通过第二心律分析验证算法301评估所获得的ECG数据以确定可电击或不可电击的心律是否存在。在分析期414内的很短时间后(在一些实施例中为5秒)，与在同时期408内通过第一心律分析算法300所做出的和监控的判断相比，做出可电击心律的判断。
图4示出在分析和监控期408内分类为“可电击”且在分析期414的第一秒后评估也是“可电击”的一种实例。由于这些分类是匹配的，用于传递电击的指令是通过AED控制电路立即提供的。因此，则可能做出这种快速的电击决定，这是因为该方法增加了可在CPR后很快确定的早期心律分类中的置信度。
图5为说明心律评估和AED操作的实例时间线的图500，该图不包括对在平行的算法中的心律评估的初始匹配。在这里，期间508不保持一致的“可电击”分类或第二心律分析验证算法301显示不可电击的心律。在这种情况下，心律分析算法301完成分析期514并基于仅通过心律分析算法301判断的分类而请求治疗。
在图4和5中描绘了另一组原自AED的语音提示。这些进一步的语音提示紧接在404的给出不触碰患者的指令后发生。具体地，接下来的语音提示416将宣布“准备电击。请离开患者！”
相对于电池充电，该充电被设计成由与分析和释抑期406、408、410、412和414部分共有的期间418内继续。然而，电池充电时间短的足以在做出早期电击决策之前为传递除颤脉冲做好准备。在一些实施例中，快充电池也是可能的，其可在比图4和5所示的短的多的时间内完成充电。
还应理解的是，示例性实施例或示例性实施例仅是实例且并不旨在以任何方式限制本发明的范围、适用性或配置。相反地，前面的详细描述将使本领域的技术人员了解本发明以实施(多个)示例性实施例。应理解的是，在不脱离如在所附权利要求和其法律等同物中设置的本发明的范围的前提下可对元件的功能和布置进行各种变化。
上面的实施例均是说明性的而非限制性的。额外的实施例均在权利要求中。虽然已参照特定实施例描述了本发明，但本领域的技术人员将认识到可在不脱离本发明的精神和范围的前提下在形式和细节上进行改变。
在阅读本发明后，对于本领域的技术人员来说，本发明的各种修改可变得显而易见。例如，在相关领域中的普通技术人员将认识到，在本发明的精神内，所描述的用于本发明的不同实施例的各种特性可适当地进行组合、取消组合并单独或以不同的组合方式与其他特性再组合。同样地，上述各种特性应全部被认为是实例实施例而不是用于限制本发明的范围或精神。因此，上述内容不得被考虑为用于限制本发明的范围。
为了解释本发明的权利要求，其明确的意图是除非在权利要求中引用了具体的术语“用于……的方式”或“用于……的步骤”外，均不会调用美国法典第35编的第六段第112条的规定。

Claims (22)

1.一种自动体外除颤器，其包括：
ECG传感器，其获得与患者的心脏活动相对应的ECG信号；
提示装置，其提供心肺复苏(CPR)指令；
控制系统，其包括微处理器，所述微处理器被编程用于在终止CPR的指令后运行两个心率分析算法，所述两个心率分析算法分析所述ECG信号的片段以判断可电击心律的存在，且所述两个心率分析算法中的一个提供延迟启动的可电击心律验证算法；以及
治疗生成电路，其用于响应于判断可电击心律的存在的所述控制系统而用除颤脉冲处理所述可电击心律。
2.根据权利要求1所述的自动体外除颤器，其中所述两个心律分析算法中的第一个包括分析在所述提示装置给出停止CPR的通知后立即接收到的所述ECG信号。
3.根据权利要求2所述的自动体外除颤器，其中所述心律分析算法中的第二个为延迟启动的可电击心律验证算法且包括分析在所述提示装置给出停止CPR的所述通知后有数秒延迟后获得的ECG信号。
4.根据权利要求1所述的自动体外除颤器，其中所述ECG传感器包括一对电极。
5.根据权利要求1所述的自动体外除颤器，其中所述心律分析算法为基本上相同的算法。
6.一种自动体外除颤器，其包括：
ECG传感器，其获得与患者的心脏活动相对应的ECG信号；
提示装置，其用于提供CPR指令；
控制系统，其包括微处理器，所述微处理器适于使用第一算法在所述ECG信号的第一片段中判断可电击心律的存在且使用第二验证算法在所述ECG信号的第二片段中判断可电击心律的存在，其中所述第一算法和所述第二验证算法平行运行并分析所述ECG信号的至少一些共同的片段，且其中所述第一片段在给出停止CPR的指令时开始，所述第二片段在所述第一片段开始后的短短几秒后开始；以及
发电电路，其提供除颤脉冲，所述除颤脉冲被选择性用于当所述控制系统判断可电击心律的存在时处理所述可电击心律；以及
脉冲传递电路，其传递所述除颤脉冲。
7.根据权利要求6所述的自动体外除颤器，其中所述ECG传感器包括一对电极。
8.根据权利要求6所述的自动体外除颤器，其中所述提示装置提供语音提示。
9.根据权利要求6所述的自动体外除颤器，其中配备所述AED以在判断可电击心律存在的情况下，在收到停止CPR的所述AED的指令后少于10秒的时间内提供一次除颤电击。
10.一种自动体外除颤器，适于减少在终止心肺复苏和施行除颤电击之间的延迟，其包括：
ECG传感器，其获得与患者的心脏活动相对应的ECG信号；
处理器，其运行多个心律分析算法，其中每个算法在心肺复苏后以不同的启动时间基于所述ECG信号的片段而独立地确定可电击心律的存在以验证可电击心律的存在。
11.根据权利要求10所述的自动体外除颤器，其中所述心律分析算法中的一个包括分析在所述提示装置给出停止CPR的通知后立即接收到的所述ECG信号。
12.根据权利要求11所述的自动体外除颤器，其中所述心律分析算法中的不同的一个为延迟启动的验证算法且包括分析在所述提示装置给出停止CPR的所述通知后的数秒延迟后获得的ECG信号。
13.根据权利要求11所述的自动体外除颤器，其中所述ECG传感器包括一对电极。
14.一种用于以自动体外除颤器(AED)传递除颤电击的方法，其包括：
在心肺复苏(CPR)期间给AED充电；
用所述AED的提示装置提示CPR的中断；
使用所述AED以第一算法自动分析紧接着CPR的患者的ECG数据的第一片段以判断所述ECG数据是否具有初始可电击分类；
在所述初始可电击分类后以所述第一算法监控所述ECG数据以验证所述可电击分类保持一致；
在所述第一算法分析和监控ECG数据以获得独立的心律分类的同时，以第二验证算法分析相对于所述ECG数据的第一片段具有延迟启动时间的所述ECG数据的第二片段；以及
使用所述第二验证算法的所述独立心律分类与所述第一算法的所述分类进行比较，以经由所使用的AED上的所述提示装置提供复苏建议以传递所述除颤电击。
15.根据权利要求14所述的方法，所述患者ECG数据的第一片段以及所述ECG数据的第二片段具有一些共同的ECG数据。
16.根据权利要求14所述的方法，其中当所述第一算法以及所述第二验证算法的所述心律分类均为可电击的时候，所述AED建议将所述除颤电击提供至所述患者。
17.根据权利要求14所述的方法，其中所述AED的所述提示装置提供语音提示。
18.一种用AED减少在终止心肺复苏和施行除颤电击之间的延迟的方法，其包括：
使所述AED发出提示以发起CPR；
使所述AED自动为所述除颤电击充电；
使所述AED提示CPR的中断；
使用所述AED以第一算法自动分析紧接着CPR的第一组ECG数据，以判断所述ECG数据是否具有可电击心律分类；
使用所述AED自动分析相对于所述第一组ECG数据以延迟启动而获得的第二组ECG数据以判断所述ECG数据是否具有可电击心律分类；以及
使用所述AED自动将所述第一组ECG数据的分类与所述第二组ECG数据进行比较以判断是否应传递除颤电击。
19.根据权利要求18所述的方法，其中所述第一组ECG数据与所述第二组ECG数据包含一些共同的ECG数据。
20.根据权利要求18所述的方法，其中当所述第一组数据的和所述第二组数据的所述心律分类均为可电击的时候，所述AED建议将除颤电击提供至所述患者。
21.根据权利要求18所述的方法，其中所述AED为半自动装置，且所述自动比较所述分类导致提示用户按下按钮以发起通过AED进行所述除颤电击的传递。
22.根据权利要求18所述的方法，其中所述AED为全自动装置，且所述比较分类导致无需用户采取任何进一步的行动，所述AED自动发起所述除颤电击的传递。
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CN112714663A (zh) * 2018-12-29 2021-04-27 深圳迈瑞生物医疗电子股份有限公司 除颤方法、自动体外除颤仪及计算机可读取介质
WO2023115482A1 (zh) * 2021-12-23 2023-06-29 深圳迈瑞生物医疗电子股份有限公司 用于除颤仪的节律分析和决策方法、装置以及存储介质

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