CN109717865A - Catheter tip localization method - Google Patents
Catheter tip localization method Download PDFInfo
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- CN109717865A CN109717865A CN201811511174.9A CN201811511174A CN109717865A CN 109717865 A CN109717865 A CN 109717865A CN 201811511174 A CN201811511174 A CN 201811511174A CN 109717865 A CN109717865 A CN 109717865A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
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Abstract
This application involves a kind of catheter tip localization methods, and the catheter tip in Puncture tubation is located at heart based on ECG signal, including acquire body surface ecg and internal electrocardiosignal simultaneously.Within a preset time interval, the location information of body surface QRS complex is obtained according to the body surface ecg.The current P wave forward direction amplitude and current P wave negative sense amplitude of complete P-QRS wave in vivo in the internal electrocardiosignal are obtained according to the positioning of the location information of the body surface QRS complex.Forward direction P wave tendency chart is drawn according to the ratio of the current P wave forward direction amplitude and default P wave forward direction wave amplitude.Negative sense P wave tendency chart is drawn according to the ratio of the current P wave negative sense amplitude and default P wave negative sense wave amplitude.It is compared according to the forward direction P wave tendency chart and the negative sense P wave tendency chart with default tendency information, judges the position of the catheter tip.Above-mentioned catheter tip localization method, increases factor of judgment, improves judging nicety rate.
Description
Technical field
This application involves intravascular device field of locating technology, more particularly to a kind of catheter tip localization method.
Background technique
Central venous catheter (the Peripherally Inserted Central Venous being placed in through peripheral vein
Catheters, PICC) it is the more infusion tool of current clinical use.It is needed in surgical procedure by conduit via human body passages through which vital energy circulates
Superior vena cava is more accurately punctured to close to atrium dextrum intersection, this makes it possible to drug is inputted blood circulation system rapidly
Apart from the closer location information of heart.The key of Puncture tubation is that medical staff is allowed promptly and accurately to find catheter tip
Location information thrombus, phlebitis, wall of vein burn into vein can be caused to wear if conduit puncture position information is excessively shallow or too deep
The complication such as hole, myocardial perforation.
For the precise positioning in realization conduit in vivo puncture process, need using such as x-ray positioning, electrocardio
The auxiliary positionings modes such as (electrocardiogram, ECG) positioning.Wherein, x-ray positioning system volume is larger, complicated for operation,
It needs to be operated by senior medical practitioner, and nurse is needed to assist, and human body receives roentgen radiation x for a long time can kill internal leucocyte,
Reduce body immunity.ECG positioning system passes through the P in ecg wave form in monitoring puncture process using conduit inner guide wire as electrode
Wave changes to judge catheter tip location.ECG positioning system has small in size, easy to operate, the advantages such as intuitive display.Common doctor
Shield personnel can grasp by simple training, be not required to other support staff, and to human body without any injury.Therefore ECG positioning system
System is clinically using more and more.
It is clinical at present to use traditional ECG localization method, it is that the ratio of R wave is accounted for using P wave mostly to determine the position of conduit
It sets, referred to as percentage method.After i.e. internal electrocardiosignal export, P wave has significant change.The height of P wave height and R wave is analyzed at this time
Degree relationship.When P wave height accounts for 50%-the 70% of R wave height, catheter position at this time is set to optimum position.But when
When the overall magnitude of waveform is smaller in patient body or the variation of the amplitude of P wave is unobvious, this method can not judge or not
Easily determine whether conduit reaches optimum position.
Summary of the invention
Based on this, it is necessary to be unable to judge accurately whether conduit reaches asking for optimum position for catheter tip localization method
Topic, provides a kind of catheter tip localization method.
Catheter tip in Puncture tubation is located in heart based on ECG signal by a kind of catheter tip localization method
Place, comprising:
Body surface ecg and internal electrocardiosignal are acquired simultaneously；
Within a preset time interval, the location information of body surface QRS complex is obtained according to the body surface ecg；
Complete internal P- in the internal electrocardiosignal is obtained according to the positioning of the location information of the body surface QRS complex
The current P wave forward direction amplitude of QRS wave and current P wave negative sense amplitude；
Forward direction P wave tendency chart is drawn according to the ratio of the current P wave forward direction amplitude and default P wave forward direction wave amplitude；
Negative sense P wave tendency chart is drawn according to the ratio of the current P wave negative sense amplitude and default P wave negative sense wave amplitude；
It is compared according to the forward direction P wave tendency chart and the negative sense P wave tendency chart with default tendency information, judges institute
State the position of catheter tip.
Catheter tip in Puncture tubation can be located in by above-mentioned catheter tip localization method based on ECG signal
At heart, positioned by acquiring body surface ecg and internal electrocardiosignal simultaneously, and according to the location information of body surface QRS complex
Obtain the current P wave forward direction amplitude and current P wave negative sense amplitude of complete P-QRS wave in vivo in internal electrocardiosignal.According to institute
The ratio for stating current P wave forward direction amplitude and default P wave forward direction wave amplitude draws forward direction P wave tendency chart.Simultaneously according to the current P
The ratio of wave negative sense amplitude and default P wave negative sense wave amplitude draws negative sense P wave tendency chart.According to the forward direction P wave tendency chart and
The negative sense P wave tendency chart is compared with default tendency information, judges the position of the catheter tip.Simultaneously according to positive P
The variation tendency of wave and negative sense P wave judges the position of catheter end, increases factor of judgment, improves judging nicety rate.
Can when overall magnitude is smaller or the amplitude variation of P wave is unobvious of waveform in vivo, catheter tip described in accurate judgement
Position.Catheter tip localization method advantages such as clear, easy to operate with judgment basis, can be greatly improved puncturing operation
Practicability and success rate be not required to other support staff, and to human body without any injury and during use.
It is described described in vivo according to the positioning acquisition of the location information of the body surface QRS complex in one of the embodiments,
In electrocardiosignal the step of the complete current P wave forward direction amplitude and current P wave negative sense amplitude of P-QRS wave in vivo, comprising:
Obtain the location information and the two neighboring body surface QRS wave of at least two continuous body surface QRS complexes
The RR interphase width of group；
According to the location information and RR interphase width of the two neighboring body surface QRS complex, obtain complete described internal
The detection zone of P-QRS wave；
Internal P wave location information is obtained in detection zone positioning；
The current P wave forward direction amplitude and the current P wave negative sense amplitude are obtained according to the P wave location information.
It is described in one of the embodiments, to position the step of obtaining internal P wave location information, packet in the detection zone
It includes:
The first P wave location information is obtained using difference Slope Method in the detection zone；
The 2nd P wave location information is obtained using local distance method of changing in the detection zone；
Determine that internal P wave position is believed according to the first P wave location information and the 2nd P wave location information obtained
Breath.
It is described according to the first P wave location information obtained and the 2nd P wave position in one of the embodiments,
Information determines the step of internal P wave location information, comprising:
Judge whether the first P wave location information and the 2nd P wave location information are consistent；
If consistent, using the first P wave location information or the 2nd P wave location information as the internal P wave position
Confidence breath；
If inconsistent, according to the first P wave location information, the 2nd P wave location information and default physiology is combined
Parameter area determines the internal P wave location information.
If described inconsistent in one of the embodiments, according to the first P wave location information, the 2nd P wave position
Information and the step of determine the internal P wave location information in conjunction with default physiological parameter range, comprising:
The first P wave location information and the 2nd P wave location information are judged according to the default physiological parameter range
Inconsistent reason；
When the offset of baseline straight line is violent, using the first P wave location information obtained using difference Slope Method as institute
State internal P wave location information；
When there are the interference of tapering waveform, the 2nd P wave location information obtained using local distance method of changing is made
For the internal P wave location information.
The ratio according to the current P wave forward direction amplitude and default P wave forward direction wave amplitude in one of the embodiments,
Value was drawn in the step of forward direction P wave tendency chart, and the default P wave forward direction amplitude is the body surface P wave forward direction amplitude that operation consent obtains.
The ratio according to the current P wave negative sense amplitude and default P wave negative sense wave amplitude in one of the embodiments,
Value was drawn in the step of negative sense P wave tendency chart, and the default P wave negative sense amplitude is the body surface P wave negative sense amplitude that operation consent obtains.
It is described according to the forward direction P wave tendency chart and the negative sense P wave tendency chart and default in one of the embodiments,
After the step of tendency information compares, and judges the position of the catheter tip,
Show the complete internal P-QRS wave；
Show the forward direction P wave tendency chart and the negative sense P wave tendency chart.
Described the step of showing the complete internal P-QRS wave in one of the embodiments, comprising:
The complete body surface P-QRS wave is obtained according to the body surface ecg, using the body surface P-QRS wave bottom of as
Line profile is shown；
When obtaining the complete internal P-QRS wave, the internal P-QRS is shown on the basis of the shading profile
Wave, the P wave component of the P wave component and the internal P-QRS wave that make the body surface P-QRS wave are located at same in default marker.
In one of the embodiments, further include:
Receive user to freeze to instruct, obtain freezing information, the freezing information include: current time, heart rate information,
The complete internal P-QRS wave；
Subregion shows the freezing information sequentially in time.
Detailed description of the invention
Fig. 1 is a kind of catheter tip localization method flow chart provided by the embodiments of the present application；
Fig. 2 is a kind of P wave of electrocardiogram provided by the embodiments of the present application and end of picc relation schematic diagram；
Fig. 3 is provided by the embodiments of the present application a kind of according to the positioning acquisition of the location information of the body surface QRS complex
The flow chart of the current P wave forward direction amplitude and current P wave negative sense amplitude of complete P-QRS wave in vivo in internal electrocardiosignal；
Fig. 4 is a kind of process that internal P wave location information is obtained in detection zone positioning provided by the embodiments of the present application
Figure；
Fig. 5 is the schematic diagram of local distance transformation；
Fig. 6 is provided by the embodiments of the present application a kind of according to the first P wave location information and the 2nd P wave that obtain
Location information determines the flow chart of internal P wave location information；
Fig. 7 is another catheter tip localization method flow chart provided by the embodiments of the present application；
Fig. 8 is a kind of flow chart for showing the complete internal P-QRS wave provided by the embodiments of the present application；
Fig. 9 is a kind of interface display diagram of display window provided by the embodiments of the present application；
Figure 10 is a kind of forward direction P wave and negative sense P wave tendency chart provided by the embodiments of the present application；
Figure 11 is another catheter tip localization method flow chart provided by the embodiments of the present application.
Specific embodiment
It is with reference to the accompanying drawings and embodiments, right in order to which the objects, technical solutions and advantages of the application are more clearly understood
The application is further elaborated.It should be appreciated that specific embodiment described herein is only used to explain the application, and
It is not used in restriction the application.
It should be noted that heart contraction and diastole once constitute a cardiac cycle.The electrocardio of one cardiac cycle is believed
Number generally comprise P wave, PR sections, QRS complex, ST sections, T wave etc..Wherein, P wave, the electric shock of normal heart are dynamic since sinoatrial node.
Since sinoatrial node is located at the intersection of atrium dextrum and superior vena cava, so the excitement of sinoatrial node is transmitted to atrium dextrum first, pass through
Interatrial tract passes to atrium sinistrum, forms the P wave on electrocardiogram.P wave represents the excitement in atrium, is the first wave in each wave group,
First half represents atrium dextrum excitement, the latter half of excitement for representing atrium sinistrum.QRS complex, including three closely coupled waves, first
A downward wave is known as Q wave, and the upright wave of the high point of after Q wave is known as R wave, and the wave after R wave under is known as S wave.Because of it
It is closely coupled, and ventricle electricity ignition process is reflected, therefore it is referred to as QRS complex.This wave group reflects left and right biventricular remove
Pole process.
Conduit in Puncture tubation can be understood as the central venous catheter PICC being placed in through peripheral vein.The puncture
Tube placing operation is based on four electrode Electrocardiographs.Described four electric Electrocardiographs include at least external electrode and internal electrode.It is described internal
Electrode H is the conductance silk in the central venous catheter being placed in through peripheral vein.Wherein, external electrode includes external electrode RA (right
Arm), external electrode LL (left leg) and external electrode RL (right leg).Wherein, the external electrode RA is placed in the right arm of human body,
The external electrode LL is placed in the left leg of human body, and the external electrode RL is placed in the right leg of human body.The RA and LL forms body surface
II is led.H lead forms internal II with LL and leads.The body surface II leads to lead with the internal II and can form double II and lead real time contrast.
Referring to Figure 1, the application provides a kind of catheter tip localization method.The catheter tip localization method is based on electrocardio
Catheter tip in Puncture tubation is located at heart by figure signal.The catheter tip localization method includes:
S10, while acquiring body surface ecg and internal electrocardiosignal.
It in the step S10, needs the patient for carrying out Puncture tubation before puncture, connects body surface conducting wire first,
That is external electrode RA, external electrode LL and external electrode RL.Wherein, the Crocodile-type clamp of a body surface lead, which is connected to, is punctured
Conductance silk.In puncture process, by venipuncture, the central venous catheter PICC being placed in through peripheral vein is pierced into human body.
At this point it is possible to acquire body surface ecg, i.e. human body surface EGC waveform data in real time by the external electrode simultaneously.It utilizes
Conductance silk in PICC, i.e. internal electrode H acquire the intracorporal internal electrocardiosignal of people.
S20 obtains the location information of body surface QRS complex according to the body surface ecg within a preset time interval.
In the step S20, the preset time is 2~3 seconds.It, can be in the prefixed time interval 2~3 seconds
Obtaining 2000~3000 users indicates the data of body surface and internal ecg information.It is obtained according to the body surface ecg of acquisition
Take the location information of body surface QRS complex.The QRS complex is distributed in the medium, high frequency region of electrocardiosignal, and peak value falls in 10~
Between 20Hz, amplitude characteristic is clearly, significant with the difference of other waveforms.Real-time detection method and non real-time detection can be used
Method detects the location information of the QRS complex.Wherein, the non real-time detection mode can using wavelet analysis method,
Neural network and be based on feature recognition technique.The real-time detection method can be filtered difference processing and be tied to signal
Amplitude is closed to determine the position of QRS complex.Specifically, the vertex of R wave, RR in each period be can detecte out based on difference Slope Method
Interphase information, so respectively forwardly, find turning point backward, to obtain the position of Q wave and S wave.That is, available QRS wave
The location information of group, calculates the width information of QRS complex.At the same time it can also according to the width of RR interphase and QRS wave, to the heart
Electric signal carries out diagnostic classification.
S30 is obtained complete internal in the internal electrocardiosignal according to the positioning of the location information of the body surface QRS complex
The current P wave forward direction amplitude of P-QRS wave and current P wave negative sense amplitude.
In the step S30, corresponding body can be oriented according to the location information of the body surface QRS complex of acquisition
The location information of interior QRS complex.Intracorporal P wave in the course of surgery, can become towering, to the detection of the internal QRS complex
Big interference is brought, so that the location information of each QRS complex cannot be detected accurately.Due to the body surface QRS complex and
The location information of the internal QRS complex is consistent, therefore the internal QRS complex that can be determined by body surface lead waveform
Location information.It can be in the base of QRS complex in conjunction with preset algorithm according to the location information of the internal QRS complex of acquisition
Complete P-QRS wave is obtained on plinth, to obtain current P wave forward direction amplitude and current P wave negative sense amplitude.
S40 draws forward direction P wave trend according to the ratio of the current P wave forward direction amplitude and default P wave forward direction wave amplitude
Figure.S50 draws negative sense P wave tendency chart according to the ratio of the current P wave negative sense amplitude and default P wave negative sense wave amplitude.
In the step S340 and the step S50, the default P wave forward direction amplitude and the default P wave negative sense width
The stable body surface P-wave amplitude that value can obtain for operation consent.The default P wave forward direction amplitude and the default P wave negative sense width
The average value or some metastable P wave amplitude of the multiple continuous body surface P-wave amplitudes obtained in value or surgical procedure
Value.In addition, the default P wave forward direction amplitude and the default P wave negative sense amplitude are also possible to doctor according to the body surface heart of user
The customized amplitude of electric signal.Therefore, to the setting of the default P wave forward direction amplitude and the default P wave negative sense amplitude
Mode can be set according to user demand.
S60 is compared with default tendency information according to the forward direction P wave tendency chart and the negative sense P wave tendency chart, is sentenced
Break the position of the catheter tip.
In the step S60, it should be noted that based on internal P wave in the different parts meeting such as superior vena cava, atrium dextrum
Occur specific variations can accurately in positioning body the catheter tip location information.The specific variations are understood that
Are as follows: the catheter tip enters superior vena cava, and internal P wave forward direction amplitude can gradually rise, and negative sense amplitude is held essentially constant.Institute
When stating catheter tip and reaching upper wall boundary tie point (the Cavoatrial Junction, CAJ) of superior vena cava and atrium dextrum, body
Interior P wave forward direction amplitude reaches maximum, and negative sense amplitude still remains unchanged.Wherein, superior vena cava and the upper wall of atrium dextrum, which have a common boundary, connects
Point CAJ, that is, lower 1/3 section of superior vena cava, close to atrium dextrum intersection, CAJ indicates the terminal and PICC of superior vena cava
The optimum position of Peripherally Inserted Central Catheter tip indwelling.As the catheter tip continues to move to enter the right heart
Room top, internal P wave negative sense amplitude are gradually reduced.When the catheter tip is moved in the middle part of atrium dextrum, there is bimodal P wave.
It is that internal P wave is mainly rendered as negative sense P wave into low right atrium.
According to the specific variations, the ratio of the current positive and negative amplitude of P wave and the default positive and negative amplitude of P wave can be set and preset
The mapping relations of end of picc information can accurately position the location information of catheter tip according to the mapping relations.
According to the corresponding relationship of P wave of electrocardiogram and end of picc, Fig. 2 is referred to, analysis sets the forward direction P wave tendency chart in advance
With the negative sense P wave tendency chart, the default tendency information is formed.Wherein, when the catheter tip reaches position 2 in Fig. 2,
The i.e. described catheter tip reaches CAJ.The forward direction P wave tendency chart and the negative sense P wave obtained according to internal electrocardiosignal becomes
Gesture figure is compared with the default tendency information, to judge the position of the catheter tip.
The catheter tip localization method according to the forward direction P wave tendency chart and the negative sense P wave tendency chart with preset
Gesture information compares, and judges the position of the catheter tip.Simultaneously according to the variation tendency of positive P wave and negative sense P wave to leading
The position of pipe end is judged, factor of judgment is increased, can waveform in vivo overall magnitude is smaller or the amplitude of P wave becomes
When changing unobvious, the position of catheter tip described in accurate judgement.There is the catheter tip localization method judgment basis to define, grasp
Work such as facilitates at the advantages, the practicability and success rate of puncturing operation can be greatly improved, and during use, it is auxiliary to be not required to other
The person of helping others, and to human body without any injury.
It is in one embodiment, described to be obtained according to the positioning of the location information of the body surface QRS complex please also refer to Fig. 3
Take the step of the current P wave forward direction amplitude and current P wave negative sense amplitude of complete P-QRS wave in vivo in the internal electrocardiosignal
Suddenly, comprising:
S310 obtains the location information and the two neighboring body surface of at least two continuous body surface QRS complexes
The RR interphase width of QRS complex.
In the step S310, it can accurately can be obtained according to the body surface power information of acquisition in this preset time
Complete electrocardiographic wave in being spaced, i.e., the complete P-QRS wave.The prefixed time interval is 2~3 seconds.According to pre-
If the complete ecg wave form obtained in time interval, can filter out at least two continuous QRS complexes and two
RR interphase width between the continuous QRS complex.
In one embodiment, at least three continuous QRS complexes can be filtered out, that is, obtain two continuous QRS
The RR interphase width of wave group.If two continuous RR interphase width are equal within a preset range, show that serious wave does not occur
The situation of shape interference, such as sufferer burst arrhythmia cordis or strenuous exercise etc..So as to think the QRS complex obtained
Location information is accurate.
S320 is obtained complete described according to the location information and RR interphase width of the two neighboring body surface QRS complex
The detection zone of internal P-QRS wave.
In the step S320, due to, the location information and RR interphase width of the body surface QRS complex and it is described in vivo
The location information and RR interphase width of QRS complex are with uniformity.Meanwhile waveform included by the electrocardiosignal of cardiac cycle, P
Wave, PR sections, QRS complex, ST sections, T wave etc., wherein P wave represents the excitement in atrium, is the first wave in each wave group, is located at
Before QRS complex.According to the location information and RR interphase width of QRS complex described in the two of acquisition continuous body surfaces, so that it may
Indirectly extrapolate the detection zone of the internal P-QRS wave.
S330 obtains internal P wave location information in detection zone positioning.
In the step S330, in the detection zone of the internal P-QRS wave of acquisition, according to preset algorithm
Accurately orient the location information of internal P wave.The preset algorithm can be difference slope combination local distance converter technique.
S340 obtains the current P wave forward direction amplitude and the current P wave negative sense amplitude according to the P wave location information.
In the step S340, P wave location information include P wave rise, not-go-end point, magnitude references line, P-wave amplitude and
Time width etc..The current P wave forward direction amplitude can be obtained according to the P wave location information of acquisition and the current P wave is negative
To amplitude.
It is in one embodiment, described to obtain internal P wave location information in detection zone positioning please also refer to Fig. 4
The step of, comprising:
S331 obtains the first P wave location information using difference Slope Method in the detection zone.
In the step S331, for considering the QRS complex currently chosen and a upper QRS complex in electrocardiosignal
Between, T is excluded, the existing segment of P wave meeting finds P wave position by difference Slope Method based on this segment.
The negative slope of internal ecg information is determined according to difference formula (1)
Diff (x)=S (x)-S (x-t) (1)
Diff (x) is signal after difference, and S (x) is internal P wave detection zone difference front signal, and t is the interval of setting.It is described
Between be divided into time difference of difference.X is current point coordinate.It can be according to determining suitable difference interval using frequency, using default
The difference result of time interval finds the amplitude maximum of the electrocardiosignal of gradient maxima, and P wave detection zone difference front signal is logical
Amplitude calibration is crossed, to obtain amplitude maximum position, the location information of the position is just the first P wave location information.Wherein, the first P
Wave location information includes the rising of the first P wave, dead-centre position information, magnitude references line, the first P-wave amplitude and time width etc..
Wherein, the first P wave is to have the waveform obviously to rise and fall for baseline waveform except removal QRS complex and T wave.
S332 obtains the 2nd P wave location information using local distance method of changing in the detection zone.
In the step S332, it should be noted that local distance transformation refers to and chooses in signal curve to be analyzed
A secondary segment comprising the characteristic point extracted rises through the section, not-go-end point does straight line, signal curve in calculating secondary segment
On every bit to connect this section rise, the distance of the straight line of not-go-end point, using maximum distance point as the spy in the segment signal curve
Sign point.Fig. 5 is the schematic diagram of local distance transformation, and wherein AB indicates the start-stop endpoint of selected secondary segment, and C is the feature extracted
Point.According to local distance converter technique, appropriate, not-go-end point can be selected in P wave detection zone to be measured, do straight line, counted
The every bit of segment signal to be analyzed is calculated to the distance of the straight line, as shown in formula (2), corresponds to the 2nd P wave apart from maximum point
Peak value, then available 2nd P wave location information, calculates the second P-wave amplitude and time width.
D=max | Ax+by+C | (2)
Wherein, x is current point coordinate, and y is corresponding signal amplitude value, and a, b, c are the straight line coefficients that start-stop point determines.
It should be noted that the sequence of the step S331 and the step S332 can exchange, the elder generation of the two is not limited
Sequence afterwards.
S333 determines internal P wave position according to the first P wave location information and the 2nd P wave location information obtained
Confidence breath.
It is in one embodiment, described according to the first P wave location information obtained and described please also refer to Fig. 6
The step of 2nd P wave location information determines internal P wave location information, comprising:
S334 judges whether the first P wave location information and the 2nd P wave location information are consistent.
In the step S334, the first P wave location information can be obtained by difference Slope Method in detection zone,
The 2nd P wave location information can be obtained using local distance method of changing.Wherein, the internal P wave location information can be
The first P position information may be the 2nd P wave location information.During operation, if by external environment
It influences, ecg information will be interfered, use that difference Slope Method and local range conversion method obtain respectively described the
One P wave position and the 2nd P wave position are inconsistent.If not receiving extraneous interference, check the mark Slope Method and part are used
The first P wave position and the 2nd P wave position that converter technique obtains are almost the same.Wherein, consistency can be P wave position
At least one of the rising of P wave included in information, not-go-end point, magnitude references line, P-wave amplitude and time width.?
Consistency with the first P wave location information and the 2nd P wave location information that obtain by comparing, and then described in determination
Internal P wave location information.
S335, if unanimously, using the first P wave location information or the 2nd P wave location information as the internal P
Wave location information.
In the step S335, when the acquisition of current electrocardiosignal is not by external interference, can will have consistent
The first P wave location information or the 2nd P wave location information of property are as the internal P wave location information.
S336 according to the first P wave location information, the 2nd P wave location information and is combined default if inconsistent
Physiological parameter range determines the internal P wave location information.
In the step S336, if by external interference in surgical procedure, it can be according to the first P wave position of acquisition
Confidence breath, the 2nd P wave location information determine the accurate internal P wave location information.
In one embodiment, if it is described inconsistent, according to the first P wave location information, the 2nd P wave location information
And the step of in conjunction with default physiological parameter range determining the internal P wave location information, comprising: according to the default physiological parameter
Range judges the first P wave location information and the inconsistent reason of the 2nd P wave location information.When baseline straight line deviates play
When strong, using the first P wave location information obtained using difference Slope Method as the internal P wave location information.Work as presence
When tapering waveform interferes, using the 2nd P wave location information obtained using local distance method of changing as the internal P wave position
Confidence breath.When obtaining internal P wave location information, can be obtained corresponding in conjunction with difference Slope Method and local distance change method
Testing result is determined the internal P wave location information using corresponding preset strategy according to testing result, detection can be improved
The accuracy of the internal P wave location information.
In one embodiment, described to be drawn according to the current P wave forward direction amplitude and the ratio of default P wave forward direction wave amplitude
In the step of making forward direction P wave tendency chart, the default P wave forward direction amplitude is the body surface P wave forward direction amplitude that operation consent obtains.One
In a embodiment, the ratio according to the current P wave negative sense amplitude and default P wave negative sense wave amplitude draws negative sense P wave and becomes
In the step of gesture figure, the default P wave negative sense amplitude is the body surface P wave negative sense amplitude that operation consent obtains.The default P wave is positive
Amplitude and the default P wave negative sense amplitude may be the average value of the multiple continuous body surface P-wave amplitudes obtained in surgical procedure
Or some metastable P-wave amplitude.In addition, the default P wave forward direction amplitude and the default P wave negative sense amplitude can also be with
It is a body surface ecg customized amplitude of the doctor according to user.Therefore, to the default P wave forward direction amplitude and described
The setting means of default P wave negative sense amplitude can be set according to user demand.
It is in one embodiment, described to become according to the forward direction P wave tendency chart and the negative sense P wave please also refer to Fig. 7
After the step of gesture figure is compared with default tendency information, judges the position of the catheter tip, S70 shows complete institute
State internal P-QRS wave.S80 shows the forward direction P wave tendency chart and the negative sense P wave tendency chart.In the step S70 and institute
It states in step S80, when complete the P-QRS wave and the forward direction P wave tendency chart and the negative sense P wave trend in vivo of acquisition
When figure, all information that can be will acquire are shown, so that medical staff checks.
Please also refer to Fig. 8, in one embodiment, described the step of showing the complete internal P-QRS wave, packet
It includes:
S710 obtains the complete body surface P-QRS wave according to the body surface ecg, by the body surface P-QRS wave
It is shown as shading profile.
In the step S710, according to the body surface P-QRS wave of acquisition, and difference slope and local distance are combined
Converter technique, the available complete body surface P-QRS wave.Wherein it is possible to which the body surface P-QRS wave that will acquire is as shading
Profile is shown.It is appreciated that the body surface P-QRS wave that can be will acquire is shown in individual region.
S720 is shown described internal when obtaining the complete internal P-QRS wave on the basis of shading profile
P-QRS wave is being marked with the P wave component of the P wave component of the body surface P-QRS wave and the internal P-QRS wave in advance positioned at same
Know position.
In the step S720, when the complete internal P-QRS wave of acquisition, shown on the basis of shading profile
The internal P-QRS wave for showing acquisition makes the P wave component of the body surface P-QRS wave and the P wave component of the internal P-QRS wave
Positioned at same in default marker.
In one embodiment, as shown in figure 9, above- mentioned information can be shown by display window.The display window
Mouth includes multiple display areas.Internal ecg wave form of the internal waveform display area for P-QRS wave in real-time display body.Body surface
Wave regions are used for the body surface ecg waveform of real-time display body surface P-QRS wave.Comparison display area is for showing body surface P-QRS wave
(dotted line expression) and internal P-QRS wave (solid line expression) comparison diagram.Wherein, the body surface P-QRS wave is as shading profile right
It is shown than display area.Wherein, it presets marker and dynamic marks presentation is carried out in the comparison display area by chain-dotted line.Institute
Stating default marker may include positive marker and negative sense marker.It is positive P wave directly can be obtained by default marker
Amplitude and P wave negative sense amplitude, variation are intuitive.In addition, can show positive P-wave amplitude and negative sense P wave in P wave trend display area
The trend chart of amplitude.The P wave trend display area can also show the heart rate value of current patient, most effective physiology
Information is intuitively supplied to operator.Internal, body surface waveform at the same time it can also will acquire is saved.Implement at one
In example, it is as shown in Figure 10 to obtain P wave tendency chart described in the forward direction P wave tendency chart and negative sense.When the forward direction P wave and described negative
When being located within the scope of lateral time coordinate about 18-19 to P wave.The catheter tip reaches optimum position.
Please also refer to Figure 11, in one embodiment, the catheter tip localization method further include:
S910 receives user and freezes to instruct, and obtains freezing information, the freezing information includes: current time, heart rate
Information, the complete internal P-QRS wave.
In the step S910, when needing to freeze a certain internal P-QRS wave, when medical staff's selection is freezed i.e.
It can intercept and freeze current intracorporal one segment comprising P wave and shown.When receive user freeze instruction can obtain
Freezing information.The freezing information includes current time, heart rate information, the complete internal P-QRS wave.It is appreciated that
In each freezes body while P wave, it can also freeze to record time and heart rate value information.It is used it should be noted that freezing instruction
It can be only P wave component in freezing the P wave plate section for including in presently described internal P-QRS wave, or complete described
P-QRS wave.
S920, subregion shows the freezing information sequentially in time.
In the step S920, the display window further includes for showing waveform in multiple freezes bodies of freezing information
Display area shows corresponding freezing information for subregion in chronological order.It is shown by the way that multiple frozen waveforms are arranged
Region, detect medical staff freezing unit freeze instruction when, convenient, accurately can freeze and show surgical procedure
The corresponding P wave morphology of different parts where middle catheter tip.Medical staff is allowed more precisely to sentence by the intuitive comparison of different moments
Disconnected conduit position information out, while the Wave data freezed is supplied to medical staff and wears as operation report archive and PICC
Pierce the research of example.
It is appreciated that the title of the internal P wave freezed can also be by doctor's customized setting according to the actual situation, to meet
The demand of Different hospital different situations operation report.While the internal P wave that display is freezed, the record freezed can also be shown
Freezing information can also be saved in disease shelves by time and heart rate value information, be printed out as report, realize patient's physiologic information
Hypermnesia record property.
The application can intuitively compare the variation of P wave using different display format.First, waveform display area in vivo
The real-time monitoring comparison of wave shape of the internal P-QRS wave and the body surface P-QRS wave may be implemented with body surface waveform display area.
Second, showing comparison while comparing display area realizes single complete P-QRS wave contour in vivo and default P wave.It is described
Default P wave is carried out customized by doctor.Third, showing that the tendency chart of forward direction P wave and negative sense P wave supplies in the wave trend display area P
Medical staff judges the position of the catheter tip.Fourth, medical staff can be aobvious in multiple frozen waveforms by subjective consciousness
Show the comparison of the internal P wave of different parts where different moments catheter tip is freezed in region.Pass through above-mentioned control methods, Neng Gourang
Medical care quickly determines the variation tendency of internal P wave, determines the location information where catheter tip in time.
By the catheter tip localization method, various danger brought by blindmate when can be to avoid PICC puncture and intubation
Evil.It can be convenient medical staff by positive P wave and negative sense P wave trend and judge the position of the catheter tip, and pass through medical care
What the subjective consciousness of personnel was simple and efficient preserves internal Wave data.The heart can be improved in the catheter tip localization method
Efficiency of the practice, versatility and the success rate of electric positioning operation.The catheter tip localization method can be operated by hospital bed, be not necessarily to
Operating room.The catheter tip localization method operating process is simple, and a full set can be completed by the independent simple operations of nurse and set pipe hand
Art process.
Each technical characteristic of embodiment described above can be combined arbitrarily, for simplicity of description, not to above-mentioned reality
It applies all possible combination of each technical characteristic in example to be all described, as long as however, the combination of these technical characteristics is not deposited
In contradiction, all should be considered as described in this specification.
The several embodiments of the application above described embodiment only expresses, the description thereof is more specific and detailed, but simultaneously
The limitation to claim therefore cannot be interpreted as.It should be pointed out that coming for those of ordinary skill in the art
It says, without departing from the concept of this application, various modifications and improvements can be made, these belong to the protection of the application
Range.Therefore, the scope of protection shall be subject to the appended claims for the application patent.
Claims (10)
1. the catheter tip in Puncture tubation is located in heart based on ECG signal by a kind of catheter tip localization method
Place characterized by comprising
Body surface ecg and internal electrocardiosignal are acquired simultaneously；
Within a preset time interval, the location information of body surface QRS complex is obtained according to the body surface ecg；
Complete P-QRS wave in vivo in the internal electrocardiosignal is obtained according to the positioning of the location information of the body surface QRS complex
Current P wave forward direction amplitude and current P wave negative sense amplitude；
Forward direction P wave tendency chart is drawn according to the ratio of the current P wave forward direction amplitude and default P wave forward direction wave amplitude；
Negative sense P wave tendency chart is drawn according to the ratio of the current P wave negative sense amplitude and default P wave negative sense wave amplitude；
It compares according to the forward direction P wave tendency chart and the negative sense P wave tendency chart with default tendency information, is led described in judgement
The position of pipe end.
2. catheter tip localization method according to claim 1, which is characterized in that described according to the body surface QRS complex
Location information positioning obtain the complete current P wave forward direction amplitude of P-QRS wave and current P in vivo in the internal electrocardiosignal
The step of wave negative sense amplitude, comprising:
Obtain the location information and the two neighboring body surface QRS complex of at least two continuous body surface QRS complexes
RR interphase width；
According to the location information and RR interphase width of the two neighboring body surface QRS complex, the complete internal P-QRS is obtained
The detection zone of wave；
Internal P wave location information is obtained in detection zone positioning；
The current P wave forward direction amplitude and the current P wave negative sense amplitude are obtained according to the P wave location information.
3. catheter tip localization method according to claim 2, which is characterized in that described position in the detection zone obtains
The step of internal P wave location information, comprising:
The first P wave location information is obtained using difference Slope Method in the detection zone；
The 2nd P wave location information is obtained using local distance method of changing in the detection zone；
Internal P wave location information is determined according to the first P wave location information and the 2nd P wave location information obtained.
4. catheter tip localization method according to claim 3, which is characterized in that described according to the first P obtained
The step of wave location information and the 2nd P wave location information determine internal P wave location information, comprising:
Judge whether the first P wave location information and the 2nd P wave location information are consistent；
If consistent, believe using the first P wave location information or the 2nd P wave location information as the internal P wave position
Breath；
If inconsistent, according to the first P wave location information, the 2nd P wave location information and default physiological parameter is combined
Range determines the internal P wave location information.
5. catheter tip localization method according to claim 4, which is characterized in that if described inconsistent, according to
First P wave location information, the 2nd P wave location information and the internal P wave location information is determined in conjunction with default physiological parameter range
The step of, comprising:
Judge that the first P wave location information and the 2nd P wave location information are different according to the default physiological parameter range
The reason of cause；
When the offset of baseline straight line is violent, using the first P wave location information obtained using difference Slope Method as the body
Interior P wave location information；
When there are the interference of tapering waveform, using the 2nd P wave location information obtained using local distance method of changing as institute
State internal P wave location information.
6. catheter tip localization method according to claim 1, which is characterized in that described positive according to the current P wave
The ratio of amplitude and default P wave forward direction wave amplitude was drawn in the step of forward direction P wave tendency chart, and the default P wave forward direction amplitude is
The body surface P wave forward direction amplitude that operation consent obtains.
7. catheter tip localization method according to claim 1, which is characterized in that described according to the current P wave negative sense
The ratio of amplitude and default P wave negative sense wave amplitude was drawn in the step of negative sense P wave tendency chart, and the default P wave negative sense amplitude is
The body surface P wave negative sense amplitude that operation consent obtains.
8. catheter tip localization method according to claim 1, which is characterized in that described according to the forward direction P wave trend
After the step of figure and the negative sense P wave tendency chart compare with default tendency information, judge the position of the catheter tip,
Show the complete internal P-QRS wave；
Show the forward direction P wave tendency chart and the negative sense P wave tendency chart.
9. catheter tip localization method according to claim 8, which is characterized in that described to show the complete internal P-
The step of QRS wave, comprising:
The complete body surface P-QRS wave is obtained according to the body surface ecg, using the body surface P-QRS wave as shading wheel
Exterior feature is shown；
When obtaining the complete internal P-QRS wave, the internal P-QRS wave is shown on the basis of the shading profile,
The P wave component of the P wave component and the internal P-QRS wave that make the body surface P-QRS wave is located at same in default marker.
10. catheter tip localization method according to claim 1, which is characterized in that further include:
It receives user to freeze to instruct, obtains freezing information, the freezing information includes: current time, heart rate information, complete
The internal P-QRS wave；
Subregion shows the freezing information sequentially in time.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202011126735.0A CN112043274B (en) | 2018-12-11 | 2018-12-11 | Catheter tip positioning system |
| CN201811511174.9A CN109717865A (en) | 2018-12-11 | 2018-12-11 | Catheter tip localization method |
| PCT/CN2019/072607 WO2020118872A1 (en) | 2018-12-11 | 2019-01-22 | Catheter tip positioning method |
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| CN201811511174.9A CN109717865A (en) | 2018-12-11 | 2018-12-11 | Catheter tip localization method |
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| CN117379062A (en) * | 2023-12-12 | 2024-01-12 | 浙江好络维医疗技术有限公司 | Single-lead dry electrode electrocardiogram P wave identification method, device, equipment and medium |
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| CN115177358B (en) * | 2022-07-12 | 2024-08-27 | 上海宏桐实业有限公司 | Positioning system of intracardiac mapping electrode catheter based on intracavity signal |
Family Cites Families (12)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7794407B2 (en) * | 2006-10-23 | 2010-09-14 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
| CN101766484B (en) * | 2010-01-18 | 2011-09-07 | 董军 | Method and equipment for identification and classification of electrocardiogram |
| WO2011097312A1 (en) * | 2010-02-02 | 2011-08-11 | C.R. Bard, Inc. | Apparatus and method for catheter navigation and tip location |
| JP6405090B2 (en) * | 2010-09-23 | 2018-10-17 | シー・アール・バード・インコーポレーテッドＣ Ｒ Ｂａｒｄ Ｉｎｃｏｒｐｏｒａｔｅｄ | Medical system for tracking the position of a medical device within a patient's vasculature and method for operating the medical system |
| WO2014027340A1 (en) * | 2012-08-15 | 2014-02-20 | Elcam Medical Agricultural Cooperative Association Ltd. | System and method for accurate placement of a catheter tip in a patient |
| ES2811323T3 (en) * | 2014-02-06 | 2021-03-11 | Bard Inc C R | Systems for the guidance and placement of an intravascular device |
| CN104771161A (en) * | 2015-04-15 | 2015-07-15 | 深圳开立生物医疗科技股份有限公司 | Catheter tail end positioning method, device and system |
| CN105030228B (en) * | 2015-06-29 | 2019-07-02 | 深圳市理邦精密仪器股份有限公司 | The method and device of its P wave position is determined in electrocardiosignal |
| CN105054922A (en) * | 2015-07-17 | 2015-11-18 | 深圳开立生物医疗科技股份有限公司 | Intravascular catheter location prompting method, device and system |
| WO2017122117A1 (en) * | 2016-01-13 | 2017-07-20 | Uber Diagnostics Pte. Ltd. | A device and method for accurately navigating a catheter during vascular access |
| US20180177419A1 (en) * | 2016-09-13 | 2018-06-28 | Edan Instruments, Inc. | Method and device for presenting st event in electrocardiogram |
| CN108685605B (en) * | 2017-12-20 | 2019-12-17 | 深圳市科曼医疗设备有限公司 | Catheter tip positioning method and system |
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| CN117379062A (en) * | 2023-12-12 | 2024-01-12 | 浙江好络维医疗技术有限公司 | Single-lead dry electrode electrocardiogram P wave identification method, device, equipment and medium |
| CN117379062B (en) * | 2023-12-12 | 2024-04-05 | 浙江好络维医疗技术有限公司 | Single-lead dry electrode electrocardiogram P wave identification method, device, equipment and medium |
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| CN112043274A (en) | 2020-12-08 |
| WO2020118872A1 (en) | 2020-06-18 |
| CN112043274B (en) | 2022-12-23 |
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