CN110384485B - Method and device for detecting body hemodynamics response in external counterpulsation treatment - Google Patents
Method and device for detecting body hemodynamics response in external counterpulsation treatment Download PDFInfo
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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
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/02028—Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
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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
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
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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
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
Abstract
The invention discloses a detection method and a device for body hemodynamics response in external counterpulsation treatment, wherein the detection method comprises the following steps: collecting physiological information of a sampler, and respectively collecting blood vessel and blood flow state data before and during external counterpulsation treatment; segmenting an arterial tree based on an arterial tree structure model, collecting length and radius data of each blood vessel segment of a healthy volunteer, setting a baseline reference value, and constructing an arterial tree geometric solving model; calculating and setting boundary conditions, correcting and calibrating conditions, solving and calculating the flow and pressure pulse wave distribution of each position of the arterial tree based on the pulse wave transmission theory and the model, and calculating the blood flow perfusion and blood pressure level of the target blood vessel section and the visceral organs before and during external counterpulsation treatment. The invention can non-invasively, real-timely and effectively analyze the instant hemodynamic effect of external counterpulsation intervention treatment, and solves the technical bottleneck that the current external counterpulsation therapy lacks an effective instant hemodynamic effect evaluation method.
Description
Technical Field
The invention relates to the technical field of medicine, in particular to a method and a device for detecting the body hemodynamics response in the external counterpulsation treatment.
Background
The working principle of the external counterpulsation therapy is as follows: the special air bag sleeves are wrapped on the crus and the buttocks of a patient in sections, an electronic control device detects the electrocardiogram R wave of the patient, the contraction phase and the diastole phase of the heart are calculated in real time through an electronic computer, and accordingly, an air source device is instructed to inflate and exhaust each section of air bag, each section of air bag is inflated sequentially from far to near with a time difference of about 50ms in the diastole phase of the heart, the diastolic pressure is improved, arterial blood is driven back to the upper half body, the venous return heart blood volume is increased, and the blood perfusion of important organs of the upper half body such as heart, brain, kidney and the like is improved; when the heart enters the systole, the computer commands all the air bags to exhaust quickly and synchronously, after the lower limbs are decompressed, the artery is relaxed to receive the blood from the aorta, thereby reducing the afterload of the heart.
The direct aim of the external counterpulsation treatment is to increase the venous return blood volume and the cardiac output, thereby improving the blood perfusion of organs and tissues, particularly obviously increasing the blood supply of coronary artery of the heart and providing effective instant hemodynamic support for ischemic patients. The clinical external counterpulsation therapy is established aiming at myocardial ischemia, and starts from instant blood flow dynamics benefit, non-invasiveness and convenience, the patient' S finger pulse wave is selected as an evaluation means, the D/S value of the finger pulse volume wave in treatment is calculated as an evaluation index, and the coronary artery blood flow dynamics benefit can meet the clinical requirement if the D/S is more than or equal to 1.2. At present, the external counterpulsation therapy is widely used for treating ischemic diseases of heart and cerebral circulation systems, the indications include angina pectoris caused by coronary heart disease, ischemic stroke, diabetic foot, sudden deafness and the like, and the instant hemodynamic therapy benefit follows the evaluation standard that the D/S of the traditional finger pulse volume wave is more than or equal to 1.2.
However, there is a difference between the pulse wave and the finger pulse wave at the heart, brain, lower limbs, etc., especially when there are lesions, plaques, etc. in the circulatory system. Therefore, the existing method which simply uses the D/S value of the finger pulse volume wave waveform as the immediate effect evaluation standard of the external counterpulsation treatment is inaccurate and has huge defects, and the method is one of the root causes that the curative effect of patients with different disease types and individual differences after receiving the external counterpulsation treatment often has larger difference.
Furthermore, current interventional measurement techniques are not suitable for external counterpulsation due to the invasive nature, whereas non-interventional measurement techniques can only obtain blood flow velocities of a portion of superficial vessels. Whether the intervention is performed or not, the overall hemodynamic response of the body in the external counterpulsation intervention, particularly the hemodynamic conditions of important parts such as coronary arteries, aorta and the like cannot be effectively evaluated. The hemodynamics numerical simulation technology which is rapidly developed in recent years, particularly a one-dimensional model based on a pulse wave transmission theory, provides a new idea for effectively evaluating the hemodynamics characteristics of an organism, however, the current one-dimensional model has limitations, the modeling is very time-consuming and costly, the pulse wave transmission model takes blood flow waves at an aortic valve outlet and an ascending aorta as unique inlet boundary conditions, and due to the reason that an aortic valve is closed in a diastole, the one-dimensional model cannot reflect the intervention effect of an external counterpulsation effect on the diastolic waves, and the model itself needs to be greatly improved.
Disclosure of Invention
The technical problem to be solved by the present invention is to provide a method and a device for detecting and analyzing the hemodynamic response of a body in external counterpulsation treatment, aiming at solving the problem that in the prior art, the diastolic pressure and the blood perfusion effect at the target visceral organs cannot be accurately judged simply by using the ratio of the volume wave D/S of the finger pulse as an evaluation index; the method solves the problem that the current pulse wave transmission model is not suitable for solving the blood flow pulse wave and the pressure pulse wave of the arterial tree of the organism under the intervention of the external counterpulsation calculation.
The technical scheme adopted by the invention for solving the technical problem is as follows:
a method for detecting a hemodynamic response of an organism in external counterpulsation therapy, wherein the method comprises:
collecting physiological information of a sampler, and respectively collecting state data of blood vessels and blood flow of the sampler before and during external counterpulsation intervention treatment by adopting an ultrasonic bedside machine;
segmenting (26) an arterial tree based on an arterial tree structure model, collecting blood vessel internal diameter data of healthy volunteers meeting preset requirements, setting a baseline reference value, and constructing an arterial tree geometric model according to an exponential model of the arterial structure and a preset mathematical model;
setting solving boundary conditions, correcting and calibrating conditions, and carrying out numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correcting and calibrating conditions and on the basis of a pulse wave transmission theory and a calculation model to obtain blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment;
and calculating and analyzing the blood perfusion condition and the blood pressure condition of the target blood vessel section part and the target organ by using the pulse wave calculation results of the positions of the arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through contrastive analysis.
Preferably, the physiological information includes: the height information, the weight information, the sex information, the age information and the health information of the sampler.
Preferably, the state data of the blood vessel and the blood flow of the sampler includes: blood flow velocity and frequency spectrum of the common artery, ascending aorta and brachial artery and blood vessel inner diameter data of the left side and the right side neck of the sampler.
Preferably, the collecting physiological information of the sampler and acquiring the state data of the blood vessel and the blood flow of the sampler before and during the external counterpulsation treatment by using an ultrasound bedside machine respectively further comprises:
the systolic pressure and the diastolic pressure at the artery position of the person to be sampled are measured by the cuff-type blood pressure measuring apparatus.
Preferably, the segmenting the arterial tree based on the arterial tree structure model, acquiring the length and the inner diameter data of each blood vessel segment of a healthy volunteer meeting preset requirements, setting a baseline reference value, and calculating and constructing the arterial tree geometric model of the patient by using the exponential model of the arterial structure and a preset mathematical model, comprises:
dividing the artery into an upper artery and a lower artery, wherein the upper artery and the lower artery form a branch vascular network and an arterial tree structure;
dividing the arterial tree into 26 sections according to the arterial tree structure model;
utilizing a blood vessel enhanced CT to scan the whole blood vessel of a healthy volunteer which meets the requirements of age, height and physical condition, taking the average value of the length of the blood vessel as a baseline reference value, and utilizing a preset mathematical model and the baseline reference value to establish a calculation model of the length of each segment of the arterial tree of the patient; and establishing an inner diameter calculation model of each part of the arterial tree of the patient by using the exponential model of the arterial structure, a preset mathematical model and a baseline reference value.
Preferably, the setting and solving boundary conditions, correction and calibration conditions, and performing numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correction and calibration conditions and on the pulse wave transmission theory and the calculation model to obtain blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment includes:
setting boundary conditions by using ascending aorta blood flow wave of a sampler; calculating an exit boundary condition using a blood pressure measurement of the brachial artery; solving a model based on pulse wave transmission theory and 1D wave propagation, and setting a correction condition and a calibration condition for solving by combining blood flow waves of a common carotid artery and a brachial artery, and solving the pulse wave transmission condition and the pulse wave distribution condition of an arterial tree before and during external counterpulsation intervention treatment;
and calculating and analyzing the blood perfusion level and the blood pressure level of the target blood vessel section part and the target organ by using the pulse wave calculation results of the positions of the arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect analysis and evaluation report of the external counterpulsation intervention treatment.
A device for detecting the hemodynamic response of a subject during external counterpulsation therapy, wherein said device comprises:
the data collection module is used for collecting physiological information of a sampler and collecting blood vessel and blood flow state data of the sampler before and during external counterpulsation treatment by adopting an ultrasonic bedside machine;
the model building module is used for segmenting the arterial tree based on the arterial tree structure model, acquiring the length and the inner diameter data of each blood vessel of a healthy volunteer which meet the preset requirements, setting a baseline reference value, and building an arterial tree geometric model according to the exponential model of the arterial structure and a preset mathematical model;
the model solving module is used for setting and solving boundary conditions, correction and calibration conditions, carrying out numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correction and calibration conditions and on the basis of a pulse wave transmission theory and a calculation model, and obtaining blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment;
and the model evaluation module is used for calculating and analyzing the blood flow perfusion condition and the blood pressure condition of the target blood vessel section part and the target organ by utilizing the pulse wave calculation results of the positions of the arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through comparative analysis.
Preferably, the arterial tree model building module comprises:
the first sub-module is used for scanning the whole body blood vessels of a plurality of healthy volunteers meeting the requirements of age, height and physical conditions by using a blood vessel enhanced CT technology to obtain geometric information; dividing the arterial tree of the cardiac circulatory system into 26 sections by using an arterial tree structure model; establishing a baseline model of the human cardiac circulation arterial system by using the average value of the enhanced CT measurement data and the arterial tree model;
the second sub-module is used for calculating a mathematical model according to the artery segment, and calculating the length of each segment of artery of the patient by using the baseline model of the artery system and the individual information of the patient;
and the third sub-module is used for measuring the internal diameters of the common carotid artery, the ascending aorta, the brachial artery and the femoral artery of the patient by utilizing the color ultrasound technology and an ultrasonic bedside machine, taking the internal diameters as correction and calibration conditions, and calculating the inlet radius and the outlet radius of each section of artery of the patient by combining an index model of an artery structure and a preset mathematical model.
Preferably, the model solving module comprises:
the inlet boundary condition setting submodule is used for setting a solving boundary condition of pulse wave transmission by utilizing blood flow waves of ascending aorta before and during external counterpulsation treatment of a sampler;
the outlet boundary condition setting submodule is used for calculating the outlet boundary condition of the model by using brachial artery blood pressure measurement data before and during external counterpulsation treatment of a sampler and adopting a general centralized parameter calculation method;
the model calculation submodule is used for calculating blood flow pulse waves and pressure pulse waves at all positions of an arterial tree by combining a one-dimensional pulse wave transmission theory and a 1D wave propagation model;
and the model correction and calibration module is used for correcting and calibrating the pulse wave calculation result of the artery tree by using the blood flow wave measurement data of the common carotid artery and the brachial artery until the result obtained by the model calculation is matched with the correction and calibration conditions, namely the total flow error is not more than 10 percent and the maximum difference of the waveforms is not more than 10 percent.
Preferably, the model evaluation module comprises:
the blood perfusion evaluation submodule is used for calculating and evaluating the blood perfusion level and the blood redistribution characteristic of a target blood vessel section and important visceral organs such as the heart, the brain, the kidney, the lung and the like in the external counterpulsation intervention treatment;
and the blood pressure evaluation submodule is used for calculating and evaluating the change characteristics of the blood pressure level, particularly the diastolic pressure, of the target blood vessel segment and important organs such as the heart, the brain, the kidney, the lung and the like in the external counterpulsation intervention treatment.
The invention has the beneficial effects that: according to the invention, because the state data of the blood vessel and the blood flow of a sampler are collected, the flow pulse wave and the pressure pulse wave at each position of the arterial tree in the external counterpulsation intervention treatment are solved and obtained by adopting the pulse wave transmission theory and the one-dimensional solving model, the defect that the hemodynamic response of an organism, especially important visceral organs, is not effectively monitored and evaluated in the current external counterpulsation treatment is overcome, and an important basis is laid for the precise development of the therapy.
The invention collects the blood flow velocity and frequency spectrum of three parts of ascending aorta, common carotid artery and brachial artery, and calculates the corresponding blood flow wave. By adopting the ascending aorta blood flow wave as the boundary condition of the model inlet and the common carotid artery and brachial artery blood flow wave as the correction and calibration conditions, the problem that the influence of diastolic pressurization wave generated by external counterpulsation on the transmission of arterial tree pulse wave can not be calculated due to the fact that the one-dimensional pulse wave transmission model only takes the ascending aorta blood flow wave as the boundary condition of the model inlet is solved, and the problem that the one-dimensional pulse wave transmission model is not suitable for calculating the body hemodynamics response in the external counterpulsation interventional therapy is solved.
The invention provides a rapid, convenient and low-cost reconstruction method of the geometric characteristics of an arterial tree, which scans the whole body blood vessels of a plurality of healthy volunteers meeting the conditions by utilizing an enhanced CT technology, takes the average value of the length and the inner diameter of each segment of the blood vessels as a baseline reference value, further combines the ultrasonic measurement results of the inner diameters of the common carotid artery, the ascending aorta, the brachial artery and the femoral artery of a specific sampler (patient) and an arterial tree structure mathematical model, calculates the length and the width of each segment of the arterial tree of the sampler (patient), and solves the problems that the time consumption and the consumption of extracting the information of the arterial tree for geometric reconstruction and a contrast agent influence the sampler due to the enhanced CT or Magnetic Resonance Imaging (MRI) are needed by the conventional pulse wave calculation model.
Drawings
FIG. 1 is a flow chart of the preferred embodiment of the method for detecting the hemodynamic response of a subject during external counterpulsation provided by the present invention.
Fig. 2 is a human vascular network diagram and its corresponding arterial tree structure diagram in the method for detecting the body hemodynamic response in the external counterpulsation treatment provided by the present invention.
FIG. 3 is a schematic diagram of another arterial tree structure in the method for detecting the hemodynamic response of an organism in the external counterpulsation treatment provided by the invention.
FIG. 4 is a functional block diagram of the device for detecting the hemodynamic response of the body in the external counterpulsation therapy provided by the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention clearer and clearer, the present invention is further described in detail below with reference to the accompanying drawings and examples. It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention.
The method for detecting the body hemodynamics response in the external counterpulsation treatment can be applied to a terminal. The terminal may be, but is not limited to, various personal computers, notebook computers, mobile phones, tablet computers, vehicle-mounted computers, and the like. The terminal of the invention adopts a multi-core processor. The processor of the terminal may be at least one of a Central Processing Unit (CPU), a Graphics Processing Unit (GPU), a Video Processing Unit (VPU), and the like.
The indications of the prior external counterpulsation comprise ischemic cardiovascular and cerebrovascular diseases, peripheral blood vessels and micro-vascular diseases, and mainly comprise the following components: (1) coronary heart disease, angina pectoris, and myocardial infarction. (2) Cerebral arteriosclerosis, cerebral thrombosis, cerebral arterial embolism, paralysis agitans, vertebrobasilar artery insufficiency, cerebrovascular accident sequela. (3) Fundus artery embolism, central serous retina, choroidopathy, and optic atrophy. (4) Sudden deafness. (5) diabetes due to blood supply insufficiency of pancreatic arteriosclerosis. (6) Arterial embolization of the limb. (7) Ischemic disease sequelae caused by other arteriosclerosis and blood circulation disorders. (8) Sports fatigue, rehabilitation and health care.
The working principle of external counterpulsation is as follows: the special air bag sleeves are wrapped on the crus and the buttocks of a patient in sections, an electronic control system detects the electrocardiogram R wave of the patient, an electronic computer calculates the systole and the diastole of the heart in real time, and accordingly an air source system is instructed to inflate and exhaust each section of air bag, each section of air bag is sequentially inflated from far to near with a time difference of about 50ms in the diastole of the heart, the diastolic pressure is improved, arterial blood is driven back to the upper half body, the venous return heart blood volume is increased, and the blood perfusion of important organs of the upper half body such as heart, brain, kidney and the like is improved; when the heart enters the systole, the computer commands all the air bags to exhaust quickly and synchronously, after the lower limbs are decompressed, the artery is relaxed to receive the blood from the aorta, and the afterload of the heart is relieved.
The direct aim of the external counterpulsation is to increase the venous return blood volume and the cardiac output, thereby improving the blood perfusion of organs and tissues, particularly obviously increasing the blood supply of coronary artery of the heart, and providing effective instant hemodynamics support for ischemic patients; the long-term goal is mainly to promote the circulation of the heart and brain collateral and improve the cardiovascular and cerebrovascular functions. Therefore, the hemodynamics response characteristics of the body, the heart, the brain, the kidney and other important organs under the action of external counterpulsation are of great importance, and the method is not only a theoretical basis for counterpulsation intervention modes, parameter setting and device research and development, but also the most important index for evaluating the counterpulsation treatment effect.
However, a technique for evaluating the hemodynamic response characteristics of a patient's body and a target organ in real time during the external counterpulsation intervention has not been established so far. The technical scheme of more than 30 years ago is still used in clinic, namely, the finger pulse volume wave is used as the only evaluation means of the instant hemodynamic effect. The treatment of heart, brain, peripheral vascular diseases and tissue microvascular disorders adopts the same modes and parameters, and lacks precision and individuation, so that the benefits of patients are often greatly different, and meanwhile, the design concept of the external counterpulsation device is insubstantially broken through for more than 30 years. The lack of non-invasive and non-invasive accurate evaluation technology for tissue and organ blood perfusion in the process of external counterpulsation is the main technical bottleneck causing the above dilemma.
Therefore, the effective evaluation technology of the body hemodynamics response in the external counterpulsation intervention treatment becomes one of the key technologies influencing the development of the current external counterpulsation therapy and devices. Only when the real-time and non-invasive evaluation technology of the blood flow, the pulse wave and the blood flow redistribution of each part of the heart-brain circulation arterial tree is developed in the counter-pulsation intervention treatment, the more accurate counter-pulsation intervention technology and device can be designed, the personalized treatment scheme is formulated according to the specificity of target organs, the disease species and the individual difference of patients, the optimal hemodynamics effect is obtained, and the clinical curative effect and the safety of the external counter-pulsation treatment are effectively improved finally.
Since external counterpulsation therapy was originally aimed primarily at improving myocardial ischemia, the perfusion of coronary blood flow was primarily dependent on diastolic blood pressure. Therefore, when external counterpulsation therapy and devices are developed in the early stage, designers adopt blood pressure as an indirect evaluation index and continue to use until now under the condition that the change of coronary blood flow cannot be monitored in real time technically. At present, in the clinical extracorporeal counterpulsation therapy and device at home and abroad, finger pulse volume waves of a patient in the treatment process are collected, and the ratio (D/S) of diastolic pressure waves (D) to systolic pressure waves (S) is utilized to judge whether the immediate hemodynamic effect is achieved, namely D/S is more than or equal to 1.2, the requirement of curative effect is considered to be met, otherwise, the medical staff is required to adjust working parameters such as counterpulsation pressure, inflation and deflation time and the like until the requirement is met.
The technical scheme is simple, convenient and noninvasive, has good effect in the treatment of various ischemic vascular diseases, particularly the treatment of coronary heart disease and angina pectoris, and has been written into relevant clinical guidelines and expert consensus as an evaluation method and standard of instant blood flow effect of external counterpulsation. However, this evaluation method is too coarse and general, inaccurate, has very significant drawbacks, and fails to make the most reasonable adjustments to counterpulsation patterns and parameters to achieve optimal clinical benefit based on the species and patient-to-patient variability.
The current clinical external counterpulsation therapy is established aiming at myocardial ischemia, and an instant curative effect evaluation standard that the fingerpulse wave D/S is more than or equal to 1.2 is set for improving the coronary artery blood perfusion as a target, however, the optimal effect of improving the cerebral artery, peripheral blood vessels and micro blood vessel blood perfusion can not be achieved according to the evaluation standard, so that the optimal curative effect of treating ischemic stroke, diabetic foot, fundus artery embolism, sudden deafness and other diseases is generated. Recent studies at hong kong chinese university indicate that current evaluation criteria and counterpulsation parameters fail to achieve optimal cerebral artery perfusion enhancement, suggesting the use of counterpulsation pressures of 0.02MPa, which are much lower than the guideline recommendations (above 0.03 MPa), in the treatment of ischemic stroke.
The D/S value of the existing evaluation method is calculated based on the volume wave of the finger pulse wave, however, the pulse waves at the positions of the heart, brain, feet and the like and the waveform of the finger pulse wave have certain difference, especially under the condition that the circulatory system has lesion, plaque and the like, the D/S of the finger pulse wave is more than or equal to 1.2, which does not mean that the diastolic pressure and the blood perfusion at the target organ can achieve satisfactory effect, on the contrary, the D/S of the finger pulse wave is less than 1.2, which does not mean that the diastolic pressure and the blood perfusion at the target organ can not achieve satisfactory effect, and the D/S is closely related to the individual characteristics (age, height, weight, blood vessel and blood condition, disease condition and the like) of the patient. At the same time, high counterpulsation pressures may increase the risk of adverse events such as skin abrasion, lower back pain, deep vein thrombosis of the lower limb, internal carotid-cavernous sinus fistula, etc.
In addition, interventional and non-interventional measurement technologies are introduced by an external counterpulsation treatment center to monitor the hemodynamic changes of target organs in counterpulsation intervention treatment, and clinical researchers at the university of salt lake city and the university of independent cooperation of Japan measure the blood flow velocity and the blood pressure changes in the external counterpulsation intervention treatment by adopting interventional technologies such as right heart catheterization, radial artery catheterization, measurement of coronary pressure and Doppler blood flow, synchronous left and right heart catheter examination and the like. In addition, no matter the measurement method is an interventional or non-interventional measurement method, only the hemodynamic data of a certain blood vessel part or a certain blood vessel parts can be obtained, and the cardio-cerebral-peripheral vascular hemodynamic response condition and the blood flow redistribution characteristic cannot be systematically evaluated.
Currently, it is more feasible to evaluate the overall hemodynamic status of the arterial tree of a human body by a method combining a numerical simulation model, wherein a 1D wave propagation model (one-dimensional model) established based on a pulse wave transmission theory is considered as the most effective and feasible model. However, at present, there are significant limitations to one-dimensional models, which limit their wide clinical application: firstly, the whole blood vessels of a patient need to be scanned by utilizing imaging technologies such as CT, MRI and the like for reconstructing a geometric model, which is time-consuming and cost-consuming; secondly, because the existing one-dimensional model only takes the blood flow wave at the inlet of the ascending aorta as the inlet boundary condition, and the blood flow at the ascending aorta is almost 0 due to the closed aortic valve in the diastole, the one-dimensional model cannot reflect the influence of the diastolic pressurization wave generated by the external counterpulsation effect on the transmission of the arterial tree pulse wave, and the existing one-dimensional model is not suitable for evaluating the body hemodynamics response condition in the external counterpulsation intervention treatment.
Therefore, in order to solve the problems in the prior art, the embodiment provides a method for detecting a hemodynamic response of a body in external counterpulsation treatment, as specifically shown in fig. 1, comprising the following steps:
s100, collecting physiological information of a sampler, and respectively collecting state data of blood vessels and blood flow of the sampler before and in external counterpulsation treatment by adopting an ultrasonic bedside machine;
s200, segmenting an arterial tree based on an arterial tree structure model, collecting the length and the inner diameter data of each blood vessel segment of a healthy volunteer meeting preset requirements, setting a baseline reference value, and constructing a geometric solving model of the arterial tree of the patient according to an exponential model of the arterial structure and a preset mathematical model;
step S300, setting and solving boundary conditions, correction and calibration conditions, and carrying out numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correction and calibration conditions and on the basis of a pulse wave transmission theory and a calculation model to obtain blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment;
and S400, calculating and analyzing the blood flow perfusion condition and the blood pressure condition of the target blood vessel section part and the target organ by using the pulse wave calculation results of the positions of the arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through comparative analysis.
Specifically, the present embodiment first collects physiological information of a sampler, including: the height information, the weight information, the sex information and the age information of the sampler. And an ultrasonic bedside machine is further adopted to collect the state data of the blood vessel and the blood flow of the sampler in the external counterpulsation treatment before and after the external counterpulsation treatment, wherein the state data of the blood vessel and the blood flow of the sampler comprise: blood flow velocity and frequency spectrum of the common artery, ascending aorta and brachial artery and blood vessel inner diameter data of the left side and the right side neck of the sampler. When the sampler is a disease patient, the cuff type blood pressure measuring device is used to measure the systolic pressure and the diastolic pressure of the artery position of the sampler.
Further, the human artery is divided into an upper artery and a lower artery, the upper artery is an aorta, the lower artery is a peripheral artery, and the lower artery is an arteriole at the extremity. The superior and inferior arteries form a large network of branch vessels, as shown in detail in panel a of fig. 2. The length and the pipe diameter of the artery of the human body are different with the factors of height, weight, sex, age and the like and are influenced by pathological factors. The arterial tree is divided into 26 segments according to an arterial tree structure model (the arterial tree structure model is created by Olufsen et al), as shown in a diagram B in figure 2 and a diagram 3, the length of the human aorta mainly depends on the height, and the length of each vascular segment also depends on individual characteristics such as sex, age, weight, disease condition and other factors, so that the calculation model of the adult aorta length is proposed as follows:
Li＝k1ik2iL0i,i＝1,25
wherein L is the length of the individual vessel segment; l is0Selecting healthy volunteers with height of about 170cm as reference for the standard value of the length of the blood vessel section; k is a radical of1To take into account the influence coefficient of the individual body height, k1∈[0.8,1.2]； k2To take account of the influence coefficients of other factors of the individual, k2∈[0.9,1.0]The specific lengths of the different blood vessel segments are shown in table 1 below, in this embodiment, the cardiac artery blood vessel is used to enhance the CT scan to scan the whole blood vessel of the healthy volunteer according to the requirements of age, height and physical condition, and the average value is taken as L0To the reference value of (c). For example, cardiac arterial vascular enhancement CT is used for scanning the whole body blood vessels of 3 healthy volunteers with the age of about 25 years and the height of 170-175 cm.
TABLE 1
Since the arterial vessel tapers along its length, in the form of a conical tube, an exponential model is used to describe the conical vessel internal diameter variation:
wherein r istop、rbotProximal and distal radii, respectively, and L is the length of the vessel segment.
For a bifurcation site, the vessel radii of the parent and two daughter vessels can be expressed by the following approximate linear equation:
(r0)d1＝α(r0)pa,(r0)d2＝β(r0)pa
wherein (r)0)pa,(r0)d1,(r0)d2The radiuses of the main pipe, the sub pipe 1 and the sub pipe 2 are respectively; alpha and beta are asymmetric parameters, and 0.9 and 0.6 are respectively taken. For a vessel with n branches (as shown in fig. 3), the radius change can be described by the following equation:
(r0)k,n＝αkβn-kr0
in this embodiment, the inside diameters of the vessels at the three sites of the carotid artery, the brachial artery and the femoral artery of the patient (i.e. the patient is determined to be diseased) are measured by using an ultrasound bedside machine, and then the radii of the entrance and the exit of the vessel segments at each part of the arterial tree are calculated by combining the above models, as shown in fig. 2. Meanwhile, the heart artery blood vessel enhanced CT is used for scanning the internal diameter of the whole blood vessel of 3 healthy volunteers (the age is about 25 years, and the height is 170-175 cm) with satisfactory physical conditions, and the average value of the internal diameter is taken as a baseline reference value of healthy adults.
TABLE 2
Further, in this embodiment, the vessel wall is considered to be impermeable, the influence of gravity is ignored, and the vessel is longitudinally restrained. Under the above assumptions, aortic blood flow motion can be described by the Navier-Stokes equation and its variations:
the continuous equation:
momentum equation in conservation form:
wherein, p [ Pa]Is blood pressure, q [ m ]3]To the blood flow volume, z [ m ]]Is the abscissa, t [ s ]]Is time, A [ m ]2]Is the cross-sectional area of the blood vessel, Cm2·P·a-1 ]For vascular compliance, rho [ kg m ]-3]Is the blood density, am]The intravascular radius is defined as the kinematic viscosity v 1.046cm2. A and C0Calculated by the following formula:
A(z,t)＝A0+C0(p-p0)
wherein μ is Poisson's ratio, a0[m]As the vessel radius at the reference pressure, h m]Is wall thickness, E [ Pa]Is the Young's modulus. EH and a0Can be calculated using the empirical formula of Olufsen:
the fitting parameters are respectively as follows:
k1＝2.0×106[kg/(m·s2)],
k2＝-2.253×103[m-1],
k3＝8.65×104[kg/(m·s2)]
in this embodiment, boundary conditions, correction and calibration conditions are set in combination with the blood flow waves of the ascending aorta, common carotid artery and brachial artery of the person who samples; and calculating the hemodynamic parameters in the external counterpulsation effect by combining the blood flow waves of the ascending aorta, the common carotid artery and the brachial artery. The one-dimensional model takes the flow waves at the outlet of the aortic valve and the ascending aorta as inlet boundary conditions, and takes the impedance of the arteriole and the vein as outlet boundary conditions. For the outlet boundary condition, the impedance value of the outlet part is calculated by using the existing pulse wave transmission calculation method and model. For the entry boundary condition, the existing pulse wave transfer model takes the flow wave of the ascending aorta as the only entry boundary condition, thus causing the situation that the existing pulse wave transfer model is not suitable for calculating the external counterpulsation effect. The blood flow in the ascending aorta is influenced by the opening and closing of the aortic valve, and the blood flow in the ascending aorta is 0 or close to 0 at diastole due to the closing of the valve. For the external counterpulsation intervention therapy, the main action mechanism is to increase the blood perfusion of the important organs of the upper half body and simultaneously reduce the systolic pressure by increasing the volume of the return heart blood and improving the diastolic perfusion pressure of the arterial system, and the main influence is to generate diastolic pressure waves so as to increase the blood perfusion level of the arterial tree system and the important organs. Therefore, if the original setting mode of the boundary condition of the pulse wave transmission calculation model is still used, the influence of the counterpulsation on the pulse wave cannot be reflected, and the purpose of evaluating the hemodynamics effect of the extracorporeal counterpulsation intervention treatment by using the pulse wave transmission model is realized.
In the invention, because the influence of the external counterpulsation on the pulse waves at the carotid artery and the brachial artery is considered to be obvious, and the two parts belong to superficial blood vessels, the ultrasonic blood flow measurement is easy to realize, the invention provides a new idea for calculating the pulse waves in the external counterpulsation intervention treatment by combining the blood flow waves of the ascending aorta, the common carotid artery and the brachial artery. Firstly, calculating the flow pulse wave and the pressure pulse wave of an arterial tree before and during counterpulsation treatment by using a measured and calculated ascending aorta blood flow wave and pulse wave transmission calculation model; and correcting and calibrating the arterial tree flow wave and the pressure wave in the counterpulsation intervention through the measured and calculated common carotid artery and brachial artery flow waves, and enabling the blood flow wave waveforms, the total flow calculation value and the measured value of the common carotid artery and the brachial artery parts to reach the error allowable range through adjusting the inlet boundary condition in the counterpulsation intervention, and considering that the calculation results of the flow pulse wave and the pressure pulse wave at other parts of the arterial tree at the moment meet the requirements.
The invention solves the problem that the practical and feasible technology is lacked to effectively evaluate the whole body hemodynamics response condition and the target blood vessel and organ blood perfusion condition in the external counterpulsation treatment, lays an important foundation for developing the heart, brain and peripheral vascular disease difference and the precise external counterpulsation intervention treatment aiming at individual difference, and also lays an important foundation for developing a more targeted intelligent external counterpulsation device, thereby obviously improving the external counterpulsation treatment and the clinical benefit of the device.
Based on the above embodiment, the invention further provides a device for detecting the hemodynamic response of the body in the external counterpulsation treatment, and the functional block diagram of the device can be shown in fig. 4. The device includes: a data collection module 410, a model construction module 420, a model solution module 430, and a model evaluation module 440.
Specifically, the data collecting module 410 is configured to collect physiological information of a sampler, and collect blood vessel and blood flow state data of the sampler before and during external counterpulsation treatment by using an ultrasound bedside machine;
the model construction module 420 is used for segmenting the arterial tree based on the arterial tree structure model, acquiring the length and the inner diameter data of each blood vessel of a healthy volunteer which meet the preset requirements, setting a baseline reference value, and constructing a geometric solution model of the arterial tree of the patient according to the exponential model of the arterial structure and a preset mathematical model;
and the model solving module 430 is used for setting boundary conditions, solving correction and calibration conditions, solving the arterial tree system pulse wave transmission by using the pulse wave transmission theory and the 1D wave propagation model based on the boundary conditions, the solved correction and calibration conditions and the arterial tree geometric model, and acquiring blood flow and blood pressure pulse waves of all parts of the arterial tree of the body of the patient before and during external counterpulsation treatment, wherein the solved result is used for evaluating the blood flow perfusion effect of the target visceral organs.
And the model evaluation module 440 is configured to calculate and analyze blood perfusion conditions and blood pressure conditions of important parts of each blood vessel and target organs by using pulse wave calculation results of positions of the arterial tree before and during the external counterpulsation treatment, and form a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through contrastive analysis.
Preferably, the data collection module 410 in this embodiment is further configured to: for the above-mentioned sampler, the systolic pressure and diastolic pressure of the brachial artery of the sampler are measured by using an armcap type blood pressure measuring apparatus.
Preferably, the model building module 420 in this embodiment includes: the first sub-module scans the whole body blood vessels of a plurality of healthy volunteers meeting the requirements of age, height and physical conditions by using a blood vessel enhanced CT technology to obtain geometric information; dividing the arteries of the cardiovascular system into 26 sections by using an arterial tree structure model; and establishing a baseline model of the human cardiac circulation arterial system by using the average value of the enhanced CT measurement data and the arterial tree model. And the second sub-module calculates the length of each section of artery of the patient by utilizing the baseline model of the artery system and the individual information of the patient according to a preset geometric mathematical model of the artery section. And the third sub-module measures the internal diameters of the common carotid artery, the ascending aorta, the brachial artery and the femoral artery of the patient by utilizing a color ultrasonic technology and an ultrasonic bedside machine, takes the internal diameters as correction and calibration conditions, and calculates the inlet radius and the outlet radius of each section of artery of the patient by combining an index model of an artery structure and a preset mathematical model.
Preferably, the model solving module 430 in this embodiment includes: the inlet boundary condition setting submodule is used for setting a solving boundary condition of pulse wave transmission by utilizing blood flow waves of ascending aorta before and during external counterpulsation treatment of a sampler; the outlet boundary condition setting submodule is used for calculating the outlet boundary condition of the model by using brachial artery blood pressure measurement data before and during external counterpulsation treatment of a sampler and adopting a general centralized parameter calculation method; the model calculation submodule is used for calculating blood flow pulse waves and pressure pulse waves at all positions of an arterial tree by combining a one-dimensional pulse wave transmission theory and a 1D wave propagation model; and the model correction and calibration module is used for correcting and calibrating the pulse wave calculation result of the artery tree by using the blood flow wave measurement data of the common carotid artery and the brachial artery until the result obtained by the model calculation is matched with the correction and calibration conditions, namely the total flow error is not more than 10 percent and the maximum difference of the waveforms is not more than 10 percent.
Preferably, the model evaluation module 440 in this embodiment includes: the blood perfusion evaluation submodule is used for calculating and evaluating the blood perfusion level and the blood redistribution characteristic of a target blood vessel section and important visceral organs such as the heart, the brain, the kidney, the lung and the like in the external counterpulsation intervention treatment; and the blood pressure evaluation submodule is used for calculating and evaluating the change characteristics of the blood pressure level, particularly the diastolic pressure, of the target blood vessel segment and important organs such as the heart, the brain, the kidney, the lung and the like in the external counterpulsation intervention treatment.
Preferably, the apparatus in this embodiment may be an intelligent terminal, and the method steps in the above embodiments may be implemented by the intelligent terminal, so as to identify and locate the target in the video image. Preferably, the memory of the intelligent terminal comprises a nonvolatile storage medium and an internal memory. The nonvolatile storage medium stores an operating device and a computer program. The internal memory provides an environment for the operation device in the nonvolatile storage medium and the execution of the computer program. The intelligent terminal comprises a memory and a processor, wherein the memory stores a computer program, and the processor can at least realize the following steps when executing the computer program:
collecting physiological information of a sampler, and respectively collecting state data of blood vessels and blood flow of the sampler before and during external counterpulsation intervention treatment by adopting an ultrasonic bedside machine;
segmenting an arterial tree based on an arterial tree structure model, acquiring length and inner diameter data of each blood vessel of a healthy volunteer meeting preset requirements, setting a baseline reference value, and constructing a geometric solving model of the arterial tree of the patient according to an exponential model of the arterial structure and a preset mathematical model;
setting solving boundary conditions, correcting and calibrating conditions, and carrying out numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correcting and calibrating conditions and on the basis of a pulse wave transmission theory and a calculation model to obtain blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment;
and calculating and analyzing the blood perfusion condition and the blood pressure condition of the target blood vessel section part and the target organ by using the pulse wave calculation results of the positions of the arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through contrastive analysis.
In summary, the invention discloses a method and a device for detecting the hemodynamic response of an organism in the external counterpulsation treatment, wherein the method comprises the following steps: collecting physiological information of a sampler, and respectively collecting state data of blood vessels and blood flow of the sampler before and during external counterpulsation treatment; segmenting an arterial tree based on an Olufsen arterial tree structure segmentation method, collecting the length and inner diameter data of each blood vessel segment of a healthy volunteer meeting the preset requirements, setting a baseline reference value, and calculating and constructing an arterial tree geometric model of a patient; setting solved boundary conditions and correction and calibration conditions according to the ultrasonic measurement results, further calculating blood flow pulse waves and pressure pulse wave distribution of all parts of the arterial tree based on the pulse wave transmission theory and a solved model, and calculating blood flow perfusion and blood pressure levels of target blood vessel sections and visceral organs before and during external counterpulsation treatment according to the blood flow pulse waves and the pressure pulse wave distribution. The invention overcomes the defect that the existing external counterpulsation therapy lacks a rapid detection and evaluation technology aiming at the instant hemodynamics response of a target blood vessel section and organs, and is expected to play a role in the precision of the external counterpulsation intervention therapy and the intelligent development of devices.
It is to be understood that the invention is not limited to the examples described above, but that modifications and variations may be effected thereto by those of ordinary skill in the art in light of the foregoing description, and that all such modifications and variations are intended to be within the scope of the invention as defined by the appended claims.
Claims (3)
1. A device for detecting the hemodynamic response of a body during external counterpulsation therapy, said device comprising:
the data collection module is used for collecting physiological information of a sampler and collecting blood vessel and blood flow state data of the sampler before and during external counterpulsation treatment by adopting an ultrasonic bedside machine;
the model building module is used for segmenting the arterial tree based on the arterial tree structure model, collecting the blood vessel internal diameter data of the healthy volunteers meeting the preset requirements, setting a baseline reference value, and building an arterial tree geometric model according to the exponential model of the arterial structure and a preset mathematical model;
the model solving module is used for setting and solving boundary conditions, correction and calibration conditions, carrying out numerical solution on the pulse wave transmission condition and the pulse wave distribution of the arterial tree based on the geometric model of the arterial tree, the boundary conditions and the correction and calibration conditions and on the basis of a pulse wave transmission theory and a calculation model, and obtaining blood flow pulse waves and pressure pulse waves of each blood vessel section of the arterial tree before and during external counterpulsation treatment;
the model evaluation module is used for calculating and analyzing the blood flow perfusion condition and the blood pressure condition of a target blood vessel section part and a target organ by utilizing pulse wave calculation results of all positions of an arterial tree before and during the external counterpulsation treatment, and forming a real-time hemodynamic effect evaluation report of the external counterpulsation treatment through contrast analysis;
the model building module comprises:
the first sub-module is used for scanning the whole body blood vessels of a plurality of volunteers meeting the requirements of age, height and physical conditions by using a blood vessel enhanced CT technology to obtain geometric information; dividing the arteries of the cardiovascular system into 26 sections by using an arterial tree structure model; establishing a baseline model of a human body cardiac circulation arterial system by using an average value of enhanced CT measurement data and an arterial tree segmentation method;
the second sub-module is used for calculating a mathematical model according to the artery segment, and calculating the length of each segment of artery of the patient by using the baseline model of the artery system and the individual information of the patient;
and the third sub-module is used for measuring the internal diameters of the common carotid artery, the ascending aorta, the brachial artery and the femoral artery of the patient by utilizing the color ultrasound technology and an ultrasonic bedside machine, taking the internal diameters as correction and calibration conditions, and calculating the inlet radius and the outlet radius of each section of artery of the patient by combining an index model of an artery structure and a preset mathematical model.
2. The apparatus for detecting the hemodynamic response of a subject in extracorporeal counterpulsation therapy according to claim 1, wherein said model solving module comprises:
the inlet boundary condition setting submodule is used for setting a solving boundary condition of pulse wave transmission by utilizing blood flow waves of ascending aorta before and during external counterpulsation treatment of a sampler;
the outlet boundary condition setting submodule is used for calculating the outlet boundary condition of the model by using brachial artery blood pressure measurement data before and during external counterpulsation treatment of a sampler and adopting a general centralized parameter calculation method;
the model calculation submodule is used for calculating blood flow pulse waves and pressure pulse waves of each position of an arterial tree before and during external counterpulsation treatment by combining a one-dimensional pulse wave transmission theory and a 1D wave propagation model;
and the model correction and calibration module is used for correcting and calibrating the calculation results of the blood flow pulse wave and the pressure pulse wave at each position of the artery tree by using the blood flow wave measurement data of the common carotid artery and the brachial artery until the calculation result of the model is matched with the correction and calibration conditions, namely the total flow error is not more than 10 percent and the maximum difference of the waveforms is not more than 10 percent.
3. The apparatus for detecting the hemodynamic response of a subject in extracorporeal counterpulsation therapy according to claim 1, wherein said model evaluation module comprises:
the blood perfusion evaluation submodule is used for calculating and evaluating the blood perfusion level and the blood redistribution characteristic of a target blood vessel section, the heart, the brain, the kidney and the lung in the external counterpulsation intervention treatment;
and the blood pressure evaluation submodule is used for calculating and evaluating the blood pressure level of the target blood vessel section and the heart, the brain, the kidney and the lung in the external counterpulsation intervention treatment.
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