CN114521894A - Blood oxygen saturation monitoring and liver function testing system based on central venous catheter - Google Patents
Blood oxygen saturation monitoring and liver function testing system based on central venous catheter Download PDFInfo
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- 239000008280 blood Substances 0.000 title claims abstract description 84
- 210000004369 blood Anatomy 0.000 title claims abstract description 84
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 title claims abstract description 83
- 239000001301 oxygen Substances 0.000 title claims abstract description 83
- 229910052760 oxygen Inorganic materials 0.000 title claims abstract description 83
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- 238000012360 testing method Methods 0.000 title claims abstract description 25
- MOFVSTNWEDAEEK-UHFFFAOYSA-M indocyanine green Chemical compound [Na+].[O-]S(=O)(=O)CCCCN1C2=CC=C3C=CC=CC3=C2C(C)(C)C1=CC=CC=CC=CC1=[N+](CCCCS([O-])(=O)=O)C2=CC=C(C=CC=C3)C3=C2C1(C)C MOFVSTNWEDAEEK-UHFFFAOYSA-M 0.000 claims abstract description 124
- 229960004657 indocyanine green Drugs 0.000 claims abstract description 123
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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
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
- A61B5/14551—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases
- A61B5/14556—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases by fluorescence
-
- 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
- A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
- A61B5/02152—Measuring pressure in heart or blood vessels by means inserted into the body specially adapted for venous pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
- A61B5/4222—Evaluating particular parts, e.g. particular organs
- A61B5/4244—Evaluating particular parts, e.g. particular organs liver
Abstract
The invention provides a system for monitoring blood oxygen saturation and testing liver function based on a central venous catheter, which at least comprises the central venous catheter and a photoelectric module, wherein a catheter body in the central venous catheter is of a multi-cavity structure, an independent coloring agent injection cavity and an optical fiber cavity are arranged in the catheter body, a coloring agent injection channel and a coloring agent injection joint which are communicated with the coloring agent injection cavity and an optical fiber joint which is connected with optical fibers in the optical fiber cavity are connected above the catheter body through a fixed support; the photoelectric module is connected with an optical fiber joint in the multi-cavity central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit. The system can obtain the blood oxygen saturation of the central vein and the pressure of the central vein of a patient simultaneously through one-time puncture implantation, is provided with a special channel for injecting indocyanine green, and helps to evaluate the liver function of the patient by monitoring the concentration change in a period of time after ICG injection.
Description
Technical Field
The invention provides a system capable of simultaneously monitoring blood oxygen saturation and testing liver function based on a central venous catheter, and belongs to the technical field of medical instruments.
Background
With the development of science and technology and the progress of applied medicine, minimally invasive treatment is widely applied to clinical medicine, and medical care personnel can more accurately obtain physiological characteristic parameters of patients through the minimally invasive technology so as to more quickly and accurately judge the course and physiological state of patients and conveniently and effectively adopt treatment schemes in time.
Clinically, mixed venous oxygen saturation (SvO)2) Can reflect the general venous oxygenation condition, but needs to keep a pulmonary artery catheter, and the central venous oxygen saturation (ScvO)2) Can be obtained by a central venous catheter indwelling in the superior vena cava at the level of the right atrium, good correlation and correspondence between the two has been observed in a wide range of clinical practices, and the SvO is applied in the last decade by a minimally invasive monitoring technique2Change of monitoring to ScvO2Has become a trend. The traditional method for monitoring venous oxygen saturation requires blood sample extraction and in vitro colorimetry or blood gas analyzer to obtain results, although the results are obtainedBut accurate but not continuous monitoring. In most critically ill patients, real-time monitoring of ScvO is required2When ScvO is used2<At 60%, patient mortality increased significantly, and traditional vital signs suggest that tissue oxygen insufficiency is late. By integrating fiber optic measurement technology in the central vein, real-time changes in oxygen supply balance can be discovered, and tracking treatment effects in real time continuously can significantly reduce complications and mortality.
Meanwhile, the diagnostic drug indocyanine green (ICG) is injected into a blood vessel, the concentration change of the indocyanine green is measured, the ICG clearance rate can be calculated, the method can be used as a dynamic index for observing the whole liver function and the blood perfusion of the liver, can help doctors to judge whether the liver function of a patient is incomplete, whether the rest liver function can maintain planned resection operation, whether abnormal liver function can be caused after operation and the like, liver hypoperfusion can be quickly detected in ICU application, the survival rate is estimated, and intervention measures are indicated when the clearance rate is lower than 16%/Min. The traditional method adopts intravenous injection of one side arm, blood drawing assay of the other side arm after 15 minutes to determine the concentration value of indocyanine green, and the clearance rate of indocyanine green is calculated for 15 min. The critical patients mostly need central venous catheterization, concentration change curves from ICG injection to excretion completion can be measured through ICG injection and blood drawing detection (see figure 1), clearance indexes required for 5 minutes, 10 minutes, 15 minutes and the like are calculated, and continuous liver function indexes and change trends during the measurement period are obtained.
However, in the prior art, when performing blood oxygen saturation monitoring and liver function testing, separate devices (including a catheter and a monitoring device) are used, and for a patient needing blood oxygen saturation monitoring and liver function testing, the number of times of puncture and consumed medical consumables are increased, so that the pain of the patient is increased and the treatment cost is increased.
Disclosure of Invention
The invention solves the defects in the background technology and provides a blood oxygen saturation monitoring and liver function testing system based on a central venous catheter. When medical personnel need to carry out central venous minimally invasive puncture on a patient to obtain more physiological characteristics of the patient, the system can simultaneously obtain the central venous blood oxygen saturation and the central venous pressure of the patient through one-time puncture implantation, is provided with a special channel for injection of indocyanine green (ICG), and helps to evaluate the liver function of the patient by monitoring concentration change (plasma clearance rate of the ICG) within a period of time after ICG injection.
The technical scheme adopted for realizing the above purpose of the invention is as follows:
a blood oxygen saturation monitoring and liver function testing system based on a central venous catheter at least comprises the central venous catheter and a photoelectric module, wherein a catheter body in the central venous catheter is of a multi-cavity structure, an independent coloring agent injection cavity and an optical fiber cavity are arranged in the catheter body, and a coloring agent injection channel and a coloring agent injection joint which are communicated with the coloring agent injection cavity and an optical fiber joint which is connected with an optical fiber in the optical fiber cavity are connected above the catheter body through a fixed support;
the photoelectric module is connected with an optical fiber connector in the multi-cavity central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light of at least three wave bands, the AD sampling unit is used for carrying out signal conversion, the calculating unit calculates digital signals converted in the AD sampling unit and transmits the calculation results to the communication unit, and the communication unit is in communication connection with terminal equipment;
two calculation modes are arranged in the calculation unit: a blood oxygen saturation monitoring mode without dye injection, and a blood oxygen saturation monitoring plus liver function test mode with dye injection.
In particular, the wavelengths that the transmitting unit and the receiving unit can transmit and receive are in particular λ1＝660nm，λ2＝805nm，λ3The staining agent is indocyanine green (ICG) 940 nm.
Specifically, the specific calculation method in the blood oxygen saturation monitoring mode without injecting the stain is as follows:
only reduced hemoglobin Hb and oxygenated hemoglobin HbO are considered in this mode2Shadow ofAt two wavelengths λ1And λ2Absorption coefficient of
And
comprises the following steps:
and further calculating by a double-wavelength method:
substituting the above equation into the defining equation for blood oxygen saturation:
ScvO2＝[CHbO2*100]/[CHbO2+CHb]
due to the selection of lambda1At 660nm, band λ2805nm is oxygen and hemoglobin HbO2And the equivalent intersection point of the absorbance coefficient curve of reduced hemoglobin Hb, i.e. epsilonλ2 HbO2＝ελ2 HbTherefore, further derived:
in the above formula, ScvO2Central venous oxygen saturation (%), epsilonλ1 Hb、ελ1 HbO2、ελ2 Hb、ελ2 HbO2Are all constants, C, obtained by time domain or frequency domain spectroscopyHbO2Oxyhemoglobin concentration, CHbReduction of the hemoglobin concentration, Dλ1、Dλ2Is obtained by measuring the light intensity.
Specifically, the specific calculation method in the blood oxygen saturation monitoring and liver function test mode by injecting the coloring agent is as follows:
when ICG is injected, the peak value of the absorption wave is 805nm, and the absorption of 660nm wavelength is also influenced, and the 940nm wavelength is not influenced; d with the wavelength of 940nm needing to be selected and not influencedλ3Calculate the corresponding DLambda 2 correctionThen eliminate Dλ2The ICG concentration is calculated after the influence is corrected, and then D after the influence of the ICG is eliminated is calculatedLambda 1 correctionAnd the blood oxygen saturation can be calculated finally.
(1): after ICG injection, with Dλ3Calculate the corresponding DLambda 2 correctionValue of
Firstly, when injecting indocyanine green-free ICG, according to the wave band lambda2805nm and λ3D was derived using the dual wavelength method at 940nmλ2And Dλ3The ratio of (d) and the blood oxygen saturation are linearly related:
Dλ3/Dλ2＝ελ3 Hb/ελ2 Hb+(ελ3 HbO2/ελ2 Hb-ελ3 Hb/ελ2 Hb)ScvO2
further simplifying calculation by using theoretical value to obtain lambda in wave band2805nm and λ3The relationship between the change of the reflection intensity of 940nm hemoglobin:
Dλ2＝Dλ3/[1-K2*(ScvO2-51)]
using the currently measured Dλ3And calculating the blood oxygen saturation concentration of the indocyanine green ICG at the last time, and obtaining:
Dlambda 2 correction＝Dλ3/[1-K2*(ScvO2-51)]；
(2): liver function calculation
Liver function was measured by indocyanine green clearance test method, when indocyanine green ICG was injected, wavelength λ2The absorption coefficient of 805nm is increased byInfluence of the ICG absorption Peak of indocyanine green, i.e.
μ0 Lambda 2 correction＝ελ2 HbCHb+ελ2 HbO2CHbO2+ελ2 ICGCICG
Then according to the following formula:
Dλ2＝(ελ2 HbCHb+ελ2 HbCHbO2+ελ2 ICGCICG)*K
Dlambda 2 correction＝(ελ2 bCHb+ελ2 HbCHbO2+ελ2 HbO2CHbO2)*K
Subtracting the two equations to obtain:
Dλ2-Dlambda 2 correction＝ελ2 ICGCICGK; k in this equation is a constant, further calculating:
CICG＝(Dλ2-Dlambda 2 correction)/ελ2 ICGK, thereby calculating the real-time concentration C of indocyanine green ICGICG；
Substituting the calculation into the following equation: rn ═ Cn/C0*100％；
Further, it is obtained that: rn＝(Dλ2-DLambda 2 correction)n/(Dλ2-DLambda 2 correction)0*100％；
In the above formula: epsilonλ2 ICGRn is the residual rate of indocyanine green ICG in blood after n minutes, C is a constant obtained by time domain or frequency domain spectroscopynIs the concentration of indocyanine green ICG after n minutes, C0Is the concentration of indocyanine green ICG at time reference 0 after ICG injection; wherein (D)λ2-DLambda 2 correction)nAnd (D)λ2-DLambda 2 correction)0Rate of change D of reflected light intensity measured at n minutes and 0, respectivelyλ2And corrected DLambda 2 correctionA difference of (d);
(3): calculation of blood oxygen saturation after indocyanine green ICG injection
The absorption coefficient for the wavelength λ 1 ═ 660nm after ICG injection of indocyanine green also increases the effect of ICG absorption:
μ0 λ1＝ελ1 HbCHb+ελ1 HbO2CHbO2+ελ1 ICGCICG
Dλ1＝(ελ1 HbCHb+ελ1 HbCHbO2+ελ1 ICGCICG)*K
rate of change D of reflected light intensity after elimination of ICGLambda 1 correctionComprising only Hb and HbO2The following components:
Dlambda 1 correction＝(ελ1 HbCHb+ελ1 HbCHbO2)*K
＝Dλ1-ελ1 ICGCICG*K
Substitution into ICG concentration C calculated for hepatic functionICG：
DLambda 1 correction＝Dλ1-ελ1 ICG*(Dλ2-DLambda 2 correction)/ελ2 ICG
The corrected central venous oxygen saturation ScvO is calculated by the following formula2 correction：
Specifically, the inner wall of the coloring agent injection channel is coated with a light-shielding coating, or the coloring agent injection channel is made of a colored material.
Specifically, a catheter body in the central venous catheter is of a four-cavity structure, a pressure measurement cavity and a transfusion cavity are further arranged besides a coloring agent injection cavity and an optical fiber cavity, the pressure measurement cavity is used for penetrating a guide wire guide catheter during puncture and is placed in the pressure measurement cavity, and after the puncture is finished, the guide wire is drawn out and then is connected with invasive blood pressure measurement equipment to measure the central venous blood pressure; the transfusion cavity is used for blood collection and transfusion; the upper part of the catheter body is connected with a pressure measurement channel and a pressure measurement joint which are communicated with the pressure measurement cavity through a fixed support, and an infusion channel and an infusion joint which are communicated with the infusion cavity.
Specifically, the outlets of the optical fiber cavity and the pressure measurement cavity are located at the far end of the catheter body, and the outlets of the infusion cavity and the dyeing agent injection cavity are located at the near end of the catheter body.
Specifically, the coloring agent injection connector, the pressure measurement connector and the infusion connector are all standard luer connectors.
Specifically, the terminal device is a monitor, and the monitor controls the photoelectric module through the digital communication interface, and is used for setting the intensity and time-sharing frequency of the light radiation output by each wavelength, receiving the received light intensity of each wavelength fed back by analysis, and intelligently adjusting the luminous light intensity to obtain the optimal measurement result.
Specifically, the monitor has a human-computer interface interaction function, and can input calibration parameters and display a blood oxygen saturation measurement result and a stain concentration change curve in real time.
The inventive principle of the present application is as follows: according to the applicant's study of spectral analysis, the measurement of the concentration of oxyhemoglobin (HbO) was carried out from2) The absorption spectrum curves (shown in figure 2) of the reduced hemoglobin (Hb) and the indocyanine green (ICG) are obviously different from each other in absorption spectrum, and the method adopts three wavelengths to simultaneously complete the measurement of the blood oxygen saturation and the ICG concentration. At a wavelength of 805nm is Hb and HbO2The absorption coefficient of the equal value point of the absorption coefficient of the two is not changed along with the change of the blood oxygen saturation, the wavelength measurement is hardly influenced by other substances in blood, and the equal value point is an ideal reference wavelength for measuring the blood oxygen saturation by adopting the dual wavelength. The ICG has an absorption peak just at 805nm, the absorption coefficient of the ICG is far greater than that of hemoglobin, measurement data of the wavelength after ICG injection cannot be directly used for calculating the blood oxygen saturation level and is used for ICG concentration measurement, and meanwhile, the influence of hemoglobin components in the wavelength needs to be eliminated when ICG is accurately measured. The absorption range of ICG light radiation is mainly concentrated between the wavelengths 700 and 900nm, so that light radiation outside this range is usedThe absorption of the test light radiation at wavelength is mainly influenced by the variation of the blood oxygen saturation. Light near 660nm wavelength on HbO2The difference between the absorption coefficient and the Hb is approximately maximum and approximately 10 times, and when the blood oxygen saturation is different, the blood is most sensitive to the change of the light absorption amount of the wavelength; after ICG injection, it will interfere with the absorption at 660nm, causing the measurement error of blood oxygen saturation, and it is necessary to calculate the ICG concentration and then eliminate the effect.
In the wavelength range of 850-950 nm, the two curves change slowly and are approximately overlapped, and 940nm which is larger than 900nm is selected as a third measurement wavelength to avoid the influence of ICG. HbO at 940nm wavelength2The difference between the measured absorbance and the equivalent point of 805nm is not large, the linear relation is formed between the ratio of the change rate of the reflection light intensity of 805nm and the blood oxygen saturation, and hemoglobin (Hb + HbO) corresponding to the wavelength of 805nm is calculated by using the measured change rate of the 940nm reflection light intensity after ICG injection according to the blood oxygen saturation2) The resulting rate of change of reflected light intensity is subtracted from the measured rate of change of 805nm intensity by hemoglobin (Hb + HbO)2) The corresponding absorption amount part of (A), the accurate ICG concentration data can be calculated, and the ICG interference of 660nm is further corrected according to the ICG concentration to obtain the hemoglobin (Hb + HbO)2) So that blood oxygen saturation can be calculated after ICG injection.
In conclusion, compared with the prior art, the system for monitoring blood oxygen saturation and testing liver function based on the central venous catheter provided by the application can monitor the central venous blood oxygen saturation, the central venous pressure and the liver function of a patient through one-time puncture of the central venous catheter, so that the pain of the patient in puncture is reduced, and the medical cost is reduced.
Drawings
FIG. 1 is a graph showing the variation of concentration of ICG during the whole period from the injection to the completion of excretion in the prior art;
FIG. 2 shows oxyhemoglobin (HbO) in the context of the invention2) Absorption spectrum profiles of reduced hemoglobin (Hb) and indocyanine green (ICG);
FIG. 3 is a schematic diagram showing an overall configuration of a test system in an embodiment;
FIG. 4 is a sectional view taken along line A-A of FIG. 3;
in the figure: 1-a catheter body, 2-a stain injection cavity, 3-an optical fiber cavity, 4-a fixed support, 5-a stain injection channel, 6-a stain injection connector, 7-an optical fiber connector, 8-a pressure measurement cavity, 9-an infusion cavity, 10-a pressure measurement channel, 11-a pressure measurement connector, 12-an infusion channel and 13-an infusion connector.
Detailed Description
The present invention will be described in detail with reference to the following drawings and specific embodiments, but the scope of the present invention is not limited to the following embodiments.
The structure of the system for monitoring blood oxygen saturation and testing liver function based on central venous catheter provided in the embodiment is shown in fig. 3 and 4:
The top of pipe body is connected with through fixed bolster 4 and injects the coloring agent injection channel 5 and the coloring agent injection joint 6 of chamber intercommunication with the coloring agent, the inner wall of coloring agent injection channel on the coating have a light-resistant coating, perhaps the material of coloring agent injection channel is coloured material, this passageway is used for injecting indocyanine green, has avoided on-the-spot light radiation to disturb, and the liver function test is accomplished to the interior optical fiber measurement indocyanine green concentration of cooperation pipe. The upper part of the catheter body is connected with an optical fiber connector 7 connected with an optical fiber in the optical fiber cavity through a fixed support, and the photoelectric module is connected with the optical fiber connector in the multi-cavity central venous catheter. The upper part of the catheter body is connected with a pressure measuring channel 10 and a pressure measuring joint 11 which are communicated with the pressure measuring cavity, and an infusion channel 12 and an infusion joint 13 which are communicated with the infusion cavity through a fixed support. The stain injection connector, the pressure measurement connector and the infusion connector are all standard luer connectors.
When the invention is used, the catheter body is placed into the central vein of a patient through puncture auxiliary instruments such as a guide wire, a puncture needle and the like, and the catheter is fixed on the body surface of the patient through the fixing bracket after the catheter is placed into the central vein of the patient. After the catheter is fixed, the adaptive invasive blood pressure measuring equipment is connected, and the central venous blood is conveyed to the blood pressure measuring equipment through the blood pressure testing channel to complete the monitoring of the central venous blood pressure. After the catheter is fixed, the catheter can be connected with related pipelines, valves or tee joints through the infusion channel, and the intravenous blood sampling and injection can be completed by matching with an injector and an infusion apparatus.
In a specific using link, the terminal equipment is a monitor, the monitor equipment controls the photoelectric module through a digital communication interface, sets the intensity and time-sharing frequency of light radiation output by each wavelength, receives and analyzes the received light intensity of each wavelength fed back, can intelligently adjust the luminous light intensity to obtain the optimal measuring result, and respectively calculates ScvO through comparison of multiple groups of data2And ICG concentration. The monitor has a human-computer interface interaction function, and can input calibration parameters and display ScvO in real time2Measurement results and ICG concentration variation curves.
The photoelectric module comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light of at least three wave bands, the AD sampling unit is used for carrying out signal conversion, the calculating unit calculates digital signals converted in the AD sampling unit and transmits the calculation results to the communication unit, and the communication unit is in communication connection with the terminal equipment.
Two calculation modes are arranged in the calculation unit: a blood oxygen saturation monitoring mode without dye injection, and a blood oxygen saturation monitoring plus liver function test mode with dye injection.
The above two calculation modes will be explained in detail in the following embodiment.
The invention discloses a blood oxygen saturation monitoring mode without injecting a coloring agent, which uses a light radiation reflection detection mode of red light and near infrared spectrum, in a biological tissue, the reflection detection mode and the transmission detection mode both conform to Lambert-Beer law, the change rate of light intensity of a certain single wavelength is represented by D, and a general light intensity change formula is as follows:
D＝-μ0K (1)
μ0＝εC (2)
i.e. the rate of change of the intensity of light reflected D and the absorption coefficient mu0In direct proportion, K is a constant related to the reflection structure of the light system, and epsilon is the absorptivity of the light absorbing substance; c is the concentration of the light absorbing species.
The rate of change of light intensity is based on Lambert-Beer's law, and the light intensity with single wavelength is I0Measured from the emitted and reflected light intensities I:
D＝Ln I/I0 (3)
after the system is started with the correct catheter to central vein and the correct connection, blood gas analysis or laboratory tests can be performed by extracting central vein blood oxygen through the catheter before injecting ICG, and ScvO is input into the monitoring equipment2The laboratory blood gas analysis and examination result can be used for calibrating the measuring system once, and the system error caused by the measuring error of the emission light intensity and the reflection light intensity is further reduced.
Specifically, in the practical application scene of the invention, the diameters of the transmitting optical fiber and the receiving optical fiber are within 0.5mm, the two optical fibers are arranged side by side and directly enter the blood vessel along with the catheter for measurement, and the reflected light path in the blood vessel is only related to blood and is not influenced by other tissue components of a human body. The measured central vein and artery of human body are different, the blood pressure of central vein is lower, its normal value is 5-10mmHg, pressure wave is basically stable, and the change rate of light reflection intensity is not changed with the heart pulse, and is a stable value.
Emission intensity I of each wavelength0The light-emitting unit can be controlled by a photoelectric module and can be adjusted in multiple stages, the intensity of each stage is calibrated through tests, and in order to ensure the stability of the light-emitting unit, the light-emitting unit is provided with heat preservation measures and constant temperature control.
In the red light and near infrared light region of 600-Hemoglobin (HbO)2) Much smaller than it is. Thus, when the selected wavelength is in the near infrared region (e.g., λ)1＝660nmλ2＝805nmλ3940nm) of three beams, only reduced hemoglobin (Hb) and oxygenated hemoglobin (HbO) are considered2) The absorption coefficient at two wavelengths may be rewritten as equation (2) below:
by the dual wavelength method:
substituting the above equation into the defining equation for blood oxygen saturation:
ScvO2＝[CHbO2*100]/[CHbO2+CHb]
wherein: ScvO2Central venous oxygen saturation (%), CHbO2Oxyhemoglobin concentration, CHbReducing hemoglobin concentration and selecting lambda1Is 660nm, lambda2When the curve of the absorption coefficients of the oxygen and hemoglobin HbO2 and reduced hemoglobin Hb is equal to the intersection point (805nm), i.e.. epsilonλ2 HbO2＝ελ2 HbThen, obtaining:
in the formulaλ1 Hb、ελ1 HbO2、ελ2 Hb、ελ2 HbO2Are all constants and can be obtained by time domain or frequency domain spectroscopy, Dλ1、Dλ2Can be obtained by measuring the light intensity。
ScvO can be calculated using the above formula for blood oxygen saturation monitoring only when ICG is not injected2。
Second, blood oxygen saturation monitoring and liver function test mode of injecting coloring agent
When the ICG is injected, the peak value of the absorption wave is 805nm, and the absorption of the wavelength of 660nm is also influenced, and the wavelength of 940nm is not influenced. D with the wavelength of 940nm needing to be selected and not influencedλ3Calculate the corresponding DLambda 2 correctionThen eliminate Dλ2The ICG concentration is calculated after the influence is corrected, and then D after the influence of the ICG is eliminated is calculatedLambda 1 correctionAnd the blood oxygen saturation can be calculated finally.
(1): after ICG injection, with Dλ3Calculate the corresponding Dλ2Correction value
The change of the reflected light intensity at 805nm is not affected by the change of the blood oxygen saturation, and the change rate of the reflected light intensity at 940nm is slightly reduced along with the increase of the blood oxygen saturation, and D is directly usedλ3Substitution Dλ2The calculation has an error of about 1% -5%. According to the formula (6), for the ICG injection-free, the wave band lambda2805nm and λ3D can be derived using the dual wavelength method at 940nmλ2And Dλ3The ratio of (d) and the blood oxygen saturation are linearly related:
Dλ3/Dλ2＝ελ3 Hb/ελ2 Hb+(ελ3 HbO2/ελ2 Hb-ελ3 Hb/ελ2 Hb)ScvO2 (8)
can further utilize theoretical value to simplify calculation to obtain lambda in wave band2805nm and λ3940nm hemoglobin reflection intensity variation relation
Dλ2＝Dλ3/[1-K2*(ScvO2-51)] (9)
Dλ3At a wavelength of 940nm, to Dλ2At 805nm, K2The theoretical value is about 0.1%, and in practical application, the blood oxygen saturation concentration value obtained by blood gas test can be used for measuringK2And (6) correcting.
Because the blood oxygen saturation concentration of the vein of the human body does not change rapidly, the blood oxygen saturation concentration can be considered to be kept unchanged within a few seconds immediately before and after the injection into the ICG, and the currently measured D can be usedλ3And the last calculation of the blood oxygen saturation concentration several seconds before the injection, the following results are obtained:
Dlambda 2 correction＝Dλ3/[1-K2*(ScvO2-51)] (10)
Since the blood oxygen saturation concentration of the human vein does not change rapidly, the ScvO calculated last time can be used every time thereafter2To calculate to obtain DLambda 2 correction
(2): liver function computing
Liver function was measured by indocyanine green clearance test method, when indocyanine green ICG was injected, wavelength λ2The absorption coefficient of 805nm increases the influence of the ICG absorption peak of indocyanine green, i.e.
μ0 λ2＝ελ2 HbCHb+ελ2 HbO2CHbO2+ελ2 ICGCICG (11)
Measuring the concentration of ICG using the wavelength lambda of the ICG absorption peak2805nm, elimination of Hb and HbO is required2According to formula (1):
Dλ2＝(ελ2 HbCHb+ελ2 HbCHbO2+ελ2 ICGCICG)*K(12)
Dlambda 2 correction＝(ελ2 HbCHbO2+ελ2 HbO2CHbO2)*K (13)
Subtraction of two formulae
Dλ2-DLambda 2 correction＝ελ2 ICGCICG*K；
K is a constant in this equation when the entire optical measurement structure is determined to be constant, and is further calculated as:
CICG＝(Dλ2-Dlambda 2 correction)/ελ2 ICGK (14)
Thus calculating the real-time concentration C of the indocyanine green ICGICG；
Liver function testing was achieved by monitoring changes in the residual rate within 15 minutes after ICG injection:
Rn＝Cn/C0*100％
in the above formula: epsilonλ2 ICGIs a constant obtained by time domain or frequency domain spectroscopy, RnIs the ICG residual rate of indocyanine green in blood after n minutes, CnIs the concentration of indocyanine green ICG after n minutes, C0Is the concentration of indocyanine green ICG at time reference 0 after ICG injection; wherein (D)λ2-DLambda 2 correction)nAnd (D)λ2-DLambda 2 correction)0Rate of change D of reflected light intensity measured at n minutes and 0, respectivelyλ2And corrected DLambda 2 correctionThe difference of (a).
(3): oxygen saturation calculation after ICG injection
Similarly, the absorption coefficient for the wavelength λ 1 of 660nm also increases the effect of ICG absorption:
μ0 λ1＝ελ1 HbCHb+ελ1 HbO2CHbO2+ελ1 ICGCICG (15)
Dλ1＝(ελ1 HbCHb+ελ1 HbCHbO2+ελ1 ICGCICG)*K (16)
rate of change D of reflected light intensity after elimination of ICGLambda 1 correctionComprising only Hb and HbO2Part (A) of
DLambda 1 correction＝(ελ1 HbCHb+ελ1 HbCHbO2)*K
＝Dλ1-ελ1 ICGCICG*K
Substitution into the ICG concentration C calculated for liver functionICG
DLambda 1 correction＝Dλ1-ελ1 ICG*(Dλ2-DLambda 2 correction)/ελ2 ICG (17)
The corrected central venous oxygen saturation ScvO is calculated by the following formula2 correction：
The present invention is not limited to the above-described embodiments, and various modifications and variations of the present invention are intended to be included within the scope of the claims and the equivalent technology of the present invention if they do not depart from the spirit and scope of the present invention.
Claims (10)
1. The utility model provides a blood oxygen saturation monitoring and liver function test system based on central venous catheter, includes central venous catheter and optoelectronic module at least, its characterized in that:
the catheter body in the central venous catheter is of a multi-cavity structure, an independent coloring agent injection cavity and an independent optical fiber cavity are arranged in the catheter body, and a coloring agent injection channel and a coloring agent injection connector which are communicated with the coloring agent injection cavity and an optical fiber connector which is connected with an optical fiber in the optical fiber cavity are connected above the catheter body through a fixed support;
the photoelectric module is connected with an optical fiber connector in the multi-cavity central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light of at least three wave bands, the AD sampling unit is used for carrying out signal conversion, the calculating unit calculates digital signals converted in the AD sampling unit and transmits the calculation results to the communication unit, and the communication unit is in communication connection with terminal equipment;
two calculation modes are arranged in the calculation unit: a blood oxygen saturation monitoring mode without dye injection, and a blood oxygen saturation monitoring plus liver function test mode with dye injection.
2. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1, wherein: the wavelength that the transmitting unit and the receiving unit can transmit and receive is in particular lambda1＝660nm，λ2＝805nm，λ3The staining agent is indocyanine green (ICG) 940 nm.
3. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 2, wherein: the specific calculation method in the blood oxygen saturation monitoring mode without the injected stain is as follows:
only reduced hemoglobin Hb and oxygenated hemoglobin HbO are considered in this mode2At two wavelengths lambda1And λ2Absorption coefficient of
And
comprises the following steps:
and further calculating by a double-wavelength method:
substituting the above equation into the defining equation for blood oxygen saturation:
ScvO2＝[CHbO2*100]/[CHbO2+CHb]
due to selection of λ1At 660nm, band λ2805nm for oxygen and hemoglobin HbO2And the equivalent intersection point of the absorbance coefficient curve of reduced hemoglobin Hb, i.e. epsilonλ2 HbO2＝ελ2 HbTherefore, further derived:
in the above formula, ScvO2Central venous oxygen saturation (%), epsilonλ1 Hb、ελ1 HbO2、ελ2 Hb、ελ2 HbO2Are all constants, C, obtained by time domain or frequency domain spectroscopyHbO2Oxyhemoglobin concentration, CHbReduction of the hemoglobin concentration, Dλ1、Dλ2Is obtained by measuring the light intensity.
4. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 3, wherein: the specific calculation method under the blood oxygen saturation monitoring and liver function test mode of injecting the coloring agent is as follows:
(1): after ICG injection, with Dλ3Calculate the corresponding DLambda 2 correctionValue of
Firstly, when injecting indocyanine green-free ICG, according to the wave band lambda2805nm and λ3D was derived using the dual wavelength method at 940nmλ2And Dλ3The ratio of (d) and the blood oxygen saturation are linearly related:
Dλ3/Dλ2＝ελ3 Hb/ελ2 Hb+(ελ3 HbO2/ελ2 Hb-ελ3 Hb/ελ2 Hb)ScvO2
further simplifying calculation by using theoretical value to obtain lambda in wave band2805nm and λ3940nm haemoglobin reflexThe relationship of light intensity variation:
Dλ2＝Dλ3/[1-K2*(ScvO2-51)]
using the currently measured Dλ3And calculating the blood oxygen saturation concentration of the indocyanine green ICG at the last time, and obtaining:
Dlambda 2 correction＝Dλ3/[1-K2*(ScvO2-51)]；
(2): liver function calculation
Liver function was measured by indocyanine green clearance test method, when indocyanine green ICG was injected, wavelength λ2The absorption coefficient of 805nm increases the influence of the ICG absorption peak of indocyanine green, i.e.
μ0 Lambda 2 correction＝ελ2 HbCHb+ελ2 HbO2CHbO2+ελ2 ICGCICG
Then according to the following formula:
Dλ2＝(ελ2 HbCHb+ελ2 HbCHbO2+ελ2 ICGCICG)*K
Dlambda 2 correction＝(ελ2 bCHb+ελ2 HbCHbO2+ελ2 HbO2CHbO2)*K
Subtracting the two equations to obtain:
Dλ2-Dlambda 2 correction＝ελ2 ICGCICGK; k in this equation is a constant, further calculating:
CICG＝(Dλ2-Dlambda 2 correction)/ελ2 ICGK, thereby calculating the real-time concentration C of indocyanine green ICGICG；
Substituting the calculation into the following equation: rn ═ Cn/C0*100％；
Further, it is obtained that: rn＝(Dλ2-DLambda 2 correction)n/(Dλ2-DLambda 2 correction)0*100％；
In the above formula: epsilonλ2 ICGRn is the residual rate of indocyanine green ICG in blood after n minutes, C is a constant obtained by time domain or frequency domain spectroscopynIs the concentration of indocyanine green ICG after n minutes, C0Is the concentration of indocyanine green ICG at time reference 0 after ICG injection; wherein (D)λ2-DLambda 2 correction)nAnd (D)λ2-DLambda 2 correction)0Rate of change D of reflected light intensity measured at n minutes and 0, respectivelyλ2And corrected DLambda 2 correctionA difference of (d);
(3): calculation of blood oxygen saturation after indocyanine green ICG injection
The absorption coefficient for the wavelength λ 1 ═ 660nm after ICG injection of indocyanine green also increases the effect of ICG absorption:
μ0 λ1＝ελ1 HbCHb+ελ1 HbO2CHbO2+ελ1 ICGCICG
Dλ1＝(ελ1 HbCHb+ελ1 HbCHbO2+ελ1 ICGCICG)*K
rate of change D of reflected light intensity after elimination of ICGLambda 1 correctionComprising only Hb and HbO2The following components:
Dlambda 1 correction＝(ελ1 HbCHb+ελ1 HbCHbO2)*K＝Dλ1-ελ1 ICGCICG*K
Substitution into ICG concentration C calculated for hepatic functionICG：
DLambda 1 correction＝Dλ1-ελ1 ICG*(Dλ2-DLambda 2 correction)/ελ2 ICG
The corrected central venous oxygen saturation ScvO is calculated by the following formula2 correction：
5. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1, wherein: the inner wall of the coloring agent injection channel is coated with a light-shading coating, or the coloring agent injection channel is made of a colored material.
6. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1, wherein: the catheter body in the central venous catheter is of a four-cavity structure, a pressure measurement cavity and a transfusion cavity are arranged besides a coloring agent injection cavity and an optical fiber cavity, the pressure measurement cavity is used for penetrating a guide wire guide catheter during puncture and is placed in, and after the puncture is finished, the guide wire is drawn out and then is connected with invasive blood pressure measurement equipment to measure the central venous blood pressure; the transfusion cavity is used for blood collection and transfusion; the upper part of the catheter body is connected with a pressure measurement channel and a pressure measurement joint which are communicated with the pressure measurement cavity, and an infusion channel and an infusion joint which are communicated with the infusion cavity through a fixed support.
7. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1 or 6, characterized in that: the outlets of the optical fiber cavity and the pressure measuring cavity are positioned at the far end of the catheter body, and the outlets of the transfusion cavity and the dyeing agent injection cavity are positioned at the near end of the catheter body.
8. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1 or 6, characterized in that: the staining agent injection joint, the pressure measuring joint and the infusion joint are all standard luer joints.
9. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 1, wherein: the terminal equipment is a monitor, the monitor controls the photoelectric module through the digital communication interface and is used for setting the intensity and time-sharing frequency of light radiation output by each wavelength, receiving the received light intensity of each wavelength fed back by analysis and intelligently adjusting the luminous light intensity to obtain the optimal measurement result.
10. A central venous catheter based blood oxygen saturation monitoring and liver function testing system according to claim 9, wherein: the monitor has a human-computer interface interaction function and can input calibration parameters and display the blood oxygen saturation measurement result and the stain concentration change curve in real time.
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| US5315995A (en) * | 1992-03-19 | 1994-05-31 | Henry Ford Hospital | Method and apparatus for continuous measurement of central venous oxygen saturation during human cardiopulmonary resuscitation and clinical shock |
| US20040064021A1 (en) * | 2002-09-28 | 2004-04-01 | Pulsion Medical Systems Ag | Catheter system |
| CN102488525A (en) * | 2011-12-14 | 2012-06-13 | 吉林大学 | Hepatic functional reserve detector capable of removing blood oxygen fluctuation interference |
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