CN1422137A - 测定血液动力状态的方法 - Google Patents
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Abstract
一种测定对象的血液动力状态的方法。该方法包括:(a)测定许多已诊断具有特定血液动力状态的患者的心脏动力指数(Cpi)和全身性血管阻力指数(SVRi)值;(b)测定相应于所述血液动力状态的Cpi和SVRi配对值的范围;(c)测定所述对象的Cpi和SVRi配对值;(d)将所述对象的Cpi和SVRi配对值与步骤(b)中测定的Cpi和SVRi配对值的范围比较;和(e)测定与所述对象的Cpi和SVRi配对值最相似的Cpi和SVRi配对值的范围。与所述范围一致的血液动力状态代表了所述对象的血液动力状态。
Description
发明领域
本发明涉及使用心脏和周围血管的性能参数测定患者的血液动力状态。
发明背景
以下文献可能与本发明的理解有关,并且本说明书中通过数字提及:
1.Roul G,Moulichon M.E.,Bareiss P,Gries P,Koegler A,SacrezJ,Germain P,Mossard J.M.,Sacrez A,Prognostic factors of chronicheart failure in NYHA class II or III:value of invasive exercisehaemodynamic data.Eur Heart J(1995);16:1387-98.
2.Marmor A,Schneeweiss A.Prognostic value of noninvasivelyobtained left ventricular contractile reserve in patients withsevere heart failure.J Am Coll Cardiol(1997)Feb;29(2):422-8.
3.Marmor A,Jain D,Cohen LS,Nevo E,Wackers FJ,Zaret BL.Left ven tricular peak power during exercise:a noninvasiveapproach for assessment of contractile reserve.J Nucl Med(1993)Nov;34(11):1877-85.
4.Tan LB.Cardiac pumping capability and prognosis in heartfailure.Lancet(1986)13(2):1360-63.
5.Sharir T,Feldman MD,Haber H,Feldman AM,Marmor A,BeckerLC,Kass DA.Ventricular心脏收缩性assessment in patients withdilated cardiomyopathy by preload-adjusted maximalpower-Validation and noninvasive application.Circulation(1994)May;89(5):2045-53.
6.Tan LB.Clinical and research implications of new conceptsin the assessment of cardiac pumping performance in heart failure.Cardiovasc Res(1987)Aug;21(8):615-22.
7.Cotter G,Metzkor E,Kalusld E,Faigenberg Z,Miller R,Simovitz A,Shaham O,Margithay D,Koren D,Blatt A,MoshlcovitzY,Zaidenstein R,Golik A.Randomized trial of high-dose IsosorbideDinitrate plus low-dose Furosamide versus high-dose Furosamideplus low-dose Isosorbide Dinitrate in severe pulmonary oedema.Lancet.(1998);351:389-93.
8.Cotter G,Kaluski E,Blatt A,Milovanov O,Moshkovitz Y,Zaidenstein R,Salas A,Alon D,Mihovitz Y,Metzger M,Vered Z,Golik A.L-NMMA(a Nitric Oxide Synthase Inhibitor)is Effectivein the Treatment of Cardiogenic Shock.Circulation.2000 Mar28;101(12):1358-61.
9.P.D.Sasieni,Statistical Analysis of the performance ofdiagnostic tests(Invited review),Cytopathology,1999,10,73-78.
10.Jeroen G.Lijmer,Ben Willen Mol,Siem Heisterkamp,GoukeJ.Bonsel,Martin H.Prins,Jan H.P.,van der Meulen,Patrik M.M.Bossuyt.Empirical Evidence of Design Related Bias in Studies ofDiagnostic Tests,JAMA,1999,282,11,1061-1066.
11.SAS/STAT User’s Guide,Version 6,Fourth Edition.Volume1,Cary,NC:SAS Institute Inc.,1989.
迄今为止,在患有充血性心力衰竭(CHF)的患者中还未发现侵入性血液动力测量与临床综合症之间的关系(1)。在遭受心脏功能急剧降低如进行性呼吸困难导致肺水肿或心原性休克的患者中,以及甚至在患有心脏收缩性慢性稳定性CHF的患者中,心脏指数(CI)或全身性血管阻力指数(SVRii)的测量还未提供任何可靠的诊断、治疗或预测值。
SVRi是血管系统对血液流动的阻力的量度并以Kg计量。*M4/sec3(=wood*M2)。在心血管系统中,SVRI=(平均动脉血压(MAP)-右动脉血压)/CI。如果不能获得的话,右动脉血压可以10-15%的MAP估计。
心脏动力指数(Cpi)是心肌的收缩状态的量度并以watts/M2计量。Cpi的测量是心脏病学中新引入的概念(2-6)。它是以流体的物理定则为基础,其中
动力=流量X压力。
在心血管系统中,Cpi可以通过用心脏指数(CI)替换流量并用MAP替换压力测量。
因此:
Cpi=CI X MAP。
这种测量在过去(2-6)部分地用于评价患有CHF的患者的心脏收缩力。可以假定在患有CHF的患者中,随着Cpi逐渐减少,SVRi补偿地增加,并且这种增加在正常范围内可以预测。此外,在急性的Cpi下降的患者,该SVRi反应可能是或者(1)适度-导致补偿或接近补偿的反应,(2)过度-导致比所需的MAP增加高得多,因此导致肺水肿,或者(3)不足-导致MAP低,活器官(脑、心脏、肾)灌注不足和心原性休克。
发明简述
本发明的目的是提供一种测定患者的血液动力状态的方法。
本发明的另一目的是提供一种监测患者的血液动力状态的方法。
因此,本发明提供了一种测定对象的血液动力状态的方法,包括:
(a)测定许多已诊断具有选自以下的血液动力状态的患者的心脏动力指数(Cpi)和全身性血管阻力指数(SVRi)值:心脏收缩性充血性心力衰竭(sCHF)、肺水肿(PE)、心原性休克(CS)、血管舒张性休克(VS)和正常状态;
(b)测定相应于所述血液动力状态的Cpi和SVRi配对值的范围;
(c)测定所述对象的Cpi和SVRi配对值;
(d)将所述对象的Cpi和SVRi配对值与步骤(b)中测定的Cpi和SVRi配对值的范围比较;和
(e)测定与所述对象的Cpi和SVRX配对值最相似的Cpi和SVRi配对值的范围,与所述范围一致的血液动力状态代表了所述对象的血液动力状态。
现已出人意料地发现,就所给患者而言,参数Cpi和SVRi的配对值代表了患者的血液动力状态。在本说明书中,术语“配对值”将用于代表基本上同时测定的给定患者的Cpi和SVRi值。
本发明的方法能够通过测定仅仅2个参数,Cpi和SVRi测定患者的血液动力状态。这些参数或者可以侵入性地例如用Swan-Ganz导管或动脉管线,或者非侵入性地例如通过Echo-doppler或非侵入性血压测量来测定。然后将所得值与预先从具有已知血液动力状态的患者收集的一系列值比较。可以图示地通过眼或者通过计算(例如通过计算机)进行比较。与所述对象的Cpi和SVRi配对值最相似的Cpi和SVRi配对值的范围将代表所述对象应分在这一组中。可以通过眼(例如当使用图时)或者通过已知的统计方法测定相似性。
用于本发明方法的已知血液动力状态是:(1)心脏收缩性或补偿型CHF(sCHF)。由于其血液动力图谱类似并且研究量少,因此这一组还包括高血压患者(HTN);(2)PE;(3)CS;(4)血管舒张或脓毒性休克(VS);和(5)称之为“正常”的组,它代表未患CHF的患者。最后一组由正常患者组成,即SVRi为约15-35wood*kM2且Cpi大于190watts/M2。
患者的Cpi和SVRi配对值的位置提供了如何治疗患者的指示。例如,如果配对值位于代表心原性休克的值的范围内,那么给予患者以促进血管阻力的治疗将是适当的(8)。另一方面,如果配对值位于代表肺水肿的值的范围内,那么给予患者以减少血管阻力的治疗将是适当的(7)。
根据预定的值,通过跟踪患者的Cpi和SVRi配对值的位置的变化可以容易地监控因疾病的自然进行或治疗引起的患者健康状况的变化。以这种方式,可以评价治疗的有效性。因此,通过血管舒张药(硝酸盐,内皮素拮抗药)或血管收缩药(L-NMMA,后叶加压素)药物操纵SVRi,本发明的方法可以具有显著的治疗意义。
根据本发明方法制备的图可以出现在例如监视器的显示器上,这样测定的患者的Cpi和SVRi可以立即绘在图上以便测定患者的“实时”健康状况。
附图简述
为了理解本发明并了解它是如何在实践中进行的,现在参照附图,仅通过非限制性实施例描述一个优选的实施方式,其中:
图1显示了以下6个诊断组的CI(L/Min/M2):CS、PE、HTN、sCHF、正常和VS;
图2显示了这6个组的肺毛细血管楔形压(mmHg);
图3显示了这6个组的Cpii(watts/M2);
图4显示了这6个组的SVRii(wood*M2);和
图5是一Y-轴代表Cpi单位(以watts/M2计)并且X-轴代表SVRi单位(Wood*M2单位)的图。该图(本说明书中还称之为“列线图”)用于将患者的血液动力状态分类并且可以通过本发明方法的一个实施方式的统计分析方法构建。正常患者用(△)表示,PE患者用(□)表示,CS患者用(O)表示,VS患者用(*)表示并且sCHF和HTN患者用(●)表示。
优选实施方式的详细描述实施例1:通过图形法测定血液动力状态患者和方法
在经受右心脏导管插入术的患者中获得血液动力数据。包含物标准:
包括通过常规临床标准(参见下面)诊断患有心脏收缩性CHF(sCHF)、高血压危象、急性肺水肿(PE)、血管舒张性休克或心原性休克的所有患者。排除标准:
显著心脏瓣膜疾病、显著心动过缓或心动过速或肾衰竭(肌酸酐>2.5mg/dl)。临床诊断标准:
1)心脏收缩性CHF:由于CHF加重,因此患者同意侵入性血液动力评价,所述CHF定义为CHF、NYHA III-IV级的临床症状和征兆,在心回波描记术上伴随有EF<35%并且持续6小时未用任何口服药治疗或者最后2小时未用静脉内药物治疗;没有达到心原性休克或肺水肿的标准。
2)肺水肿:由于急性肺充血的临床症状和征兆,在侵入性测量期间伴随有在胸部X-射线发现的肺水肿和通过脉冲测氧术测定室内空气条件下的O2饱和度<90%,因此同意。
3)心原性休克:对于因急性主冠状综合症而经皮血管再通术对血管再通、机械通风、主动脉内气囊泵(IABP)、静脉滴注流体给药和给予至少10μg/kg/Min的多巴胺无反应,并且伴随末端器官低灌注,但是不伴随有>38℃的发烧或全身性炎症综合症,因此心脏收缩血压<100mmHg持续至少1小时。
4)血管舒张性休克:收缩期血压<100mmHg,伴随有>38℃的发烧,全身性炎症综合症和末端器官低灌注的征兆持续至少3小时,对静脉滴注流体和静脉滴注至少10μg/kg/Min的多巴胺无反应。
5)高血压:MAP>135mmHg,没有末端器官低灌注、局部出血或肺水肿的征兆。这些患者包括在sCHF组中。血液动力变量评价:
在所有患者中,在荧光镜指示下使用Swan-Ganz导管进行右心脏导管插入术期间获得血液动力变量。在患者没有IABP下至少30秒的同时在进行临床诊断时使用相同疗法期间获得所有测量。
CI是通过热稀释法使用至少3个连续测量的装置在<15%的范围内测定。在正常对象中,由于伦理原因,因此不进行右心脏导管插入术。用于这组的值是通过标准非侵入性胶管管头(cuff)血压测量并通过FDA-核准的NICaS 2001(一种非侵入性在线心脏输出监视器)评价CI获得的(Cohen JA,ArnaudoV D,Zabeeda D,Schlthes L,Lashinger J,Schachner A.Non-invasive measurement of cardiac output duringcoronary artery bypass grafting.Eur.J.Card.Thoracic Surg.1998;14:64-9)。因此,在正常对象中不评价楔形压,而是使用文献(Lange RA,Hillis LD.Cardiac catheterization and hemodynamic assessment.In:Topol EJ;Textbook of Cardiovacular Medicine)引证的标准值。血液动力变量计算:
Cpi是以MAP x CI测定的并且SVRi是以(MAP-右心房压)/CI测定的。由于在正常对象中不测定右心房压,采用将其估计为10%的MAP。结果:
在本研究中登记了100个连续的患者(56个患者有心脏收缩性CHF,5个患者有HTN危象,11个患者有肺水肿,17个患者有心原性休克并且11个患者患血管舒张性休克)和20个健康自愿者。根据临床诊断的平均CI楔形压、MAP、SVRi和Cpi示于表1并以盒型图示于图1-4。由于患高血压危象(HTN)的患者的数量太少以致不能获得统计意义的分析,因此为了所有进一步分析将它们加入到心脏收缩性CHF组。
表1:在5个诊断组中不同参数的平均值和标准偏差
血液动力变量:
组 | 对象数 | 变量 | 平均值 | 标准偏差 |
CHF | 61 | SVRiICPI楔形压MAPCI | 44.8666667210.683333325.5166667101.18333332.0611667 | 8.032701560.18488237.155634717.98067860.3313153 |
肺水肿 | 11 | CVRICPI楔形压MAPCI | 88.1818182182.272727332.7272727131.36363641.3727273 | 16.738089457.36739658.603382012.68284450.3196589 |
正常 | 20 | SVRiICPI楔形压MAPCI | 25.1500000280.0000000-87.90000003.2000000 | 4.081730835.7402913-8.85497180.3568871 |
脓毒性休克 | 11 | SVRiICPI楔形压MAPCI | 11.8181818358.181818211.363636468.18181825.2181818 | 1.124115856.49215557.69769745.43724530.5344496 |
心原性休克 | 17 | SVRiICPI楔形压MAPCI | 55.637500098.937500023.312500072.18750001.4218750 | 31.076183334.98660466.508648111.29730790.6426427 |
1)心脏指数(CI)(图1):与正常相比,患心脏收缩性CHF、肺水肿和心原性休克的患者中CI的平均值显著较低,而在患血管舒张性休克的患者中较高。ROC分析发现CI的分界点<2.7L/Min/M2,可用于测定患者具有何种心力衰竭(或者心脏收缩性CHF、肺水肿或心原性休克)(灵敏度=1,特异性=0.99)。然而,可以发现在患心脏收缩性CHF、患肺水肿的患者中的73%并且患心原性休克的患者中的47%的值都在1.2-2.7L/Min/M2之间。而且,发现肺水肿和心原性休克的患者中的CI平均值几乎相同(1.4±0.4与1.35±0.7L/Min/M2,p=ns)。
2)平均动脉血压(MAP):与正常相比,患肺水肿的患者中MAP的平均值显著较高,并且根据定义,患HTN危象的患者中较高,在血管舒张性和心原性休克中较低。尽管如此,发现肺水肿、心脏收缩性CHF和HTN危象(MAP>100mmHg)之间以及心脏收缩性CHF、心原性休克和血管舒张性休克(MAP<100mmHg)之间的MAP测量大量重叠。
3)肺毛细血管楔形压(图2):与正常相比,患心脏收缩性CHF和肺水肿的患者中平均楔形压显著较高,在患血管舒张性休克的患者中较低。分析是以文献中报道的楔形压的正常值为基础的(<12mmHg(8))(p=0.001)。然而,这些组之间的楔形压值重叠非常严重。发现在患心脏收缩性CHF中的82%、患肺水肿的患者中的64%、患心原性休克的患者中的76%和患血管舒张性休克的患者中的18%的值都在12-38mmHg之间。
4)心脏动力指数(图3):与正常比较,在患心脏收缩性CHF和肺水肿的患者中Cpi平均值低,在患心原性休克的患者中极低,在患HTN危象和血管舒张性休克的患者中高。然而,在这5个组中遇到一些重叠。在正常人中75%、患心脏收缩性CHF的患者中39%、患肺水肿的患者中27%、患血管舒张性休克的患者中18%测定值为200-300watts/M2,但是患心原性休克的患者中没有一个的值在这之间(其Cpi恒定地低于170watts/M2)。
5)全身性血管阻力指数(图4):与正常比较,患心脏收缩性CHF和HTN危象的患者中SVRi的平均值显著较高,在患肺水肿的患者中极高并且在血管舒张性休克的患者中较低。ROC分析发现SVRi的分界点<35wood*M2可用于将正常对象与患任何CHF综合症的患者区别开来(特异性=1,灵敏度=0.95)。同样,发现SVRi是诊断肺水肿的手段:患有这种临床综合症的所有患者具有SVRi>67wood*M2,而在所有其它患者以及正常对象中的SVRi显著低于该值。Cpi/SVRi图(图5):
SVRi和Cpi的分布高度偏斜,而log(SVRi)和Log(CPi)偏斜不大。因此,为了进一步分析,仅使用Log的指数。然而,使用由其Log值转变回来的值构建该图。
在这些组之间两个log-参数的分布不同。然而,在这5个组中单个参数任意一个都不能分开,如表2所示。表2:仅使用Log(Cpi)或Log(SVRi)分成正确临床组的观察的数量
(1)仅使用Log(CPi)分类。
通过临床诊断→ | 心原性休克 | 心脏收缩性CHF | 正常 | 肺水肿 | 脓毒性休克 | 合计 |
通过参数↓ | ||||||
心原性休克 | 13 | 4 | 0 | 0 | 0 | 17 |
心脏收缩性CHF | 1 | 44 | 14 | 0 | 2 | 61 |
正常 | 0 | 9 | 8 | 0 | 3 | 20 |
肺水肿 | 1 | 9 | 1 | 0 | 0 | 11 |
脓毒性休克 | 0 | 0 | 3 | 0 | 8 | 11 |
(2)仅使用Log(SVRi)分类。
通过临床诊断→ | 心原性休克 | 心脏收缩性CHF | 正常 | 肺水肿 | 脓毒性休克 | 合计 |
通过参数↓ | ||||||
心原性休克 | 2 | 12 | 1 | 2 | 0 | 17 |
心脏收缩性CHF | 0 | 58 | 3 | 0 | 0 | 61 |
正常 | 0 | 3 | 17 | 0 | 0 | 20 |
肺水肿 | 2 | 0 | 0 | 9 | 0 | 11 |
脓毒性休克 | 0 | 0 | 0 | 0 | 11 | 11 |
这些数据暗示,可以使用两维判别分析获得分离。由于在两个组中少量的观察防止使用更灵活的影响函数,因此我们对具有不相等协方差矩阵的正常分布使用典型判别分析。
由于在5个组中参数变量的大的可变性,因此我们在这些组中不能支持相等的协方差矩阵。(在协方差矩阵内的均匀性试验得到P<0.0001)。使用列线图分类:
为了测定患者的状态,测定其Cpi和SVRi,并将该配对值绘于一图上,例如图5。测定的配对值在图上的位置代表该患者具有该临床症状。
心脏性能降低的血管反应对测定CHF的临床综合症起着决定性的作用。SVRi增加不足可能引起心原性休克,而血管收缩过度将诱导进行性肺充血,导致症状明显的肺水肿。使用CI和MAP量度和一简单列线图可以测定每一患者恶化的准确机理。这样通过药物操纵SVRi能够具有广泛的治疗意义。例如,ISDN可用于将患者从PE移到(move)cCHF,并且可以使用1-NMMA将患者从心原性休克移走。实施例II:使用统计分析测定血液动力状态
现在通过下面给出的实施例描述本发明方法的另一实施方式。然而,本领域技术人员应清楚,使用其它统计分析方法的其它实施方式也是可以的。1.数据统计方法:
使用单向方差分析比较5个临床组的所有参数。将Ryan-Einot-Gabriel-Welsch Multiple Range Test用于这些组之间的成对比较,而使用Dunnett’s T试验将所有组与健康对照比较。
进行1样品t-检验以将每一组的平均楔形压与正常人的楔形压(低于12mmHg)进行比较。
为了测定血液动力参数的有用性以在临床综合症之间进行区别,根据最高灵敏度和特异性,将得自逻辑回归模型的ROC曲线用于该数据以测定不同参数的最好分界点。Cpi/SVRi列线图:
使用二级判别分析开发一种分类规则。首先将两个变量(CPi和SVRi)转变成Log等级,最好近似到常态。由于患HTN的患者的数量少,因此将它们并入到心脏收缩性CHF组。该分类使用两个步骤。在第一个步骤中规则分成3类:血管舒张性休克、心原性休克和混合组,该混合组包括正常患者、心脏收缩性CHF和肺水肿(N-C-P)。如果在第一步之后患者被定义为N-C-P,那么使用第二次分类将正常、心脏收缩性CHF和肺水肿亚组分开。
所有计算都是通过SAS 6.12[SAS Institute Inc.,Cary,NC]使用步骤FREQ、MEANS、GLM、DISCRIM、GPLOT进行的。2.分类规则。A.使用计算进行分类。
步骤1.按照下式计算3个值v1、v2、v3。
v1=LCPi2*21.54+2*LCPi*LSVRi*10.61+LSVRi2*59.44-LCPi*305.24-LSVRi*417.70+1408.89
v2=LCPi2*10.12+2*LCPi*LSVRi*5.67-LSVRi2*4.99-LCPi*135.81-LSVRi*90.11+482.61
v3=LCPi2*7.29+LCPi*LSVRi*2.57+LSVRi2*4.09-LCPi*97.41-LSVRi*58.22+368.16
将患者分成
-“血管舒张性休克”组,如果v1是最小值
-“心原性休克”组,如果v2是最小值
-如果v3是最小值的话进入步骤2。
步骤2.按照下式计算3个值v4、v5、v6。
v4=LCPi2*6.45-2*LCPi*LSVRi*0.45+LSVRi2*16.01-LCPi*65.16-LSVRi*116.53+391.67
v5=LCPi2*17.75+2*LCPi*LSVRi*26.56+LSVRi2*54.27-LCPi*420.26-SVRi*758.55+2775.78
v6=LCPi2*32.95+2*LCPi*LSVRi*3.09+LSVRi2*19.72-LCPi*390.74-LSVRi*161.49+1355.57
将患者分成
-“心脏收缩性CHF”组,如果v4是v4、v5、v6中的最小值并且LSVRi<Log(67)
-“肺水肿”组,如果v5是v4、v5、v6中的最小值并且LSVRi>Log(67)
-“正常”组,如果v6是v4、v5、v6中的最小值,
由于“肺水肿”组相当小并且按照常规通过将这些患者分类我们没有获得Cpi量度>250watts/M2的分开线,因此使用值SVRi=67将患心脏收缩性CHF的患者与患肺水肿的患者分开。因此使用线SVRi=67wood*M2作为近似的分类结果。3.分类结果。
对样品使用分类规则的结果示于表3。
表3:使用Log(SVRi)和Log(CPi)分成正确临床组的观察的数量
4.分类规则的性能
通过临床诊断→ | 心原性休克 | 心脏收缩性CHF | 正常 | 肺水肿 | 脓毒性休克 | 合计 |
通过参数↓ | ||||||
心原性休克 | 15 | 2 | 0 | 0 | 0 | 17 |
心脏收缩性CHF | 0 | 60 | 1 | 0 | 0 | 61 |
正常 | 0 | 0 | 20 | 0 | 0 | 20 |
肺水肿 | 2 | 0 | 0 | 11 | 0 | 11 |
脓毒性休克 | 0 | 0 | 0 | 0 | 11 | 11 |
仅有两个可能结果和两类患者的诊断步骤的性能通常是通过使用类似正(负)预计值(9)或诊断优势率(10)表示的。就具有许多结果和许多类患者的更复杂的检验而言,整个性能可以通过使用该检验和不使用该检验导致的不正确分类患者的比例之差表示。这种测量经常称之为λ不对称(R|C),其中R(行)是真实组,C(列)是患者所分的组。就我们的数据而言,λ(R|C)=0.95(S.D.(λ)=0.03),它与根据本分类规则分类中3个错误是一致的,而不是根据组的现有概率分类的59个错误。
Claims (11)
1、一种测定对象的血液动力状态的方法,包括:
(a)测定许多已诊断具有选自以下的血液动力状态的患者的心脏动力指数(Cpi)和全身性血管阻力指数(SVRi)值:心脏收缩性充血性心力衰竭(sCHF)、肺水肿(PE)、心原性休克(CS)、血管舒张性休克(VS)和正常状态;
(b)测定相应于所述血液动力状态的Cpi和SVRi配对值的范围;
(c)测定所述对象的Cpi和SVRi配对值;
(d)将所述对象的Cpi和SVRi配对值与步骤(b)中测定的Cpi和SVRi配对值的范围比较;和
(e)测定与所述对象的Cpi和SVRi配对值最相似的Cpi和SVRi配对值的范围,与所述范围一致的血液动力状态代表了所述对象的血液动力状态。
2、如权利要求1的方法,其中所述Cpi和SVRi配对值绘于一图上,并且代表各自所述血液动力状态的Cpi和SVRi配对值的所述范围是通过所述图上的轮廓面积表示的。
3、如权利要求2的方法,其中所述图与图5大致相当。
4、如权利要求1的方法,其中代表各自所述血液动力状态的Cpi和SVRi配对值的所述范围是通过统计分析计算的,并且所述对象的所述Cpi和SVRi值通过统计方法与所述范围比较。
5、如权利要求4的方法,其中代表各自所述血液动力状态的Cpi和SVRi配对值的所述范围以图示形式呈现在显示屏上。
6、如权利要求1的方法,其中Cpi是由心脏指数(CI)和平均动脉血压(MAP)的乘积计算的。
7、如权利要求6的方法,其中所述心脏指数和/或所述血压是通过侵入性测量技术测量的。
8、如权利要求7的方法,其中所述测量心脏输出量的测量技术使用Swan-Ganz导管。
9、如权利要求1的方法,其中心脏输出量和/或所述血压是通过非侵入性测量技术测量的。
10、一种测定对象的血液动力状态的方法,包括:
(a)测定所述对象的Cpi和SVRi;
(b)通过权利要求1的方法测定所述对象的血液动力状态;
(c)在预定时间之后再次测定所述对象的Cpi和SVRi;
(d)通过权利要求1的方法再次测定所述对象的血液动力状态;和
(e)比较步骤(b)和(d)中获得的血液动力状态。
11、一种评价医学处理对对象的血液动力状态的影响的方法,包括:
(a)测定所述对象的Cpi和SVRi;
(b)通过权利要求1的方法测定所述对象的血液动力状态;
(c)对所述对象给予所述医学处理;
(d)在所述处理之后测定所述对象的Cpi和SVRi;
(e)通过权利要求1的方法测定所述对象的血液动力状态;和
(f)比较步骤(b)和(e)中获得的血液动力状态。
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CN102481104A (zh) * | 2009-06-17 | 2012-05-30 | 斯蒂芬·伍德福德 | 血液动力学性能的检测 |
CN104135918A (zh) * | 2012-02-13 | 2014-11-05 | 卡尔迪奥刻度有限公司 | 用于估计瞬时心血管性能储备的方法和系统 |
CN111067494A (zh) * | 2019-12-27 | 2020-04-28 | 西北工业大学 | 基于血流储备分数和血流阻力模型的微循环阻力快速计算方法 |
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US10552849B2 (en) | 2009-04-30 | 2020-02-04 | Deem, Inc. | System and method for offering, tracking and promoting loyalty rewards |
US9204857B2 (en) * | 2009-06-05 | 2015-12-08 | General Electric Company | System and method for monitoring hemodynamic state |
AU2014250646B2 (en) * | 2009-06-17 | 2016-09-15 | Human CHIMP Pty Ltd | Determining haemodynamic performance |
US9449288B2 (en) | 2011-05-20 | 2016-09-20 | Deem, Inc. | Travel services search |
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US4562843A (en) * | 1980-09-29 | 1986-01-07 | Ljubomir Djordjevich | System for determining characteristics of blood flow |
US4807638A (en) * | 1987-10-21 | 1989-02-28 | Bomed Medical Manufacturing, Ltd. | Noninvasive continuous mean arterial blood prssure monitor |
WO1990000367A1 (en) * | 1988-07-14 | 1990-01-25 | Bomed Medical Manufacturing, Ltd. | Management of hemodynamic state of a patient |
US5103828A (en) * | 1988-07-14 | 1992-04-14 | Bomed Medical Manufacturing, Ltd. | System for therapeutic management of hemodynamic state of patient |
US5031629A (en) * | 1989-06-02 | 1991-07-16 | Demarzo Arthur P | Hypertension analyzer apparatus |
US5743268A (en) * | 1993-10-25 | 1998-04-28 | Kabal; John | Noninvasive hemodynamic analyzer alterable to a continuous invasive hemodynamic monitor |
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2000
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- 2001-03-12 US US10/221,764 patent/US20030158493A1/en not_active Abandoned
- 2001-03-12 CA CA002402532A patent/CA2402532A1/en not_active Abandoned
- 2001-03-12 JP JP2001566421A patent/JP2003526436A/ja active Pending
- 2001-03-12 CN CN01807550A patent/CN1422137A/zh active Pending
- 2001-03-12 EP EP01912096A patent/EP1263317A2/en not_active Withdrawn
- 2001-03-12 AU AU4101201A patent/AU4101201A/xx active Pending
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102481104A (zh) * | 2009-06-17 | 2012-05-30 | 斯蒂芬·伍德福德 | 血液动力学性能的检测 |
CN104135918A (zh) * | 2012-02-13 | 2014-11-05 | 卡尔迪奥刻度有限公司 | 用于估计瞬时心血管性能储备的方法和系统 |
US9603534B2 (en) | 2012-02-13 | 2017-03-28 | Cardio Scale Ltd. | Method and system for estimating momentary cardiovascular performance reserve |
CN104135918B (zh) * | 2012-02-13 | 2017-03-29 | 卡尔迪奥刻度有限公司 | 用于估计瞬时心血管性能储备的方法和系统 |
CN111067494A (zh) * | 2019-12-27 | 2020-04-28 | 西北工业大学 | 基于血流储备分数和血流阻力模型的微循环阻力快速计算方法 |
CN111067494B (zh) * | 2019-12-27 | 2022-04-26 | 西北工业大学 | 基于血流储备分数和血流阻力模型的微循环阻力快速计算方法 |
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WO2001067948A3 (en) | 2002-01-17 |
CA2402532A1 (en) | 2001-09-20 |
AU4101201A (en) | 2001-09-24 |
JP2003526436A (ja) | 2003-09-09 |
EP1263317A2 (en) | 2002-12-11 |
US20030158493A1 (en) | 2003-08-21 |
WO2001067948A2 (en) | 2001-09-20 |
IL135032A0 (en) | 2001-05-20 |
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