CN1909829A - Apparatus and method for measuring hemodynamic parameters - Google Patents
Apparatus and method for measuring hemodynamic parameters Download PDFInfo
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Abstract
Apparatus 10 for measuring hemodynamic parameters, especially for Augmentation Index AIx and/or Ejection Duration ED, by non-invasive, cuff based occlusive, blood pressure measurement, which apparatus comprises occlusive, oscillometric automatic blood pressure meter and units, determining the values of hemodynamic parameters, characterised by an oscillation wave separating and storing signal detector 1, the sampling rate thereof is at least 200/heart cycle; and has an storage unit 5 resolution thereof is organised at least 9 bit, an preferably digital, anti-filter 8 to compensate the distortions rising at the sampling, separating and digitising the oscillation wave, an amplitude arithmetic 6 unit establishing the Augmentation Index (AIx); an synthetic organ 9 unit establishing the Ejection Duration ED. Method for non-invasive measurement of hemodynamic characteristics, especially AN and/or ED, with an occlusive, pressure-sensor cuff, placed on the brachial artery, and with the apparatus 10 according to the invention by sampling, analysing, and evaluation of the signal flow of the oscillations of the pulse waves, characterised by that a usual stepwise blood pressure measurement is performed, and the SBP, DBP and HR values are stored, thereafter the signal distortions appeared at the sampling are compensated by an anti-filter process, after it the cuff is set over the systolic pressure, i.e. to supra-systolic pressure range, preferably SBP+35 mmHg pressure, and from the received oscillation curves, on the basis of the wave amplitudes, we calculate the AIx; and on the oscillation curve determining the minimum point after the first reflex wave, we calculate the ED value.
Description
Theme of the present invention is about measuring the device of hematodinamics characteristic parameter, further is the device by oscillography (closure) the measurement method Integrated Checkout cardiovascular system that uses cuff.This device comprises oscillography automatic blood pressure measurement meter and performance element.Another theme of the present invention is the method that is used to measure.
Hypertension and arteriosclerotic formation have substantial connection.Wherein method is to measure enhancing index (AIx) parameter and the pulse wave velocity (PWV) of large artery trunks (aorta) the most widely, promptly measures arterial stiffness.Parameter PWV provides about the elastic information of arterial wall.Except that arterial wall elasticity, the AIx parameter also provides the information about peripheral arterial resistance and wall tension.The AIx parameter is meant the amplitude of first contraction wave that heart contraction produces and the difference of second reflex amplitude that produced by described first contraction wave reflection shared percent in the big amplitude in the two.When measuring PWV, determine that at first pulse wave arrives the time difference of carotid artery and femoral artery, and the distance between two measurement points, so just can calculate Supraaortic pulse wave velocity.A progress that recently obtains aspect addressing this problem is to use a kind of non-Jie's interventional method to substitute and use conduit to insert the method that the large artery trunks root is measured.At United States Patent (USP) 6,117.087 and international application no is to have described this class methods among the WO 90/11043.Yet wherein the pulse curve of pulse curve that is write down and actual artery is also not quite identical, so the center pulse curve need use mathematical method to rebuild by peripheral device.In order to realize this purpose, need to use many insertion type measurement results and non-intervention type measurement result to set up transformation model, described transformation model also can use fourier series.Yet, at upper arm is brachial artery, or radial artery, be that the measurement of carrying out on the wrist can not provide relevant arteriosclerosis process, elastic insufficient information (the Davies of central artery particularly, J.I. with his colleague: pulse wave analysis and pulse wave velocity: the key comment J.Hypertem of its power, 2003, Vol.21 No.3.463-472.).Should consider that because during checking examiner and person under inspection inevitably always can move, the inspection that the pressure transducer that this usefulness closely contacts carries out is inevitable inaccurate.
The measuring device Sphygmocor (Atcor) of the pressure transducer that same use closely contacts and Complior (Artech Medical) can realize the non-intervention measurement of PWV.Be to detect the tremulous pulse pulsation on carotid artery and the femoral artery on two points of patient's body surface.Measure the time point that pulse takes place at these two tremulous pulse places.Arrive the carotid artery and the time difference of femoral artery and the distance between the two by pulse and determine pulse wave velocity.
The deficiency of said method maximum is a complicated operation, needs sophisticated professional person, needs the long time simultaneously.The patient can not use this method and operating such devices separately at home independently.In addition, this equipment price is also very expensive.United States Patent (USP) 6,712,768 attempt to eliminate these deficiencies, are entangled in pulse wave curves that the blood pressure measurement cuff of upper arm obtains to measure the AIx parameter by detection in this patent.The appearance of first pulse wave that heart contraction produces and from health time between the appearance of second pulse wave that produces of the described primary pulse wave reflection at position down, can determine that wherein said pressure curve is charged to by the pressure with cuff and is higher than systolic pressure and obtains by pressure curve.These time points can press the pressure curve that records in the scope to determine according to diastole then, use and obtain amplitude by this method, have just determined the AIx parameter.Value that diastole is pressed and the pulse wave details between the mean arterial pressure (MAP) can not accurately be measured, even this is to change because very little pressure takes place in the cuff, the capital obviously changes the shape of pulse wave curves, and the value that wherein said diastole is pressed is meant with the high-amplitude point on the pressure parabolic curve of traditional gradual blood pressure measurement acquisition.In the pressure limit of diastole, it is more and more loose that cuff becomes, and the tension force increase of tube wall causes the amplitude of pulse wave to fluctuate, and recordable signal obviously weakens simultaneously.For these reasons, the AIx parameter can not be determined by quilt as medically or clinically requiring accurately.
Parameter ED (=heartbeat period of output) is that the time that aortic valve is in open state is the hematodinamics characteristic parameter that has no less important with Several Parameters above-mentioned.In a cardiac cycle, certain in the trough is a bit represented the concluding time of left atrium blood perfusion.(referring to Wilkinson, I.B. and his colleague's article: heart rate enlarges and arteriosclerotic dependence Am.J.Hypertens.2002 pulse pressure; J5:24-30.).Yet known non-intervention detection method also is not suitable for accurate separation echo, is not suitable for determining the end point of ED yet.With AIx and the ED value that above-mentioned known detection method obtains, compare with the ED value with the AIx that the insertion type detection method is obtained, less better aspect reliability and accuracy.
The objective of the invention is to develop a kind of checkout gear of simple, relatively inexpensive non-intervention type, be used for measuring hemodynamic parameter, simultaneously the Integrated Checkout cardiovascular system such as strengthening index (AIx), heartbeat period of output (ED), pulse wave velocity (PWV) etc.
Another object of the present invention is that this measuring device can be used as the device that medical practitioner uses, patient oneself also can independently use this device to measure simultaneously, and this device is applicable in the " home care " system, or with portable 24 h ABP monitors (ABPM) or with have the unitary ABPM of ECG and be used in combination.
The present invention is based on following common recognition, if promptly automatic sphygmomanometer is furnished with the unit of handling and analyzing vibration wave, task of the present invention can be finished in existing and the framework that carries out oscillographic type blood pressure measurement (closure) with cuff that is widely used.
We find, if sampling density and signal record density are higher than at least 2 times and at least 4 times of the used sampling density of traditional measuring method and signal record density respectively, these dynamic characteristic parameters can be identified and be suitable for processed.
We also find, by the RC unit analog input signal is resolved into AC and DC part and distortion can occur, as long as use a kind of energy this distortion to be compensated the device of (reverse filtration), just can carry out high-resolution analysis, utilize the inverse function (inverse function) of the unitary feature transmission frequency of RC to compensate the oscillating curve of cardiac cycle.Therefore, we need comprise a compensation (reverse filtration) unit in equipment, and this unit is used for eliminating the noise and the distortion of digitized signal sequence on the oscillating curve.
Above-mentioned discovery can labor obtains us when the measuring vibrations blood pressure oscillating curve (vibratory impulse), thus obtain further to find.A large amount of oscillographys (oscillometric) data that in the biological study process, obtain based on us, the discovery that we are surprised: from the viewpoint of clinical practice, the oscillating curve that monitors when carrying out the conventional vibration blood pressure measurement on brachial artery has and blood pressure pulse and the same principal character of artery diameter pulse.This fact overlaps by the position that is labeled as " elementary ripple " and " secondary wave " on the curve and is confirmed.The discovery that we are also surprised: since a cardiac cycle just caing be compared to long 4 times of time of between carotid artery and femoral artery, transmitting of obtaining by direct measuring method to the time second echo of beginning to occur, wherein said second echo is to record on the pulse wave oscillating curve of measuring by cuff.This fact proved: between detection period, we have measured the aortic blood pressure ripple in center, and we have observed the echo that directly transmits from the center large artery trunks really.In the error allowed band, this measurement result is with above-mentioned consistent with the simultaneously-measured result of Complior device.We have detected the aortic elasticity in center with this measuring method.This can use known Fa Shi reaction (Valsalva-effect) to verify.When abdominal part and chest muscle anxiety, aortic dilatancy increases, and the transmission speed of pulse wave reduces.If the pressure of cuff is suitable when measuring, the information of Huo Deing is exactly correct by this method, and this point is confirmed by our inspection.Even the variation of 10mmHG all can produce tangible change on oscillograph, thereby the result who leads to errors.Here it is measures the reason that hemodynamic parameter will carry out under the cuff pressure of being determined by existing traditional blood pressure measuring method.The position of the main ripple and first echo and amplitude should be measured when overcharging the complete closed tremulous pulse of contractive pressure, and the optimum pressure of cuff is to be higher than systolic pressure 35mmHG.Should be in blood flow at the diastolic pressure that has recorded measures when unimpeded.No matter the pressure that uses is pressure between diastole pressure and MPA (mean arterial pressure), also be to use pressure all can not obtain correct result at relaxing period.
Generally, the essence that the present invention finds is: if the pulse wave curves that in the vibration blood pressure measurement, obtains by with the resolution record that is higher than common resolution, so not only the highest amplitude that records with the sphygomanometer that uses at present but also the echo of whole oscillating curve and formation all can be used for assay.ATX, PWV and ED can adopt the cuff formula sphygomanometer measurement of non-intervention type to obtain, and this method has replaced two complicated point measurements with a point measurement.Even patient oneself just can measure, and this device can be merged in the " home care " system easily.Can also develop various professional succedaneum uses for medical research personnel and clinician.
Discuss based on above-mentioned, the solution of the present invention has provided the device of measuring hemodynamic parameter, particularly strengthens index (AIX) and/or heartbeat period of output (ED), and the blood pressure measuring method of the cuff formula closure of the non-intervention of this device use is measured.This device comprises closed type oscillography automatic sphygmomanometer and a plurality of unit of definite hemodynamic parameter value.Apparatus features of the present invention is: this device has the signal sensor that vibration wave is discrete and store, and its sampling rate reaches the circulation of the 200 times/heart at least; This device has the memory element of at least 9 bit architectures; This device preferably have digitized inverse filter (anti-filter) with compensation to vibration wave sample, the discrete and data distortion that produces when carrying out digitized; This device has the amplitude algorithm unit, to be used for determining to strengthen index (AIx); And this device has synthesis unit, to determine (ED).
The advantageous characteristic of apparatus of the present invention is that the sampling rate of described signal sensor is between 180-220 time/second.
The advantageous characteristic of device of the present invention also is: described memory element has 10 to 12 bit architectures, the signal that described cell stores is produced by vibration wave.
The advantageous characteristic of device of the present invention also is: disposed the time algorithm unit, to determine pulse wave velocity (PWV), and/or comprehensive unit, with determine heart contraction district index (Systole Area Index) (SAI) and diastole district index (Diastole Area Index) (DAI).
The advantageous characteristic of device of the present invention also is: amplitude arithmetic unit is the time algorithm unit in an object lesson (in a concretecase), is connected with a general cyclelog with comprehensive unit, and includes in the same analyzer.
A remarkable advantages of apparatus of the present invention is: it and 24 hours blood pressure monitors of hand-held mobile are united use.
Apparatus of the present invention also have a remarkable advantages to be: it can merge in the long-range medical " home care " system.
At last, apparatus of the present invention also have a remarkable advantages to be: 24 hours blood pressure monitors of it and built-in ECG function are united use, and controlled by it.
Another theme of the present invention has provided a kind of non-intervention type and has measured hemodynamic parameter, particularly strengthen the method for index (AIx) and/or heartbeat period of output (ED), this method is used the cuff of closed band pressure transducer, this cuff places brachial artery, by the device of introducing above, needing to obtain the physiological parameter of detection by sampling, analysis, assessment pulse wave oscillation signal flow.The characteristics of measuring method of the present invention are: use conventional gradual blood pressure measuring method to measure, store the SBP/DBP/HR value that obtains; Then, the distorted signals that occurs owing to sampling compensates by " anti-filter " process; Then, cuff pressure is placed on the systolic pressure, just overcharges the contractive pressure scope, preferred SBP+35 millimetres of mercury; Strengthen index (AIx) by calculating of the moving ripple curve that receives based on wave amplitude; By determining the smallest point on first echo after vibration curve, can obtain heartbeat period of output (ED) value.
The favourable characteristics of measuring method of the present invention also are: the vibration signal sequence is to be at least 180 sample/seconds, preferred 200 sampling/cardiac cycle down-samplings in sampling rate; Digital signal storage resolution reaches 9 at least.
Another of measuring method of the present invention is favourable to be characterised in that: cuff pressure places overcharges the contractive pressure scope, and it is higher than systolic pressure, preferably is higher than 35 millimetress of mercury; Pulsation wave speed (PWV) value can obtain divided by the distance between patient's breastbone and the pubis by the time difference between the main ripple and first echo; And/or with cuff pressure place the diastole of determining press or its near, the heart cycle curve of acquisition is divided into two parts by the ED end point, obtains heart contraction district index (SAI) and diastole district index (DAI) value by this method.
The present invention is described in detail by the embodiment in the embodiment and accompanying drawing, but the embodiment among the present invention to practicality required for protection or protection domain without limits.
Fig. 1 represents the present device block diagram.
Fig. 2 represents detection method logical flow chart of the present invention.
Fig. 3 represents the eigen vibration curve of cardiac cycle.
Fig. 4 represents the further feature of the oscillating curve of cardiac cycle.
Fig. 5 represents the simplified block diagram of " inverse filter " function flow.
Fig. 6 represents to limit the figure of the effective coverage of ED value.
Fig. 7 represents the block diagram of time algorithm and amplitude arithmetic unit collaborative work in apparatus of the present invention.
The structure of device 10 of the present invention is identical in respect of part with traditional blood pressure measurement, but with the technical scheme different (referring to Fig. 1) of traditional instrument.As everyone knows, the automatic blood pressure measurement meter is made up of pneumatic part and electronic section.Pneumatic part comprises the cuff of inflation, and it also has charge valve 12, air bleeding valve 13 and relief valve 14 simultaneously as pick off.One end of cuff 11 places patient's upper arm compressing brachial artery; The other end perception arterial pulse pressure wave of cuff, and send pick off 21 to pressure is converted into resistance variations by pick off 21, and described pick off 21 is such as piezoquartz.Therefore, the automatic blood pressure measurement meter belongs to the medical instrument of non-intervention type.The instrument of eparterial contact pressure sensor that is fixed on patient body with those uses is opposite, and cuff 11 itself is exactly a pick off.Charge valve 12 produces the internal pressure of cuff 11; Controllable outlet valve 13 is used to reduce cuff pressure; If the patient feels under the weather when using the pneumatic type sphygmomanometer to measure, relief valve 14 can be in the compressing of moment termination to tremulous pulse.Automatic blood pressure measurement meter electronic section can be divided into two parts in theory: signal sensor 1 and signal analyzer 2.Signal sensor will be converted to electric signal streams by the signal flow of the air pressure conversion of cuff 11 perception, thereby and the electric signal streams that converts to handled obtain the data that have dependency and be suitable for estimating with blood pressure.Analyzer 2 is handled and is estimated through suitably amplifying and having eliminated interference signals stream.At hungarian patent No.220, a kind of like this device of describing in 528 the description can be used as example.Analyzer 2 is controlled pneumatic system simultaneously.This control based on the data obtaining and handle whether be enough to be used in this fact of whole analyses.Signal sensor 1 links to each other with the cuff 11 of pneumatic part by pick off 21.Pick off 21 suitably is connected in the bridge circuit, and the pulsation pressure wave just is converted into the change of voltage like this.Measuring amplifier 22 is connected on the pick off 21 with amplifying signal stream filtered noise, and the signal by designated frequency range.The delivery outlet of measuring amplifier 22 is connected to R-C filter element 23, and filter element 23 is connected with A/D converter 25 by amplifier 24R-C.R-C filter element 23 is selected oscillation signal flow from the pulse wave analog input signal, i.e. changing unit.Amplifier 24 amplifies oscillation signal flow, and vibration wave just can be identified and determine like this, and its amplitude is defined by subsequent operation.A/D converter 25 is converted to digital signal streams with the oscillation signal flow of amplifying.Pressure in the tradition sphygomanometer in the cuff 11 is to reduce gradually from a pressure that is higher than resulting systolic pressure, with the pulsation pressure of each pressure stage (pressure step) in the record cuff 11.The result who does like this can only write down next amplitude among the ripple figure in each cardiac cycle, i.e. the digitized value of crest just.In order to finish this task, sampling rate reached for 100 point/seconds, and just was enough to find crest with 8 bit resolutions record vibrating example from analog signal flow.In fact, such sample frequency and signal resolution can not be discerned other details except that maximum amplitude.In apparatus of the present invention 10, A/D converter 25 has been equipped with sampler 4, and the may command sample frequency is higher than 2 times of traditional sampling frequency at least.Used sample frequency is 200 times/second, is equivalent to each cardiac cycle approximately and just has 200 sampled datas.A/D converter 25 further has been equipped with the storage element 5 that is higher than 8, wherein has been equipped with the storage element with 10 in the device 10 in an example of the present invention.Our experience shows that resolution is the fine structure that 10 oscillation signal flow can clearly show promptly main ripple of single heart cycle waveform and echo afterwards.Find the understanding of the inventor on the basis based on the medical discovery of describing in the description of the present invention and at this, cuff 11 is successfully applied to measures the hematodinamics characteristic parameter.The cyclelog 26 that is arranged in analyzer 2 is controlled each unit of traditional blood pressure measurement with definite and demonstration systolic pressure (SBP), diastole pressure (DBP) and heart rate (HR); Or control those for determining or showing the unit that hemodynamic parameter is further developed.Blood pressure evaluation unit 27 is used for determining SBP, the DBP in the paired pressure value and the value of HR in the cuff; And with the corresponding to pulse wave amplitude of international clinical medicine practise; Then or by the blood pressure unit 28 that links to each other with blood pressure evaluation unit 27 they are presented on the LCD screen of device 10, or they are printed according to reference format.When needs were determined further hemodynamic parameter, A/D converter 25 linked to each other with inverse filter 8 under the instruction of cyclelog 26 with other signal processing units.Because the use of RC wave filter 23 and amplifier 24, distortion appears in oscillation signal flow, therefore, uses the contrafunctional inverse filter 8 of R-C wave filter 23 transfer functions can compensate and revise all distortions.Consider that the distorted signals that originates from filtering and the amplification process relies on " frequency " of oscillation signal flow, or more particularly depend on the speed from any to another signal change, therefore, the work of inverse filter 8 is directly relevant with this factor.The analyzer 2 that suitably is connected with inverse filter 8 comprises amplitude arithmetic unit 6, time algorithm unit 7, synthesis unit 9 and comprehensive unit 3.AIx output unit 61, ED output unit 91, PWV output unit 71, SAI/DAI output unit 31 is connected on the blood pressure output unit 28 equally.(SAI refers to heart contraction district (area) index, and DAI refers to diastole district (area) index; They refer to the zone of ED terminal point front and back under heart cycle oscillation curve-sector).Amplitude arithmetic unit 6 is used for determining the amplitude of main ripple and echo, draws AIx and AIx by amplitude
80Parameter.Time algorithm unit 7 is used for determining the end point of the main ripple and first echo, by end point and utilize distance between patient's breast and the pubis, calculates the PWV value.(estimate and calculate PWV and be based on mainly that starting point (starting point is to starting point) (foot to foot) time of main ripple and echo and/or the time between the crest (peak to peak) carries out.) synthesis unit 9 is used for determining the end point of ED.And comprehensive unit 3 is determined SAI and DAI value based on the end point of ED; Their merchant is the characteristic information of prompting coronary heart disease state.Can be according to the most typical crest that occurs, data analysis unit 2 is selected representational cardiac cycle from 10 cardiac cycles that close on of record; Perhaps in other cases, the virtual cardiac cycle that produces after 10 cardiac cycles that close on are averaged in data analysis unit 2 uses.
The device 10 that the present invention introduces can also be used with Hall Hang Shi (Holter) the cardiac monitoring equipment that used in 24 hours, and method and traditional sphygomanometer are similar.An embodiment preferred of this device is to be used in combination with the automatic detection and the recording equipment of use in 24 hours in our example.
At the device 10 of another preferred embodiment of the present invention, signal sensor 1 and signal processing analysis device 2 can be divided into two parts easily on the computer (PC) of clinical use (doctor's use): with device and the special-purpose apparatus for evaluating that is sampled as the basis.Even the blood pressure pulse ripple is sampled in this case, and store all with the resolution of increase that tool has very important significance with the frequency that improves.
A highly preferred embodiment of the device 10 of introduction of the present invention is to be equipped with various device, as Infrared Detectors, the modem that is connected with telephone wire or other I/O unit, this makes that this device is enough to use as the remote sense monitoring system that can link to each other with " home care " system.
An important advantage of the device of introduction of the present invention is: need the patient of measurement data can oneself tie up cuff 11, and start measurement or start measurement by central remote sensing controller.Known in technical literature have a medical family's remote sensing nursing system of many kinds.One of them is the invention of introducing in hungarian patent (patent No. No.222 052) description.Apparatus of the present invention 10 are connected with " home care " system, the obviously examination of elevator system and monitoring capability, and the various biological information of human body that will obtain offer the doctor.
Another embodiment of device 10 of the present invention and application are that this device has been equipped with the sphygmomanometer in conjunction with the ECG device.Partial myocardial ischemia state (ischemia) is the tendency that possible cause myocardial infarction.Yet pathologic ECG state has only with reference to after the blood pressure measurement, just can make accurate assessment.If the ECG of pathological state begins blood pressure measurement immediately automatically, this integration apparatus is used widely.Carry out perfectly if install 10 usefulness device of the present invention, just can identify more hemodynamic data in case of emergency.
The purpose of method of the present invention is except obtaining as SBP, DBP, outside these conventional blood-pressure measurement datas of HR, the more important thing is the information that obtains more hemodynamic parameters, such as strengthening index (AIx), pulse wave velocity (PWV), heartbeat period of output (ED), the SAl that introduces above in addition, DAI.Device 10 using method and each unitary workflow be confirmed below (please refer to Fig. 2).
Cuff 11 is placed the tremulous pulse place of patient's upper arm.In order to obtain good measurement effect, must consider the following fact.If measure fully, use the cuff measurement that detailed details is provided, in non-intervention measuring method, have clear superiority.The method of measuring arteriotony with the contact piezometer that is pressed in patient's body surface is opposite, uses the cuff measurement not rely on gauger's skill, also need not to guarantee the enough pressure of pick off and the stability of pressure in measurement.Subjective errors and consequent wrong factor have so just been eliminated.The use cuff is measured, and cuff itself is exactly a pick off, and therefore vibration is sent to electronic section from pneumatic part.The width of cuff reduces to 66% just being enough to satisfy and measuring purpose of using when measuring the adult, and wherein the flexible pipe of cuff inside is wound on patient's upper arm.The cuff width is 7-8 centimetre (child's a size), but girth is more longer than common.
This device 10 uses common gradual sphygmomanometry.After having write down diastole pressure (DBP) and systolic pressure (SBP), can show or print result to the user.Then, the pressure of cuff is increased on the measured SBP (entering the so-called contractive pressure scope of overcharging), preferably surpasses systolic pressure 35 millimetress of mercury.The commonly used measuring method of use in the automatic blood pressure measurement of routine, the vibration signal of record, filtration, about 10 the successive cardiac cycles of amplification.This serial analog signal is by the sample frequency digitized with per second 200 times, and digitized value is handled and is stored with 10 bit resolutions.If the purpose of measuring above systolic pressure 35 millimetress of mercury is exactly that upper arm artery is compressed fully, so that there is not the blood flow mistake in measurement.Yet, propagate in the blood of vibration pressure in blood vessel, just as at water transmission, and it is applied to pressure on the cuff 11.The measurement of carrying out in the inferior scope of super contraction mainly is based on pressure wave, has removed the interference effect of blood flow.
Cuff 11 should have enough elasticity, so that pressure wave vibration is sent to electric part immediately; The pressure of cuff 11 enough height just can arrive.But the pressure of cuff can not be too high, because can allow the patient who at one end checks feel ill like this, also may damage it, and can reduce the sensitivity that the other end is measured.The optimum of the pressure that surpasses in our experience, is about 35 millimetress of mercury.We use 35 millimetress of mercury at unified regulation, can make testing result have repeatability like this.
The work process of analyzer 2 is shown in Fig. 7 a and 7b.After traditional blood pressure measurement is finished, device 10 to be carried out once new sampling, and digitized signal is proofreaied and correct, described correction is to use inverse filter 8 compensation to be filtered the distortion (as shown in Figure 5) that causes by previous RC.
Reverse filtration can make method of the present invention have 10 resolution, and this method can more carried out under the high-resolution in other cases.Need more high-resolution element may increase the cost of equipment 10.Original signal sequence a before reverse filtration
i=F (i) is stored in the memory element 5.Be corrected later signal sequence ai=f (i) and its first and second derivative data sequence a
i=f ' (i) and a
i"=f " (i) also is stored in the memory element 5.A represents amplitude in these sequences, the sequence number on the i express time axle, and wherein the interval between per two i values is 5 milliseconds in our example.
From undistorted cardiac cycle data stream, obtain representative average waveform.Amplitude according to the main ripple and first echo obtains the AIx parameter, and this parameter is atherosclerotic characteristic parameter.
Actual heart cycle curve may alter a great deal, and Fig. 3 and Fig. 4 have represented two very representative examples.As shown in Figure 3, the amplitude [a of main ripple in the cardiac cycle
Main] be less than the amplitude [a of first echo
Refi].As shown in Figure 4, the result is just in time opposite.Shown in Fig. 7 A and 7B, shown how collaborative work under the control of cyclelog 26 of amplitude arithmetic unit 6 and synthesis unit 9.Find maximum point [a in the signal sequence after revising
Max] and smallest point [a
Min] the position, just determined the amplitude and the position of main ripple and the position of ED in theory.
Yet,, depend on whether analyzed heart cycle curve belongs to Fig. 3 or this type of Fig. 4 for the explanation of this phenomenon.The peaked appearance that we suppose a is less than before this a
MaxValue.If heart cycle curve belongs to Fig. 3 type, AIx just can calculate by these two maximum points, according to the common recognition of medical domain, by the value of heart rate calibration is
AIx
80＝AIx+{0.56*(HR-80)}
If it is within regional F as shown in Figure 6, the position of minima just equals ED.(k1, the value of k2 and k3 is to determine on a large amount of experiential basis of measuring.Otherwise, just should derive from and seek ED in the sequence [ED (2)] second.If heart cycle curve belongs to type shown in Figure 4, cyclelog 26 starts the function shown in Fig. 7 b.The ED end point should not sought in having gauged signal sequence.If this point appears at after 210 milliseconds, this point just should be accepted [ED (3)].In this example, echo should be positioned at [ED (3)] and a in the correction data sequence
MaxBetween.From the angle of medical science, if ED is too short, just should be at the minima [a of and then real ED end point [ED (4)]
Max, 2] and position searching afterwards.This device is determined AIx and ED value based on final main ripple and the echo of determining, the time algorithm unit then calculates PWV according to the carotid artery of individuality and the distance between the femoral artery.
Measure and overcharge contractive pressure+35 (S+35) afterwards, with the pressure setting of cuff 11 near after measured DBP or its, and ED end point that will be found as mentioned above place digitized and the signal sequence i axle revised on after, comprehensive unit 3 is determined the zone before the ED end point [SAI] and the zone after the ED end point [DAI] under curve, and calculate their merchant, then transfer them to SAI/DAI output unit 31.
When overcharging contractive pressure, measure and when diastolic pressure measurement tangible difference is arranged.Measure when overcharging contractive pressure, brachial artery is closed fully, and do not have blood flow in this tremulous pulse this moment, and is corresponding, and artery diameter does not change.The pressure of blood occupies leading position in tremulous pulse.This pressure variation directly is reflected on the pressure of cuff.When measuring, diastolic pressure range has blood flow, because the conduction of pulse wave makes artery diameter change.At this moment, cuff will be caught this pressure variation.
As the result of the use of apparatus of the present invention and method, all hemodynamic parameters all are to determine in systolic pressure adds the reliable pressure scope of 35 millimetress of mercury.Will not be delivered to diastolic pressure and can complete successfully measurement equally in the value that systolic pressure is measured.
Briefly, apparatus and method of the present invention provide a new technical scheme, and this scheme is perfect by the clinical diagnostic method of accepting extensively.This scheme comes from the inventor's a kind of new medical discovery, and essence of the present invention is to embody the practical technique scheme of this discovery.The present invention has novelty, because using the method for closing and the device of non-intervention, promptly use cuff as before the hemodynamic parameter measured sensor, can not obtain the reliably change procedure accurately of hematodinamics process in the tremulous pulse of center.Up to the present do not find any method and apparatus, it can use cuff to transform the hematodinamics characteristic parameter reliably as pick off, and provides data in appropriate mode, to be used for further evaluation.
The solution of the present invention provides low price, wieldy method and apparatus, can be applied very soon.Do not need medical practitioner, patient oneself just can independently use this device.
Claims (11)
1. device of measuring hemodynamic parameter, particularly measure the device that strengthens Index A Ix and/or heartbeat period of output ED by non-intervention cuff closed type sphygmomanometry, it comprises a plurality of unit of closed type oscillography automatic blood pressure measurement meter and definite hemodynamic parameter value, it is characterized in that
Be used for the signal sensor (1) that vibration wave is discrete and store, its sampling rate reaches the circulation of the 200 times/heart at least; It has memory element (5), and its resolution will reach 9 at least,
The inverse filter of digit preferenceization (8), the data distortion that its compensation produces when sampling, separation and digitized vibration wave,
Amplitude algorithm unit (6), it is used for setting up AIx,
Combination mechanism unit (9), it sets up ED.
2. device as claimed in claim 1 is characterized in that, the described sampling rate of described signal sensor is 180-220 time/second.
3. device as claimed in claim 1 or 2 is characterized in that, the described memory element that is used for preserving the signal that is produced by vibration wave is set to the 10-12 position.
4. as each the described device among the claim 1-3, it is characterized in that described device also is equipped with time algorithm unit (7), described time algorithm unit (7) is used for setting up pulse rates PWV; And/or comprehensive unit (3), described comprehensive unit (3) is used for setting up heart contraction district index SAI and diastole district index D AI.
5. as each the described device among the claim 1-4, it is characterized in that, described amplitude algorithm unit (6), described combination mechanism unit (9), described preferred time algorithm unit (7) and/or comprehensive unit (3) are connected to shared routine controller (26), and are compiled into analyzer (2).
6. as each the described device among the claim 1-5, it is characterized in that described device and portable 24 hours mobile blood pressure monitors combine.
7. as each the described device among the claim 1-5, it is characterized in that described device can constitute one with the tele-medicine " home care " system.
8. as each the described device among the claim 1-5, it is characterized in that described device and 24 hours blood pressure monitors combine, blood pressure monitor was by built-in ECG control in described 24 hours.
9. the measuring method of a non-intervention type hemodynamic parameter, particularly strengthen the measuring method of Index A Ix and/or heartbeat period of output ED, it is by the cuff that is placed on arm tremulous pulse place that has pressure transducer of closure, simultaneously by as each the described device among the claim 1-8, by sampling, analyze, the signal flow that the vibration of assessment pulse produces is realized, it is characterized in that, carry out common gradual blood pressure measurement, store SBP, DBP and HR numerical value, then, the distorted signals that takes place in the sampling compensates by the processing of inverse filter, cuff (11) pressure places on the systolic pressure then, just overcharge the contractive pressure scope, preferred SBP+35mmHg is according to the oscillating curve that obtains, based on wave amplitude, calculate AIx; After first echo, on oscillating curve, determine smallest point, thereby calculate the Ed value.
10. method as claimed in claim 9 is characterized in that, described sampling rate will reach per second 180 times at least, is preferably 200 times/cardiac cycle; Described digital signal streams will be stored with 9 bit resolutions at least.
11. as claim 9 or 10 described methods, it is characterized in that, described cuff (11) pressure places the pressure limit of overcharging contractive pressure, it is higher than systolic pressure, preferred SBP+35mmHg, time difference according to primary waves and first echo, the patient's breastbone that measures respectively and the distance of pubis, can calculate pulse wave velocity PWV, and/or described cuff (11) pressure placed near fixed diastolic value or its, the heart cyclic curve that has received is divided into two parts by the ED end point, has so just constituted heart contraction district index SAI and diastole district index D AI.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| HU0400426A HU0400426D0 (en) | 2004-02-18 | 2004-02-18 | Apparatus and method for measurement of dynamic characteristic of blood and for complex monitoring of circulatory system |
| HUP0400426 | 2004-02-18 | ||
| HUP0500169 | 2005-02-03 |
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| Publication Number | Publication Date |
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| CN (1) | CN100423687C (en) |
| HU (1) | HU0400426D0 (en) |
| UA (1) | UA82094C2 (en) |
| ZA (1) | ZA200604113B (en) |
Cited By (8)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN102178516A (en) * | 2011-04-13 | 2011-09-14 | 中国科学院合肥物质科学研究院 | Method for obtaining aorta pulse wave velocity (aoPWV) based on peripheral artery pulse wave signal |
| CN102427760A (en) * | 2009-03-18 | 2012-04-25 | 爱德华兹生命科学公司 | Direct measurements of arterial pressure decoupling |
| CN102579024A (en) * | 2010-12-16 | 2012-07-18 | 通用电气公司 | Adaptive time domain filtering for improved blood pressure estimation |
| CN102711599A (en) * | 2009-12-31 | 2012-10-03 | 韦尔奇阿林公司 | Suprasystolic measurment in fast blood-pressure cycle |
| CN102711597A (en) * | 2009-11-10 | 2012-10-03 | 夏普株式会社 | Pulse wave propagation speed measurement device and pulse wave propagation speed measurement program |
| CN109843349A (en) * | 2016-10-19 | 2019-06-04 | 阿比奥梅德欧洲股份有限公司 | Ventricular assist device control |
| CN110420014A (en) * | 2019-06-13 | 2019-11-08 | 东北大学 | The wearable cardiovascular function evaluation system and method intelligently decomposed based on pulse wave |
| CN111491556A (en) * | 2017-03-13 | 2020-08-04 | 微巨数据科技(深圳)有限公司 | Method and device for the time-resolved measurement of characteristic variables of cardiac function |
Family Cites Families (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5680870A (en) * | 1995-01-04 | 1997-10-28 | Johnson & Johnson Medical, Inc. | Oscillometric blood pressure monitor which acquires blood pressure signals from composite arterial pulse signal |
| JP3631979B2 (en) * | 2001-06-06 | 2005-03-23 | コーリンメディカルテクノロジー株式会社 | Blood pressure measurement device with cardiac function evaluation function |
| JP3590613B2 (en) * | 2002-01-10 | 2004-11-17 | コーリンメディカルテクノロジー株式会社 | Amplitude increase index calculation device and arteriosclerosis test device |
| JP3675764B2 (en) * | 2002-01-18 | 2005-07-27 | コーリンメディカルテクノロジー株式会社 | Atherosclerosis inspection device |
-
2004
- 2004-02-18 HU HU0400426A patent/HU0400426D0/en unknown
-
2005
- 2005-02-16 UA UAA200510365A patent/UA82094C2/en unknown
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Cited By (13)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102427760A (en) * | 2009-03-18 | 2012-04-25 | 爱德华兹生命科学公司 | Direct measurements of arterial pressure decoupling |
| CN102427760B (en) * | 2009-03-18 | 2015-03-18 | 爱德华兹生命科学公司 | Direct measurements of arterial pressure decoupling |
| CN102711597B (en) * | 2009-11-10 | 2015-09-30 | 夏普株式会社 | Pulse wave velocity determinator and pulse wave velocity measure program |
| CN102711597A (en) * | 2009-11-10 | 2012-10-03 | 夏普株式会社 | Pulse wave propagation speed measurement device and pulse wave propagation speed measurement program |
| CN102711599B (en) * | 2009-12-31 | 2015-08-19 | 韦尔奇阿林公司 | Super contraction in rapid blood pressure circulation is measured |
| CN102711599A (en) * | 2009-12-31 | 2012-10-03 | 韦尔奇阿林公司 | Suprasystolic measurment in fast blood-pressure cycle |
| CN102579024A (en) * | 2010-12-16 | 2012-07-18 | 通用电气公司 | Adaptive time domain filtering for improved blood pressure estimation |
| CN102178516B (en) * | 2011-04-13 | 2012-09-19 | 中国科学院合肥物质科学研究院 | Method for obtaining aorta pulse wave velocity (aoPWV) based on peripheral artery pulse wave signal |
| CN102178516A (en) * | 2011-04-13 | 2011-09-14 | 中国科学院合肥物质科学研究院 | Method for obtaining aorta pulse wave velocity (aoPWV) based on peripheral artery pulse wave signal |
| CN109843349A (en) * | 2016-10-19 | 2019-06-04 | 阿比奥梅德欧洲股份有限公司 | Ventricular assist device control |
| US11285311B2 (en) | 2016-10-19 | 2022-03-29 | Abiomed Europe Gmbh | Ventricular assist device control |
| CN111491556A (en) * | 2017-03-13 | 2020-08-04 | 微巨数据科技(深圳)有限公司 | Method and device for the time-resolved measurement of characteristic variables of cardiac function |
| CN110420014A (en) * | 2019-06-13 | 2019-11-08 | 东北大学 | The wearable cardiovascular function evaluation system and method intelligently decomposed based on pulse wave |
Also Published As
| Publication number | Publication date |
|---|---|
| UA82094C2 (en) | 2008-03-11 |
| ZA200604113B (en) | 2007-08-29 |
| CN100423687C (en) | 2008-10-08 |
| HU0400426D0 (en) | 2004-04-28 |
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