JP2002533149A - プレチスモグラフ脈拍認識プロセッサ - Google Patents
プレチスモグラフ脈拍認識プロセッサInfo
- Publication number
- JP2002533149A JP2002533149A JP2000590526A JP2000590526A JP2002533149A JP 2002533149 A JP2002533149 A JP 2002533149A JP 2000590526 A JP2000590526 A JP 2000590526A JP 2000590526 A JP2000590526 A JP 2000590526A JP 2002533149 A JP2002533149 A JP 2002533149A
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- pulses
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- 238000000034 method Methods 0.000 claims description 12
- 230000000630 rising effect Effects 0.000 claims description 5
- 239000000284 extract Substances 0.000 claims description 4
- 230000001186 cumulative effect Effects 0.000 claims description 2
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 11
- 239000008280 blood Substances 0.000 description 11
- 210000004369 blood Anatomy 0.000 description 11
- 229910052760 oxygen Inorganic materials 0.000 description 11
- 239000001301 oxygen Substances 0.000 description 11
- 238000010521 absorption reaction Methods 0.000 description 10
- 230000000875 corresponding effect Effects 0.000 description 9
- 230000007774 longterm Effects 0.000 description 7
- 238000002106 pulse oximetry Methods 0.000 description 7
- 238000010586 diagram Methods 0.000 description 4
- 230000007246 mechanism Effects 0.000 description 4
- 230000002861 ventricular Effects 0.000 description 3
- 210000001765 aortic valve Anatomy 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- 238000004364 calculation method Methods 0.000 description 2
- 230000008602 contraction Effects 0.000 description 2
- 230000002596 correlated effect Effects 0.000 description 2
- 238000001514 detection method Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 238000005070 sampling Methods 0.000 description 2
- 208000007204 Brain death Diseases 0.000 description 1
- 230000008321 arterial blood flow Effects 0.000 description 1
- 230000036772 blood pressure Effects 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 208000029028 brain injury Diseases 0.000 description 1
- 230000000747 cardiac effect Effects 0.000 description 1
- 230000010339 dilation Effects 0.000 description 1
- 238000011143 downstream manufacturing Methods 0.000 description 1
- 210000004905 finger nail Anatomy 0.000 description 1
- 238000001595 flow curve Methods 0.000 description 1
- 238000007689 inspection Methods 0.000 description 1
- 230000031700 light absorption Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 210000000282 nail Anatomy 0.000 description 1
- 230000003287 optical effect Effects 0.000 description 1
- 230000010412 perfusion Effects 0.000 description 1
- 230000002093 peripheral effect Effects 0.000 description 1
- 230000036581 peripheral resistance Effects 0.000 description 1
- 230000001902 propagating effect Effects 0.000 description 1
- 230000035485 pulse pressure Effects 0.000 description 1
- 230000003068 static effect Effects 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 230000000007 visual effect Effects 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
Classifications
-
- 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
-
- 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
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
- A61B5/02416—Detecting, measuring or recording pulse rate or heart rate using photoplethysmograph signals, e.g. generated by infrared radiation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Physics & Mathematics (AREA)
- Medical Informatics (AREA)
- Surgery (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Cardiology (AREA)
- Molecular Biology (AREA)
- Veterinary Medicine (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Optics & Photonics (AREA)
- Spectroscopy & Molecular Physics (AREA)
- Physiology (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
- Photoreceptors In Electrophotography (AREA)
- Investigating Or Analysing Materials By Optical Means (AREA)
Abstract
Description
不十分な酸素供給が、数分で脳傷害及び死をもたらし得ることから、例えば、重
症者管理及び外科的処置等の医療分野において重要である。パルス酸素測定は、
酸素供給の指標である動脈血の酸素飽和度を測定するための広く容認された無侵
襲的手法である。パルス酸素濃度計(オキシメータ)は一般に、患者の酸素飽和
度の数値情報、脈拍数の数値情報、及び各脈動時に生じる可聴のインジケータ、
即ち「ビープ音」を提供する。
サとモニタとを接続するケーブルから構成される。従来より、パルス酸素測定セ
ンサは、赤色光及び赤外線(IR)発光ダイオード(LED)エミッタ、及び光
ダイオード検出器の両方を有する。センサは一般に、大人の患者の指又は幼児の
患者の足に取り付けられる。エミッタが手の指の爪を通してその下の血管及び毛
細血管に光を投じるように、センサは指に対して配置される。光ダイオードは、
LEDより放射された光が指の組織から現れると、それを検知するように、爪と
反対側の指先に配置される。
波長の動脈血による吸収の差を計算することによって酸素飽和度を決定する。パ
ルス酸素濃度計は、センサのLEDエミッタの駆動、及び光ダイオード検出器に
より生成される結果として得られる電流の読み取りを交互に行う。この電流は、
検出された光の強さに比例する。パルス酸素濃度計は、検出された赤色光及び赤
外線の強さの比率を計算し、動脈の酸素飽和値は、得られた比率に基づいて経験
的に決定される。パルス酸素濃度計は、センサを制御し、センサ信号を処理し、
患者の酸素飽和度及び脈拍数を表示するための回路を含む。更に、パルス酸素濃
度計は、動脈血流量に起因する照明された組織における血量の時間の経過に従っ
た変化の視覚化である、患者のプレチスモグラフ(血量記録器)の波形を表示し
得る。パルス酸素濃度計は、本発明の発明者の譲受人に譲受された米国特許第5,
632,272号に記載されている。
示す。波形100は、y軸110に沿って示される血量の、x軸120に沿って
示される時間に関する表示である。プレチスモグラフ波形100の形状は、心臓
拍動量、圧力勾配、動脈の弾性、及び末梢抵抗の関数である。理想的な波形10
0は、急勾配である短時間の流入フェーズ130の後に、流入フェーズの3乃至
4倍の長さの流出フェーズ140が続く、幅広い辺縁(末梢、peripheral)流動
曲線を表示する。流入フェーズ130は、心室収縮中の急激な血量流入による組
織の膨張の結果である。流出フェーズ140では、血流は弛緩期の間、血管床に
流れ続ける。弛緩期の終わりの基底線150は最小の基底組織潅流を示す。その
性質が議論されている重複切痕160が、流出フェーズ140の最中に存在する
。古くから、重複切痕160は、心室収縮期の終わりに大動脈弁が閉じることに
起因するとされている。しかしながら、これは、大動脈弁が開くと生じ、且つ動
脈流波の前に生じる、最初の素早く伝播する脈圧の周辺からの反射の結果でもあ
り得る。二重の重複切痕が、時々観察され得る。その説明ははっきりしないが、
恐らく、異なる時間に反射の結果がセンサに到達する。
分モデルを示すグラフ200である。グラフ200は、その組織部位により吸収
される光の総量を表すy軸210と、x軸220に沿って示される時間とを有す
る。総吸収量は、組織230、静脈血240、及び動脈血の基底250に起因す
る静的な吸収層を含む複数の層により表される。また、脈動(パルス)を加えら
れる動脈血260の量に起因する可変の吸収層も示される。脈動を加えられる動
脈血260の曲線270は、図1に示されるプレチスモグラフ波形100のよう
に見られる。
信号300を示す。パルス酸素濃度計は、標準のプレチスモグラフ波形100(
図1)を直接は検出しない。しかしながら、標準のプレチスモグラフは、検出さ
れた強度信号300が単に、吸収の曲線270の位相外れのバージョンであるこ
とを観察することにより、導かれ得る。即ち、検出された強度の頂点372は、
最小吸収量272(図2)の時点で生じ、検出された最小強度374は、最大吸
収量274(図2)の時点で生じる。更に、プレチスモグラフの流入フェーズで
の吸収276(図2)における急激な上昇は、強度における急降下376に反映
され、プレチスモグラフの流出フェーズでの吸収における漸落278(図2)は
、検出された強度における漸増378に反映される。
動する速度、即ち脈拍数である。一見、上述の赤色光及び赤外線プレチスモグラ
フ波形から脈拍数を決定することは容易な作業に見える。しかしながら、理想的
な条件下においてさえ、この作業は様々な生理的なプレチスモグラフ波形により
複雑になる。更に、プレチスモグラフ波形は、上記米国特許第2,632,272号に記
載されているような動作アーチファクトを含むノイズによって、しばしば変形さ
れる。特に動作アーチファクト及び他のノイズ源の存在下において、プレチスモ
グラフによる脈拍認識は、脈拍数を決定するため、及び脈の発生の視覚的又は聴
覚的な指示を提供するために有用な構成要素である。
波形内の脈拍に関する情報は、プロセッサの出力で提供される。プロセッサは、
入力波形内の複数の潜在脈拍を決定する候補脈拍部を有する。プロセッサの生理
的モデル部はその後、これらの潜在脈拍の内の生理的に容認可能な脈拍を決定す
る。プロセッサは更に、容認可能な脈拍に関する統計を提供し得る。1つの統計
は、容認可能な脈拍の周期と、入力波形セグメントの持続時間との比率である脈
拍密度である。
しての考慮から外す一連の構成要素を有する。この処理は、特徴的な重複切痕、
及びノイズ又は動作アーチファクトによりもたらされる特徴等の関係のない波形
特徴を除去する。候補脈拍部は、この三角形の波形の山及び谷に関連する潜在脈
拍を識別する指標を有する出力を提供する。
拍を捨てる一連の構成要素を有する。モデル部の第1の構成要素は、脈拍の開始
点、脈拍周期、及び脈拍の信号強度を含む潜在脈拍の特徴を抽出する。これらの
特徴は、様々なチェック(検査)項目と比較される。そのチェック項目には、所
定のしきい値より短い周期を有する脈拍であるか、非対称の脈拍であるか、後に
続く上昇傾向よりも概してなだらかな下降傾向を有する脈拍であるか、脈拍数及
び脈拍の信号強度の経験的な関係に十分に従わない脈拍であるか、及び短時間の
平均信号強度とは所定量を超えて異なる信号強度を有する脈拍であるか、が含ま
れる。
脈拍を識別するステップと、少なくとも1つの生理的に容認可能な脈拍を導き出
すために、この潜在脈拍を生理的な脈拍モデルと比較するステップと、を含む。
容認可能な脈拍に関する統計を生成する更なるステップが含まれてもよい。この
生成ステップは、容認可能な脈拍の周期(間隔)の合計を決定するステップと、
脈拍密度の値を導き出すために、この合計周期(間隔)と、入力波形セグメント
の持続時間との比率を計算するステップと、を含む。比較ステップは、潜在脈拍
から脈拍の特徴を抽出するステップと、抽出された特徴を脈拍基準に関してチェ
ックするステップと、を含む。
出力を提供するための候補脈拍手段を有する脈拍認識プロセッサである。また、
このプロセッサは、三角形の波形出力における生理的に容認可能な脈拍を決定し
、脈拍出力として容認可能な脈拍の指標を提供するためのプレチスモグラフ・モ
デル手段を有する。脈拍認識プロセッサは更に、上述の脈拍出力から累積的な脈
拍特性を決定するための脈拍統計手段を有し得る。
ロセッサ400は、候補脈拍サブプロセッサ410、プレチスモグラフ・モデル
・サブプロセッサ460、及び脈拍統計サブプロセッサ490の3つのサブプロ
セッサを有する。候補脈拍サブプロセッサ410は、様々な波形基準、即ち「エ
ッジ・チェック(辺の検査)」を用いて、入力波形の「スナップショット」41
2における候補脈拍を検出する。ある特定の実施の形態において、スナップショ
ットは、62.5Hzのサンプリング速度で抽出された検出された強度プレチス
モグラフの400サンプルである。このスナップショットは、6.4秒の波形セ
グメントを表す。候補脈拍サブプロセッサ410の出力414は、識別された候
補脈拍の三角形の波のモデルを表す入力波形セグメントの山及び谷である。候補
脈拍出力414は、プレチスモグラフ・モデル・サブプロセッサ460に入力さ
れ、プレチスモグラフ・モデル・サブプロセッサ460は、これらの候補脈拍を
生理的な脈拍のための内部モデルと比較する。プレチスモグラフ・モデル・サブ
プロセッサ460の出力462は、生理的に容認可能な脈拍である。容認可能な
脈拍出力462は、脈拍統計サブプロセッサに入力される。脈拍統計サブプロセ
ッサの出力492は、以下で説明されるように、平均脈拍周期及び脈拍密度を含
む容認可能な脈拍に関する統計である。
サは、特徴的な重複切痕を含む、理想化された三角形の波形に一致しない波形特
徴を除去する。例えば、図3に示されるように、候補脈拍構成要素は、点C及び
Dを不要として、点A、B及びEを識別しなければならない。候補脈拍サブプロ
セッサ410は先ず、入力波形セグメント内の「エッジ(辺)」を識別する。エ
ッジは、フィルタにかけられた波形信号の山及びそれに続く谷を結ぶセグメント
として定義される。その後、候補脈拍プロセッサ410は所定の条件を満たさな
いエッジを捨てる。
ィルタ510(実施の一形態における)、及びエッジ・ファインダ520を含む
エッジを識別する構成要素を有する。実施の一形態において、湾曲構成要素51
0は、波形をカーネル[1,-2,1]によりたたみ込み積分する(convolve)ことによ
り実施される。実施の一形態において、低域通過フィルタ510の代わりに、帯
域通過フィルタを用いることが可能である。これは、カーネルサイズがnである
場合に、次式のように表すことができる。
力サンプルであり、そしてwは固定の重みベクトルである。エッジ・ファインダ
520は、フィルタ510の出力における山及びそれに続く谷を識別する。
成要素が2つの波形脈拍610に適用された結果を示す。処理された波形660
は、山(頂点)A及びC、並びに対応する谷(底点)B及びDを有する。2つの
エッジが存在し、第1のエッジは、A及びBを結ぶ直線セグメント670により
表される。第2のエッジは、C及びDを結ぶ直線セグメント680により表され
る。
ッジを除去する、ΔT530、ゼロ交叉540、振幅しきい値550、及び最大
値及び最小値560のチェックを含む。ΔTチェック530は、固定間隔の範囲
内に納まらない終点間の距離を有する全てのエッジを捨てる。これは、生理的な
脈拍としては遅すぎるか早すぎる入力波形の脈拍に類似する部分を除去するため
に設計される。特定の実施の形態において、この間隔は、62.5Hzのサンプ
リング速度で5乃至30サンプルであり、即ち80乃至480ミリ秒である。つ
まり、長さが80ミリ秒未満又は480ミリ秒を超えるエッジは除去される。
エッジa(780)及びエッジb(790)が、比較のための容認可能なエッジ
の長さの最大間隔770と共に示される。この例において、35サンプル長であ
るエッジa(780)は、30サンプルである容認可能な最大間隔770の長さ
を超えるので、除去されるであろう。対照的に、25サンプル長であるエッジb
(790)は、容認される。
全てのエッジを除去する。ゼロ交叉チェックは、入力波形セグメントにおける小
さな曲率の変化、即ち、山でも谷でもない小さな隆起を除去する。
0が示される。エッジa(870)、エッジb(880)、及びエッジc(89
0)が、処理された波形860のためのゼロ線865に関して示される。この例
では、エッジa(870)及びエッジb(880)は容認されるが、エッジc(
890)は、ゼロ線865と交叉しないので除去される。
叉チェック540よりも大きい「隆起」を除去するために設計される。これは、
固定長のウィンドウ内の各エッジの右側の極値(谷)を、そのウィンドウ内の最
小値の定率に基づくしきい値と比較することにより行われる。谷が十分に深くな
い場合、エッジは拒絶される。特定の実施の形態において、ウィンドウ・サイズ
は、新生児に関しては50サンプルに設定され、大人のより遅い脈拍数に適応さ
せるために、大人に関しては100サンプルに設定される。また、最小値の60
%であるしきい値が用いられる。
60が示される。ウィンドウ970の開始点は、第1のエッジaの左側の極値(
山)942に設定される。ウィンドウ970内の最小値980が決定される。最
小値980の60%であるしきい値982が決定される。エッジaの右側の極値
992は、しきい値982と比較される。右側の極値992はしきい値982よ
りも小さい(しきい値よりもマイナスである)ので、エッジaは残される。その
後、エッジbの右側の極値993が、しきい値982と比較される。右側の極値
993はしきい値982よりも大きい(しきい値ほどマイナスではない)ので、
エッジbは除去される。同様に、エッジcは残される。次に、ウィンドウ970
はエッジbの左側の極値943に移動され、処理は繰り返される。
別の除去基準を適用する。最大値及び最小値チェック560は、チェックされて
いるエッジの最小値と、次のエッジの山との間の処理された波形の間隔を考慮す
る。最大値及び最小値チェック560は、この間隔内の処理された波形の最大値
を検出する。最大値が、そのエッジの右側の極値(最小値)の絶対値のあるパー
センテージよりも大きい場合、チェックされているエッジは除去される。最も厳
しいアルゴリズム性能を必要とする実施の一形態において、しきい値は、エッジ
の右側の極値の77%に設定される。それほど厳しくないアルゴリズム性能を必
要とする別の実施の形態において、しきい値は、エッジの右側の極値の200%
に設定される。最大値及び最小値チェック560は、脈拍に類似しているが動作
に対応するエッジを除去するのに効果的である。
波形1060が示される。最大値及び最小値チェック560は、エッジb(10
70)に適用される。エッジb(1070)の頂点である点B(1074)と、
エッジc(1080)の頂点である点C(1084)との間の間隔B−Cが考慮
される。間隔B−Cにおける最大値は、点C(1084)である。点C(108
4)は、この例では、エッジb(1070)の最小値である点P1(1072)
の絶対値の77%である第1のしきい値1078と比較される。エッジb(10
70)は、点C(1084)がこの第1のしきい値1078よりも小さいので捨
てられないであろう。別の例として、最大値及び最小値チェック560が、エッ
ジc(1080)に適用される。エッジc(1080)の頂点である点C(10
84)と、エッジd(1090)の頂点である点D(1094)との間の間隔C
−Dが考慮される。間隔C−Dにおける最大値は、点V(1093)である。点
V(1093)は、エッジc(1080)の底点である点P2(1082)の絶
対値の77%である第2のしきい値1088と比較される。エッジcは、点V(
1093)がこの第2のしきい値1088よりも大きいので捨てられるであろう
。
10の最後の構成要素である。脈拍ファインダ570は、様々なエッジ・チェッ
クを行った後に残っているエッジを、理想化された三角形の波形の候補脈拍に変
換し、候補脈拍はプレチスモグラフ・モデル・サブプロセッサ460(図4)に
供給される。残っているエッジの頂点及び底点の指標に関する情報から、入力波
形における脈拍を決定することは容易である。残っているエッジは先ず、エッジ
の対、即ち、第1及び第2のエッジ、第2及び第3のエッジ、のように分割され
る。脈拍の第1の点は、ある対の第1のエッジの頂点及び底点により決定される
指標の間隔における波形セグメントの最大値に一致する。第2の点は、第1のエ
ッジの底点と、第2のエッジの頂点との間の最小値である。第3及び最後の点は
、第2のエッジの頂点及び底点の間の最大値である。
れる特定の脈拍XYZ(1120)を含む、一連の脈拍1110として示される
脈拍ファインダ570(図5)の結果を示す。また、残っているエッジa(11
70)、b(1180)、及びc(1190)も示される。この例において、脈
拍XYZ(1120)は、エッジc(1180)及びe(1190)の対から形
成される。点X(1122)は、エッジc(1180)の頂点1182と、底点
1184との間の時間間隔における波形セグメント1140の最大値である。点
Y(1124)は、エッジc(1180)の底点1184と、エッジe(119
0)の頂点1192との間の時間間隔における波形セグメント1140の最小値
である。点Z(1128)は、エッジe(1190)の頂点1192及び底点1
194の間の時間間隔における波形セグメント1140の最大値である。
す。このサブプロセッサは、候補脈拍サブプロセッサ410(図4)により識別
された候補脈拍を入力として取得し、これらの候補脈拍の内の何れが、生理的な
プレチスモグラフ波形のための内部モデルの条件を満たすかを決定する。候補脈
拍サブプロセッサ410(図4)は、一連のチェックをエッジに対して実行する
が、プレチスモグラフ・モデル・サブプロセッサは、一連のチェックを脈拍特徴
に対して実行する。モデル・サブプロセッサの第1の構成要素は、関連する脈拍
特徴を計算する。モデル・サブプロセッサの残りは、これらの脈拍特徴をチェッ
クし、生理的に容認可能な特徴を識別する。
ッサの他の構成要素による下流での処理のために必要とされる入力候補脈拍に関
する3項目の情報を抽出する。抽出される特徴は、脈拍の開始点、周期、及び信
号強度である。
り抽出される3つのパラメータを示す。脈拍1300は、参考のために入力波形
1302に重ねて示される。開始点A(1360)は、脈拍1300の第1の山
である。周期P(1370)は、脈拍1300の第1の山1360及び第2の山
1362の発生時の時間の差である。信号強度SS(1350)は、脈拍130
0の第1の山1360及び谷1364の値の差である。信号強度SS(1350
)は、この値を、点A(1360)に対応する点での赤外線の生の信号データの
値により除算することにより正規化される。
は、15サンプルより少ない周期P(1370)(図13)を有する脈拍を捨て
る。これは、1分当たり250回の拍動(250BPM)に設定された、脈拍数
の上限に一致する。即ち、 15サンプル/拍動=(62.5サンプル/秒×60秒/分)/250拍動/分 (2) である。
この構成要素は、対応する波形がスティック・モデルにぴったり合わない場合、
即ち、脈拍を三角形の波形で表すことができない場合、これらの脈拍を捨てる。
この構成要素は、入力波形と、この波形の三角形の波の表現との間の正規化され
た差を測定する。得られた値はしきい値と比較され、正規化された差がそのしき
い値よりも大きい場合、脈拍は捨てられる。
る計算を示す。入力波形脈拍1410及び対応するスティック・モデル脈拍14
60が示される。スティック・モデル・チェック1230(図12)構成要素は
、波形脈拍1410及びスティック・モデル脈拍1460の間の濃い黒の領域1
420として示される、絶対較差の合計である第1の値を計算する。また、この
構成要素は、脈拍1410の下降部を取り囲む第1の長方形の灰色領域1470
と、脈拍1410の上昇部を取り囲む第2の灰色領域1480との合計である第
2の値を計算する。その後、スティック・モデル・チェック1230(図12)
は、第1の値を第2の値で除算することにより、第1の値を正規化する。この正
規化された値はしきい値と比較される。生理的な脈拍は、高い脈拍数では、ステ
ィック・モデルと大きく異なることはない。しかしながら、150bpmを大き
く下回る脈拍数では、重複切痕及び他の「隆起」の出現のために、これは真では
ない。従って、しきい値は脈拍数の関数である。実施の一形態において、しきい
値は次の通りである。 0.15 脈拍数<130の場合 (3) 0.430455769e-0.008109302(脈拍数) 130<脈拍数<160の場合 (4) 0.1 脈拍数>160の場合 (5)
拍の上昇部に関する正規化された傾斜角度の計算に基づく。この角は、同一周期
を有する理想の脈拍の同じ角と比較される。このチェックは、極端に非対称の脈
拍を捨てるのに効果的である。
502に重ねられた1つの三角形脈拍1500が示される。上昇脈拍部1504
は、垂直な高さa(1510)及び水平距離b(1520)を有する。高さ15
10及び距離1520は、脈拍信号強度ss(1530)、及びこの特定の実施
の形態では62.5Hzである脈拍周波数に関して正規化される。角度θ154
0は、次式のように計算される。 θ=arctan[(a/ss)/(b/62.5)]×180/π (6) 角度θは、aが信号強度に等しく、bが周期c(1550)引く6に等しい場合
、同一周期を有する理想的な脈拍の同じ角と比較される。しきい値のマージンと
して、この値に3度が加算される。従って、θは、次式のように計算されるθre f と比較される。 θref=arctan {[a/ss]/[(c-6)/62.5]}×(180/π)+3 (7) もし、θ<θrefであるならば、脈拍は捨てられる。図16は、セグメントa(
1610)が信号強度ss(1630)よりもかなり小さいので、角度チェック
により捨てられるであろう脈拍1600の例を示す。
は、上昇脈拍部の持続時間と、下降脈拍部の持続時間との比率が所定のしきい値
よりも小さい脈拍を除去する。特定の実施の形態において、しきい値は1.1で
ある。このチェックの理論的根拠は、各生理的な脈拍において、上昇部は、心室
収縮を表す下降部よりも時間が短いことである。
拍1700の例を示す。この例において、上昇部1710の持続時間a(176
0)は、下降部1720の持続時間b(1770)よりも短い。従って、上昇持
続時間1760と下降持続時間1770の比率(a/b)は、しきい値1.1よ
りも小さい。
0は、各脈拍の信号強度に基づいて、各脈拍に信頼値を割り当てる。高低2つの
レベルの信頼度が存在する。信頼度の決定は、2つのメカニズムに基づく。第1
のメカニズムは、脈拍数が多いほど、信号強度が低いという観測結果に基づいて
いる。このメカニズムは、脈拍数と信号強度との経験的な関係を用いて実施され
る。測定された信号強度が、この経験的な関係よりも固定マージンの分だけ高い
場合、脈拍の信頼度は低い。第2のメカニズムは、信号強度が短時間に過度に変
化し得ないという生理的な限界を組み入れる。脈拍信号強度が、短時間の平均信
号強度よりも固定マージンの分だけ高い場合、脈拍の信頼度は低い。脈拍が両方
の基準を満たす場合、この脈拍は高い信頼度を有する。単一の波形セグメント又
はスナップショットにおける全ての脈拍は、同一の信頼値を有する。従って、高
い信頼度を有する脈拍が1つでも存在すれば、低い信頼度を有する全ての脈拍は
、除去されるであろう。
度と脈拍数との関係は、曲線1800により示され、これは次の方程式により説
明される。 SS=110.e-0.02131PR+1 (8) 先ず、脈拍数PR(1810)が脈拍周期から決定される。次に、対応する信号
強度SSref(1820)が、方程式(8)及び脈拍数1810から決定される
。方程式(8)は、経験的に導き出されるので、個々の患者により適するように
、上下にずらされる。長期の平均信号強度(長期SS)1830、及び長期の平
均脈拍数(長期PR)1840が導き出される。長期SS(1830)が、長期
PR(1840)に対応する位置で曲線1800を超えている場合、長期SSと
曲線1800との差に2を加えた値がオフセット1850となる。測定された脈
拍信号強度(脈拍SS)が、SSref+オフセット1860よりも小さい場合、
このチェックは通過される。
・モデル・サブプロセッサ460の後に、脈拍認識プロセッサ400は、生理的
に容認可能なプレチスモグラフのための所定のモデルに該当する入力波形スナッ
プショット内の全ての脈拍を識別する。これらの脈拍に関する情報から、脈拍統
計サブプロセッサ490は、このスナップショット自体に関する統計を抽出する
ことが可能である。導き出される2つの有用な統計パラメータは、脈拍周期及び
信号強度の中間値である。400ポイント(ほぼ7秒)の波形スナップショット
内で、各脈拍に関連する周期及び信号強度は大きく異なり得るので、平均値より
も寧ろ中間値が用いられる。別のパラメータは、信号強度の信頼度のレベルであ
り、これはある実施の形態では、スナップショットの全ての認識された脈拍にと
って同じである。第4の有用なパラメータは、脈拍密度である。脈拍密度は、容
認可能な脈拍の周期(間隔)の合計を、スナップショットの長さで除算すること
により得られる。脈拍密度は、生理的に容認可能であると分類されているスナッ
プショットの比率を表す。脈拍密度は、0及び1の間の値であり、1は、スナッ
プショットの全てが生理的に容認可能であることを意味する。換言すると、脈拍
密度は、データが間違いないか、又は例えば、動作アーチファクトにより歪めら
れているかの尺度である。
に示されるように、更なるモニタリング入力を有するシステムにおいて、脈拍数
選択及び比較モジュール1900が提供され得る。例えば、酸素濃度計の脈拍数
(及び、必要に応じて、対応する信頼度情報)が、第1の入力1902で提供さ
れることが可能である。複数のパラメータを有する患者モニタでは、脈拍数又は
脈拍に関する情報(及び、場合によっては信頼度情報)もまた、ECG又はEK
Gモニタからの第2の入力1904、血圧モニタからの第3の入力1906、動
脈線からの第4の入力1908、及び他の可能なパラメータ1910、1912
で提供され得る。その後、脈拍数モジュール1900は、多様な入力を比較し、
どれが相関するか、又はどれが相関し、且つ最も高い信頼関係を有するかを決定
することが可能である。選択された脈拍数はその後、出力1914で提供される
。或いは、脈拍数モジュール1900は、個々の入力又は選択された入力を平均
するか、又は利用可能であれば、信頼度情報に基づいて重み付けされた平均を提
供してもよい。
て詳細に開示された。これらの実施の形態は、例として開示されたものであり、
本願の請求項により定義される本発明の範囲を制限するものではない。当業者は
、本発明の範囲内の多数の変形及び変更を理解するであろう。
ジを示すグラフである。
すグラフである。
である。
Claims (17)
- 【請求項1】 プレチスモグラフの波形入力、及び該波形入力内の脈拍に関
する情報を提供する脈拍認識出力を有するプロセッサであって、 前記波形入力内の複数の潜在脈拍を決定する候補脈拍部と、 前記脈拍の中の生理的に容認可能な脈拍を決定する生理的モデル部と、 を含む、プレチスモグラフ波形入力及び脈拍認識出力を有するプロセッサ。 - 【請求項2】 前記波形入力を有する脈拍の統計を決定する部分を更に含む
、請求項1に記載のプロセッサ。 - 【請求項3】 前記統計の1つが、前記波形入力内の生理的に容認可能な脈
拍の密度であることを特徴とする、請求項2に記載のプロセッサ。 - 【請求項4】 前記候補脈拍部が、前記潜在脈拍を三角形の波の山及び谷と
して識別する出力を提供する、請求項1に記載のプロセッサ。 - 【請求項5】 前記生理的モデル部が前記潜在脈拍の特徴を抽出する構成要
素を含む、請求項1に記載のプロセッサ。 - 【請求項6】 前記特徴が、脈拍周期、脈拍の開始点、及び脈拍の信号強度
の少なくとも1つを含む、請求項5に記載のプロセッサ。 - 【請求項7】 前記生理的モデル部が、前記潜在脈拍の中の所定のしきい値
未満の周期を有する潜在脈拍を無視する構成要素を含む、請求項1に記載のプロ
セッサ。 - 【請求項8】 前記生理的モデル部が、前記潜在脈拍の中の概して非対称で
ある潜在脈拍を無視する構成要素を含む、請求項1に記載のプロセッサ。 - 【請求項9】 前記生理的モデル部が、前記潜在脈拍の中の、後に続く上昇
傾斜よりも概して遅い下降傾斜を有する潜在脈拍を無視する構成要素を含む、請
求項1に記載のプロセッサ。 - 【請求項10】 前記生理的モデル部が、前記潜在脈拍の中の脈拍数及び脈
拍信号強度の経験的な関係に十分に従わない潜在脈拍を無視する構成要素を含む
、請求項1に記載のプロセッサ。 - 【請求項11】 前記生理的モデル部が、前記潜在脈拍の中の、短期の平均
信号強度とは所定量を超えて異なる信号強度を有する潜在脈拍を無視する構成要
素を含む、請求項1に記載のプロセッサ。 - 【請求項12】 プレチスモグラフ波形内の脈拍を認識する方法であって、 前記波形における複数の潜在脈拍を識別するステップと、 少なくとも1つの生理的に容認可能な脈拍を導き出すために、前記潜在脈拍を
生理的脈拍モデルと比較するステップと、 を含む、プレチスモグラフ波形内脈拍認識方法。 - 【請求項13】 前記少なくとも1つの容認可能な脈拍に関する統計を生成
するステップを更に含む、請求項13に記載の方法。 - 【請求項14】 前記統計を生成するステップが、 前記少なくとも1つの容認可能な脈拍の総周期を決定するステップと、 脈拍密度を導き出すために、前記総周期と前記波形の持続時間との比率を計算
するステップと、 を含む、請求項14に記載の方法。 - 【請求項15】 前記比較するステップが、 前記潜在脈拍から脈拍の特徴を抽出するステップと、 複数の脈拍基準に対して該特徴をチェックするステップと、 を含む、請求項13に記載の方法。
- 【請求項16】 脈拍認識プロセッサであって、 入力波形における潜在脈拍を識別し、三角形の波形出力を提供するための候補
脈拍サブプロセッサ手段と、 前記三角形の波形出力における生理的に容認可能な脈拍を決定し、脈拍出力と
して容認可能な脈拍の指標を提供するためのプレチスモグラフ・モデル・サブプ
ロセッサ手段と、 を含む、脈拍認識プロセッサ。 - 【請求項17】 前記脈拍出力から累積的な脈拍特性を決定するための脈拍
統計サブプロセッサ手段を更に含む、請求項17に記載の脈拍認識プロセッサ。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11412798P | 1998-12-30 | 1998-12-30 | |
US60/114,127 | 1998-12-30 | ||
PCT/US1999/031054 WO2000038569A1 (en) | 1998-12-30 | 1999-12-28 | Plethysmograph pulse recognition processor |
Publications (1)
Publication Number | Publication Date |
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JP2002533149A true JP2002533149A (ja) | 2002-10-08 |
Family
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JP2000590526A Pending JP2002533149A (ja) | 1998-12-30 | 1999-12-28 | プレチスモグラフ脈拍認識プロセッサ |
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US (5) | US6463311B1 (ja) |
EP (3) | EP1148813B1 (ja) |
JP (1) | JP2002533149A (ja) |
AT (2) | ATE310443T1 (ja) |
BR (1) | BR9916647A (ja) |
DE (2) | DE69943251D1 (ja) |
WO (1) | WO2000038569A1 (ja) |
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DE69943251D1 (de) | 2011-04-14 |
EP1148813A1 (en) | 2001-10-31 |
US9675286B2 (en) | 2017-06-13 |
EP1148813B1 (en) | 2005-11-23 |
BR9916647A (pt) | 2001-10-02 |
US20030032873A1 (en) | 2003-02-13 |
DE69928569T2 (de) | 2006-08-10 |
EP1632172A3 (en) | 2008-05-28 |
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US6816741B2 (en) | 2004-11-09 |
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US20060206021A1 (en) | 2006-09-14 |
US7988637B2 (en) | 2011-08-02 |
EP2305103B1 (en) | 2013-09-25 |
DE69928569D1 (de) | 2005-12-29 |
EP1632172A2 (en) | 2006-03-08 |
US20110288383A1 (en) | 2011-11-24 |
ATE310443T1 (de) | 2005-12-15 |
US20050085702A1 (en) | 2005-04-21 |
US7044918B2 (en) | 2006-05-16 |
WO2000038569A1 (en) | 2000-07-06 |
EP1632172B1 (en) | 2011-03-02 |
ATE499873T1 (de) | 2011-03-15 |
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