JP2007512043A - 胸部圧迫アーチファクトを除去するための生理学的信号処理への胸部速度の使用 - Google Patents
胸部圧迫アーチファクトを除去するための生理学的信号処理への胸部速度の使用 Download PDFInfo
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Abstract
Description
本発明は心臓蘇生を支援する装置に関する。
本発明は、優れた技術、具体的には(a)蘇生術の実施によって誘発されるECG信号中のアーチファクトを適応処理によって除去する技術、(b)モニタリングするECG信号を増幅する技術、および(c)ECGのリズムアドバイザリアルゴリズムの信頼性を高める技術を提供する。
さらに本発明は、インピーダンス法によって胸部圧迫適用中の肺容積を測定する手段を初めて提供する。本発明は圧迫に由来するアーチファクトによって改悪された、例えばインピーダンス心拍記録やパルス酸素濃度計のような別の生理学的信号のフィルタリングに使用することができる
本発明は、ゼロ次FIRフィルタを使ったCPRアーチファクトの除去に優れた性能を示す。これにより、本発明のいくつかの実施例は、従来技術で提案された適応フィルタの構造よりはるかに簡単かつ迅速なものになる。
本発明のその他の特徴および利点は、本発明の詳細な説明、図面および特許請求の範囲に記載されている。
式中、h(n)はフィルタ係数を含むベクトル、mは各フィルタのステップサイズを含むベクトル、c(n)は推定ECG信号、そしてX(n)は入力データを含むベクトルである。推定ECGは、(アーチファクトを含む)実測ECG信号からフィルタ出力y(n)を減算して得られる。
図2は、正常洞調律に応答する図1に示した適応フィルタの性能を示す例である。(a)の信号は、CPRアーチファクトを含むECG信号である。(b)の信号は基準信号として使用した圧迫速度である。(c)の信号は適応フィルタの出力である。
例えば、同期化および速度波形における位相エラーの両者を改善するには、適応チャンネル等化法を採用することができる。胸部圧迫による救命士の救命成績は時間とともに変化し、非定常処理としてモデル化する方がよい場合は、フィルタ性能を高めるために、カルマンフィルタ法を使用することもできる。
w(n+1)=w(n)−μ/2*N~ξ(n)
式中、N~ξ(n)は、nが−2v(n)e(n)に等しい時における平均二乗誤差(MSE)勾配の瞬間推定値である。(上記のN~は、本願の国際公報パンフレット中のティルデ付きNを指す。)FXLMS ANCアルゴリズムの安定性と精度は、可変カットオフローパスフィルタH(z)を追加し、胸部圧迫アーチファクトに関係しない、ECG中の周波数成分を消去することで改善することができる。一般に、胸部圧迫アーチファクトのスペクトルエネルギーは、ECGのそれより圧倒的に低い。カットオフ周波数は、多くの場合約3Hzで十分であるが、患者毎および胸部圧迫を行う救命士に応じて変化する。この難点を解消するため、v(n)と、ローパスフィルタに対する最適カットオフ周波数fCを決めるカットオフ周波数推定(CFE)法の入力に対してFFTを行う。好ましい実施例では、その決定は、5Hzを超えない、それ以下に波形エネルギーの80%が存在する周波数の計算に基づいて行われるが、このパーセンテージは変更してもよく、追加の決定論理を採用してもよい。例えば、x(n)についてFFTを計算してもよく、また、CFE法に入力してもよい。圧迫アーチファクトの周波数スペクトルX(z)の振幅ピークの振幅をまず初めに正規化し、その後、正規化した入力値X’(z)から速度スペクトルV(z)を減算することにより差スペクトルΔX’(z)=X’(z)−V’(z)が計算される。次に、スペクトルエネルギーの大部分(この実施例では97%)がその中に入るように、V(z)およびΔX’(z)についての周波数すなわち図6にそれぞれfCVおよびfCXで示す周波数を決定する。次に、fCVとfCXのいずれか低い方にfCを設定する。あるいはfCVとfCXの間の中間周波数にfCを設定することができる。
Claims (28)
- 胸部圧迫適用中の生理学的信号を取得し、
そこから胸部圧迫の速度に関する情報を決定可能なセンサーの出力を取得し、
前記胸部圧迫に起因する前記生理学的信号中の少なくとも一つの信号アーチファクトを低減するために前記速度に関する前記情報を使用することを備える、胸部圧迫適用中の生理学的信号を解析する方法。 - 前記生理学的信号はECG信号である請求項1に記載の方法。
- 前記生理学的信号はIPGである請求項1に記載の方法。
- 前記生理学的信号はICG信号である請求項1に記載の方法。
- 前記生理学的信号はパルス酸素濃度信号である請求項1に記載の方法。
- 前記センサーは速度センサーであり、前記速度に関する前記情報は前記速度センサーから決定される請求項1または2に記載の方法。
- 前記センサーは加速度計であり、前記速度に関する前記情報は前記加速度計の出力の積分から決定される請求項1または2に記載の方法。
- 前記生理学的信号中の少なくとも一つの信号アーチファクトを低減するために前記速度に関する前記情報を使用することは、前記生理学的信号と前記速度との時間整合を含む請求項1または2に記載の方法。
- 前記生理学的信号中の少なくとも一つの信号アーチファクトを低減するために前記速度に関する前記情報を使用することは、胸部圧迫アーチファクトを低減するように調節された適応フィルタを使用することを含む請求項1または2に記載の方法。
- アーチファクトの低減された前記生理学的信号を処理して心室細動が存在するか否かを判定する心室細動検出アルゴリズムを更に備える請求項1または2に記載の方法。
- 胸部圧迫が行われた時を検出し自動的に前記適応フィルタを始動する前処理工程を更に備える請求項9に記載の方法。
- 前記アルゴリズムが心室細動の存在を推定した場合に除細動ショックの伝達を可能にすることを更に備える請求項10に記載の方法。
- 前記適応フィルタに供給した生理学的信号と、前記適応フィルタによるアーチファクト低減後の生理学的信号との差を表す差分信号が生成される、請求項9に記載の方法。
- 前記差分信号は前記生理学的信号中のアーチファクト量を表す測度となる請求項13に記載の方法。
- 前記生理学的信号の以後の処理の修正に前記差分信号を使用する工程を更に備える請求項14に記載の方法。
- 前記アーチファクト量が第一の閾値を超えていることを前記差分信号が示す場合、前記心室細動検出アルゴリズムは、アーチファクトの影響に対する耐性を高めるように修正される請求項15に記載の方法。
- 前記アーチファクト量が前記第一の閾値より高い第二の閾値を超えていることを前記差分信号が示す場合、前記心室細動検出アルゴリズムの使用は停止される請求項16に記載の方法。
- 前記差分信号に対するスペクトル解析を行い、前記スペクトル解析の結果に基づいて前記生理学的信号のフィルタリングを調整する請求項15に記載の方法。
- 適応フィルタに供給するに先立ち、前記速度信号は正規化前処理を受ける請求項9に記載の方法。
- 前記適応フィルタはFIRフィルタを含む請求項90に記載の方法。
- 前記適応フィルタはゼロ次フィルタを含む請求項20に記載の方法。
- 前記適応フィルタは前記生理学的信号の推定値によって動的に制御される係数を備える請求項9に記載の方法。
- 前記適応フィルタはフィルタ出力と測定された生理学的信号との差が閾値を超えているときに自動的にリセットされる機能を備える請求項9に記載の方法。
- 自動的なリセットはステップサイズを動的に変更してフィルタの収束と安定性との関係を改善する機能を備える請求項23に記載の方法。
- 前記生理学的信号と前記速度信号に対して行われ、これら二つの信号を圧迫に対して整合させる時間整合処理を更に備える請求項1または2に記載の方法。
- 前記時間整合処理の出力に対して、前記生理学的信号と前記速度信号との間の誤差を低減させる適応フィルタ処理を行うことを更に備え請求項25に記載の方法。
- 前記適応フィルタはカルマンフィルタを含む請求項9に記載の方法。
- 前記適応フィルタは適応等化を用いる請求項9に記載の方法。
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Also Published As
Publication number | Publication date |
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US8862228B2 (en) | 2014-10-14 |
US20180325771A1 (en) | 2018-11-15 |
US20160361227A1 (en) | 2016-12-15 |
US20050101889A1 (en) | 2005-05-12 |
WO2005046431A3 (en) | 2005-09-15 |
EP1686891A2 (en) | 2006-08-09 |
US20150031972A1 (en) | 2015-01-29 |
US10058477B2 (en) | 2018-08-28 |
EP1686891A4 (en) | 2010-04-07 |
US20210085561A1 (en) | 2021-03-25 |
US20170196768A1 (en) | 2017-07-13 |
WO2005046431A2 (en) | 2005-05-26 |
US11679060B2 (en) | 2023-06-20 |
US10828232B2 (en) | 2020-11-10 |
US9545359B2 (en) | 2017-01-17 |
US9521978B2 (en) | 2016-12-20 |
US20130245393A1 (en) | 2013-09-19 |
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