JP2010512192A - プレチスモグラフ変動プロセッサ - Google Patents
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Abstract
Description
この出願は、2006年12月9日に提出されて「プレチスモグラフ変動指数」という発明の名称が付けられた先の米国仮特許出願である第60/873,663号出願と、2007年10月12日に提出されて「プレチスモグラフ変動指数」という発明の名称が付けられた先の米国仮特許出願である第60/998,782号出願について優先権を主張するものである。上記両出願のすべての内容は、参照によってこの明細書の中に組み込まれる。
図1は、プレチスモグラフ変動処理システム100の実施形態を示しており、この実施形態では、プレチスモグラフ変動(PV)の1つ以上の測定値が算出される。プレチスモグラフ変動処理システム100では、患者の状態の処置を表示するとともにそれに影響を及ぼすために、PVに応じて少なくともいくつかの表示、警告または制御がもたらされる利点がある。PV処理システム100によれば、SpO2、脈拍数(PR)、灌流指数(PI)、信号品質、および、複数波長構成においてHbCOやHbMetのような付加的血液パラメータ測定値がさらに生成される。
図2は、強度軸201対時間軸202に関してプロットされたプレチスモグラフ200を示している。このプレチスモグラフ200には複数のパルス210があり、それぞれのパルスは、山212と谷214を有し、また、時間周期216にわたって延びている。それぞれのパルス210について灌流指数(PI)値を定義することができる。
図3はPVIプロセス300の実施形態を示しており、この実施形態により、プレチスモグラフ変動指数(PVI)が導き出されるとともに表示される。初めに、第1バッファが、算出された灌流指数(PI)値で満たされる(310〜330)。ある実施形態では、これらの値は、先に説明されたように、IRチャネルに基づいている。第1バッファ335の中に充分な量の生理的許容データがあるときには、第2バッファが、算出されたプレチスモグラフ変動指数(PVI)値で満たされる(340〜360)。第2バッファにおける中央PVIが算出されて表示される(370〜380)。第1バッファにおける許容データの量が不充分であるときには、ディスプレイは最後に算出された中央PVIで凍結される(390)。
図4は、プロセスステップ401および初期設定402を有するプレチスモグラフ変動(PV)プロセッサ400の実施形態を示している。初期設定402によって、プロセスステップ401の具体的特性が決定される。PVプロセッサ400によって、1つ以上のプレチスモグラフチャネル405が入力され、PV出力値407が生成される。プレチスモグラフチャネル405のそれぞれは、脈動式酸素濃度計センサの赤色エミッタおよびIRエミッタに対応する赤色波長チャネルおよびIR波長チャネルのような異なる光センサ波長に対応している。先に引用した米国特許出願第11/367,013号に記載されたような複数波長センサが使用されるときには、3つ以上のチャネルがあってもよい。例えば、波長が約630nmから約905nmまで変化する8つのチャネルがあってもよい。ある実施形態では、PV算出において精度または堅牢性を増大させるために、2つ以上のプレチスモグラフチャネル405が、平行して、または複合プレチスモグラフとして処理される。入力装置410により、PV算出のためにどのプレチスモグラフチャネル405をプレチスモグラフ入力値414として使用するかが、選択されたチャネル初期設定412に従って決定される。入力装置410により、任意の1つのチャネル405またはいくつかのチャネル405の組み合わせを選択してよい。前処理415により、所定の式417に従ってプレチスモグラフ入力値414が修正される。ある実施形態では、プレチスモグラフベースラインにおけるあらゆる緩慢な変化すなわち低周波振動を排除するために、あるいは、プレチスモグラフ全体が吸気および呼気で上下へずらされる呼吸誘発変化のような平均値を排除するために、前処理415によりプレチスモグラフ入力値414がフィルタ処理される。ある実施形態では、前処理415は、毎分通過帯域ごとに30〜550ビートを有している帯域フィルタである。認識された許容パルス420が、先に引用した米国特許第7,044,918号に開示されたような生理的許容パルス424だけを通過させるためにパルス基準422へ適用される。
多くの臨床医は現在、患者生理機能の変化について脈動式酸素濃度計のプレチスモグラフ波形を観察している。残念なことに、脈動式酸素濃度計の製造業者間には、プレチスモグラフ波形を表示する方法に整合性がない。さらに、平滑化用、自動計数用および他の表示データ処理用のマスクは、生のプレチスモグラフ波形において変化する。このため、いくつかの患者生理機能は、ベッドサイドモニタのプレチスモグラフディスプレイの単なる観察からは容易に予測することができない。PVIのようなプレチスモグラフ変動(PV)パラメータは、必要に応じてある方向へ向けることもできる数値的フォーマットで表示されるプレチスモグラフ波形変化を有利に定量化する。従って、たとえわずかな生理的変化であっても確実に観察することが可能である。
Claims (30)
- ある組織部位の内部における拍動性血流に対応する複数のパルスを有するプレチスモグラフ波形を入力するステップと、
前記パルスに対応する複数の灌流値を導くステップと、
一連の前記灌流値のそれぞれの変動性を示す複数の変動値を決定するステップと、
前記変動値を代表するものであるプレチスモグラフ変動指数を算出するステップと、
前記プレチスモグラフ変動指数を表示するステップと、
を含むプレチスモグラフ変動方法。 - 灌流値を導くステップは、
前記パルスについての山と谷を認識するステップと、
これらの山と谷から前記パルスについてのAC値を算出するステップと、
前記パルスについてのDC値を算出するステップと、
前記AC値を前記DC値で正規化するステップと、
を含む請求項1に記載のプレチスモグラフ変動方法。 - 変動値を決定するステップは、
前記灌流値を複数のバッファの中に累積するステップと、
前記バッファのそれぞれについて1つの変動値を算出するステップと、
を含む請求項2に記載のプレチスモグラフ変動方法。 - 変動値を決定するステップは、
前記バッファのそれぞれの内部における前記灌流値を最大灌流値から最小灌流値まで並べ換えるステップと、
前記バッファのそれぞれから少なくとも1つの最大灌流値と少なくとも1つの最小灌流値とを削除するステップと、
をさらに含む請求項3に記載のプレチスモグラフ変動方法。 - 変動値を決定するステップは、
前記バッファのそれぞれについての最大灌流値と最小灌流値との間の百分率差から複数のプレチスモグラフ変動指数(PVI)を算出するステップ
をさらに含む請求項4に記載のプレチスモグラフ変動方法。 - プレチスモグラフ変動指数を算出するステップは、PVIの中央値を算出するステップを含む請求項5に記載のプレチスモグラフ変動方法。
- 前記パルスのうち生理的に許容することのできるパルスを認識するステップと、
前記バッファのそれぞれについての許容可能なデータの最小時間量を決定するステップと、
をさらに含む請求項6に記載のプレチスモグラフ変動方法。 - 入力するステップは、前記プレチスモグラフ波形のためにIRチャネルを使用するステップを含み、
認識するステップは、許容パルスを検証するために赤色チャネルを使用するステップを含む請求項7に記載のプレチスモグラフ変動方法。 - 光学的放射線の複数波長を組織部位の中へ伝達し、この組織部位の内部を流れる拍動性血液による減衰の後に前記光学的放射線を検出し、検出された光学的放射線に応じてセンサ信号を生成する光学式センサと、
複数のプレチスモグラフチャネルを生成するために、前記センサ信号を復調する患者モニタと、
少なくとも1つのプレチスモグラフチャネルを入力するとともに、それに応じてプレチスモグラフ変動(PV)パラメータを出力する、前記患者モニタの内部におけるディジタル信号プロセッサ(DSP)と、
少なくとも1つの前記プレチスモグラフチャネルを処理するとともに前記PVパラメータを導くために、前記DSPについて実行されるPVプロセスと、
前記PVパラメータに反応する患者モニタの出力装置と、
を備えるプレチスモグラフ変動処理システム。 - 前記PVプロセスは、
プレチスモグラフ特性を有する少なくとも1つの前記プレチスモグラフチャネルに対応するプレチスモグラフ入力と、
前記プレチスモグラフ特性に従うプレチスモグラフから複数のプレチスモグラフ値を抽出するプレチスモグラフ測定プロセスと、
を備える請求項9に記載のプレチスモグラフ変動処理システム。 - 前記PVプロセスは、
前記プレチスモグラフ値に対応するプレチスモグラフ値入力と、
前記プレチスモグラフ値から複数の変動値を生成するプレチスモグラフ変動プロセスと、
をさらに備える請求項10に記載のプレチスモグラフ変動処理システム。 - 前記PVプロセスは、
前記変動値に対応するプレチスモグラフ変動入力値と、
前記変動値からプレチスモグラフ変動(PV)パラメータを生成する変動パラメータプロセスと、
をさらに備える請求項11に記載のプレチスモグラフ変動処理システム。 - 前記PVプロセスは、前記プレチスモグラフ入力値へ適用された生理的許容基準をさらに備える請求項12に記載のプレチスモグラフ変動処理システム。
- 前記PVプロセスは、分散基準に従って前記プレチスモグラフ値のうちの外にあるものを削減する削減データ分散プロセスをさらに備える請求項13に記載のプレチスモグラフ変動処理システム。
- 前記PVプロセスは、少なくとも1つの平滑化制限またはスルーレート制限を前記PVパラメータへ適用する後処理をさらに備える請求項14に記載のプレチスモグラフ変動処理システム。
- 前記PVプロセスは、周期的なベースラインシフトを除くために、帯域フィルタを前記プレチスモグラフ入力値へ適用する前処理をさらに備える請求項15に記載のプレチスモグラフ変動処理システム。
- 前記患者モニタは、プレチスモグラフ変動における傾向を表示するために、PVパラメータ対時間のグラフを生成する請求項16に記載のプレチスモグラフ変動処理システム。
- その入力から複数のプレチスモグラフ値を測定する複数のプレチスモグラフチャネルのうちの少なくとも1つを入力するステップと、
前記プレチスモグラフ値の特有の時間間隔をそれぞれが含んでいる複数の時間窓を定義するステップと、
複数の変動値を算出するステップであって、これらの変動値のそれぞれが前記時間窓のうちの特有の1つに含まれたプレチスモグラフ値から導き出されるステップと、
前記変動値の特有の時間間隔をそれぞれが含んでいる複数の第2時間窓を定義するステップと、
複数のパラメータ値を算出するステップであって、それぞれのパラメータ値は、前記第2時間窓のうちの特有の1つに含まれた変動値から導き出されるステップと、
前記パラメータ値を出力するステップと、
を含むプレチスモグラフ変動方法。 - 前記プレチスモグラフチャネルのそれぞれは、ある組織部位の内部における拍動性血流に対応する複数のパルスを有し、
前記プレチスモグラフ値は、これらのパルスに基づいている
請求項18に記載のプレチスモグラフ変動方法。 - 前記プレチスモグラフ値は、前記組織部位での血液灌流の測定値である請求項19に記載のプレチスモグラフ変動方法。
- 前記プレチスモグラフ値は、吸収パルス下の区域に基づいている請求項19に記載のプレチスモグラフ変動方法。
- 前記プレチスモグラフ値は、前記パルスの包絡線に基づいている請求項18に記載のプレチスモグラフ変動方法。
- 前記プレチスモグラフ値は、正規化された包絡線高さの時系列値に基づいている請求項22に記載のプレチスモグラフ変動方法。
- 前記プレチスモグラフ値は、正規化された包絡線区域の時系列値に基づいている請求項23に記載のプレチスモグラフ変動方法。
- プレチスモグラフ入力値をディジタル信号プロセッサ(DSP)へもたらすために、光学的放射線の複数の波長をある組織部位へ伝達するとともにある組織部位の内部における拍動性血流による減衰の後に前記光学的放射線を検出するセンサを有し、前記入力値は、前記複数の波長に対応する複数のチャネルから選択され、前記DSPは、前記プレチスモグラフからプレチスモグラフ変動値を導くための指示を実行するプレチスモグラフ変動処理システムであって、
プレチスモグラフの入力装置と、
あらかじめ定義されたプレチスモグラフ特性によって前記プレチスモグラフ入力からプレチスモグラフ値を生成するための測定手段と、
前記プレチスモグラフ値から変動値を導くための算出手段と、
前記プレチスモグラフ値からプレチスモグラフ変動(PV)パラメータを導くための削減手段と、
を備えるプレチスモグラフ変動処理システム。 - ある変動式をプレチスモグラフ値の時間窓へ適用するための第1累積手段をさらに備える請求項25に記載のプレチスモグラフ変動処理システム。
- 前記第1累積手段から外にある値を削除するための分散削除手段をさらに備える請求項26に記載のプレチスモグラフ変動処理システム。
- 変動値の時間窓へデータ削減基準を適用するための第2累積手段をさらに備える請求項27に記載のプレチスモグラフ変動処理システム。
- 生理的に許容することのできないプレチスモグラフ入力からパルスを排除するための許容手段をさらに備える請求項28に記載のプレチスモグラフ変動処理システム。
- 前記PVパラメータの傾きを制限するための後処理手段をさらに備える請求項29に記載のプレチスモグラフ変動処理システム。
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JP5441707B2 (ja) | 2014-03-12 |
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