JP4762545B2 - 心肺蘇生中の胸部圧迫の深度を決定する方法 - Google Patents
心肺蘇生中の胸部圧迫の深度を決定する方法 Download PDFInfo
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Description
実際圧迫深度:ある瞬間の実際の圧迫深度。
実際圧迫開始点:胸部圧迫が開始された実際の位置または点。
自動回帰移動平均:過去のデータサンプルを現在のデータサンプルの修正に使用する機能。
圧迫深度波形のベースライン位置:深度波形の実際開始点が最も多く集まっている位置。
ベースライン制限装置:圧迫深度波形のベースラインの位置で作動するプロセッサまたは機能。
圧迫ピーク:圧迫深度が最大になる位置または点。
現在の圧迫深度:ある瞬間の圧迫深度。
現在の開始点:現在の圧迫の開始点。
圧迫深度:圧迫された胸部のある瞬間の深度で、リラックスした胸部位置からの相対的な深さ。
推定の実際圧迫開始点:胸部圧迫が開始された実際位置または点の推定値。
圧迫の初期開始点:一連の胸部圧迫が開始された位置または点。
測定された圧迫開始点:胸部圧迫が開始された位置または点の測定値。
移動平均:過去のデータサンプルを現在のデータサンプルの修正に使用する機能。
過去の開始点:すでに観測された圧迫開始点。
圧迫深度波形のピーク位置:深度波形の実際ピーク位置が最も多く集まっている位置。
圧迫開始点:胸部圧迫が開始された位置または点。
[(0.5*100%)+(1.1*98.75%)+(0.9*96.25%)] ÷ 3 = 0.853 インチ、
初期開始点に対する相対位置。
[(0.5*100%)+(1.1*98.75%)+(4.0*97.5%)+(0.9*96.25%)] ÷ 4 = 0.853 インチ、
初期開始点に対する相対位置。
別の言い方をすれば、この値は現在の圧迫の推定の実際開始点である。
ここで DBi > B の場合、DBi = 0
ここで、Dsは現在の開始点の深度、nrはベースラインを超えている開始点すべてを削除した後に残っている開始点の数、iは開始点の数(または加算指数)、DBiはith 番目の開始点の測定深度、ωは重み定数、Bはベースラインである。別の言い方をすれば、DBi*ωi-1 をiが1からnrまで加算し、その加算値をnrで割る。DBiがBより大きい場合、そのDBiはゼロとする。
[(0.5*100%)+(1.082*98.75%)+(0.902*96.25%)] ÷ 3 = 0.812 インチ、
初期開始点に対する相対位置。
別の言い方をすれば、この値は現在の圧迫の推定の実際開始点である。
ここで DBi > B の場合、DBi = 0
ここで、Dsは現在の開始点の深度、nrはベースラインを超えている開始点すべてを削除した後に残っている開始点の数、iは開始点数、DBiはith 番目の開始点の測定深度、jはベースライン内にある最近のほとんどの開始点の指数、DBi-jはベースライン内にある最近のほとんどの開始点、PSはDBi - DBi-jの大きさのステップが生じる確率、ωは重み定数、Bはベースラインである。結果のDsは現在の開始点の報告深度である。別の言い方をすれば、[DBi-j+(DBi - DBi-j)*PS]*ωi-1 をiが1からnまで加算し、その加算値をnrで割る。DBiがB(ベースライン)より大きい場合、そのDBiはゼロとする。
ここで変数は上記のように定義される。再び、Dsの値は現在の圧迫の推定の実際開始点である。
y[n] = (1-α)*y[n-1] + α*x[n].
y[n](high pass) = 1 - {(1-α)*y[n-1] + α*x[n]},
ここで、y[n](高パス)は高パス・フィルタ出力であり、その他の変数は低パスARMAフィルタの関連において定義される。高パス・フィルタは、深度、速度、あるいは加速度信号の低周波成分を除去するのに使用する。
デューティサイクルが事前に設定されたパラメータ内に収まっていない場合は、適切なデューティサイクルに影響するために圧迫のタイミングと圧迫の割合を調整するよう、ユーザフィードバック装置は蘇生実施者を誘導する。
(1) X(t) = H(t, X(t-1), y(t), u(t)) および
(2) θ(t) = h(X(t))
ここで、X(t)は時間tにおけるシステムの状態、Hは変換関数の状態、X(t-1)は以前のシステムの状態、Y(t)は測定した出力、u(t)は測定した入力、θ(t)はシステムであり、hはシステムの状態を出力に変換する。 システムの状態は、h(X(t))によりシステム出力に転換される。
(3) X(t) = X(t-1) + μQx(X(t-1), y(t), u(t)) および
(4) θ(t) = θ(t-1) + γQθ(X(t-1), y(t), u(t))
ここで、μとγは最新の段階で提供される情報の相対的な量を反映する小さな値である。Qは入力、出力、状態に関係する代数である。等式(3)と(4)は、等式(1)と(2)よりも帰納的に等式の計算が簡単であるという意味でより簡略化されている。
T0(したがってλ)は、実際加速度が独立して測定された場合に推定の実際加速度が実際加速度に最も近似するように、システム状態の適切な知識をもって選択しシステム識別の整調に使用する。このように、T0は圧迫モニタが測定を開始する前に事前に設定される。
R(t) = R(t=1) + γ(t)[φ(t)φT(t) - R(t-1)]
数学的には、グラジエント最新化は以下のように表現される。
両方の等式において、R(t)は識別分類基準のヘッセ行列式、R(t−1)は1つ前の段階での識別分類基準のヘッセ行列式、y(t)は最新化ゲイン(これは忘却因子に関連する)、そしてφ(t)は回帰ベクトルである。
γ(t) = (1+λ(t)/γ(t-1))-1
よって、最新化ゲインは忘却因子に関連している。
ここで、Vは二次損失代数、dはモデル階数の大きさ、Nはデータポイントの数である。
赤池情報分類は以下のように表現される。
(12) AIC = log[V(1+2(d/N))],
ここで、Vは二次損失代数である。二次損失代数は追加の用語を使用する追加の費用代数に関係するすべての二次代数である。
2…圧迫モニタ
3…胸骨
4…プロセッサ
5…位置変化ディスプレイ
7…心電図ディスプレイ
34…生の加速度信号
35…フィルタ
36…積分
37…フィルタ
38…積分
39,47,48…ベースライン制限装置
51…フィルタ
52…開始点検出器
55,56,57…ピーク制限装置
58…フィルタ
59…ピーク検出器
61…推定の実際深度
62…ユーザフィードバック
Claims (20)
- 胸部圧迫時の深度測定のための装置であって、
胸部圧迫の加速度に相応する加速度信号を生成可能な加速度測定器と、
前記加速度測定器に接続され、胸部圧迫の測定深度に相応する測定深度信号の生成可能な、前記加速度信号を積分する積分手段と、
前記積分手段に接続され、前記加速度信号を積分して算出された深度信号の自動回帰移動平均を計算することにより胸部圧迫の推定の実際深度に相応する推定の実際深度信号を生成するようにプログラムされたプロセッサと、を備えた装置。 - 前記プロセッサに接続されたディスプレイをさらに備え、前記ディスプレイは推定の実際深度信号を表示可能であることを特徴とする請求項1に記載の装置。
- 前記プロセッサに接続されたユーザフィードバック手段をさらに備え、前記ユーザフィードバック手段は、胸部圧迫が事前に設定された数値範囲内に収まっているかどうかを示すフィードバックを提供可能であることを特徴とする請求項1に記載の装置。
- 実際成分のほかにノイズ成分が含まれている患者の心電図信号を測定する手段と、
前記心電図信号を測定する手段と前記プロセッサとに接続され、前記心電図信号のノイズ成分を推定する手段とをさらに備え、
前記プロセッサは、前記心電図信号のノイズ成分が予め定められている範囲内になったとき、推定の実際深度信号を生成するようさらにプログラムされていることを特徴とする請求項1に記載の装置。 - 前記プロセッサに接続されたディスプレイをさらに備え、前記ディスプレイは推定の実際深度信号を表示可能であることを特徴とする請求項4に記載の装置。
- 前記プロセッサに接続されたユーザフィードバック手段をさらに備え、
前記ユーザフィードバック手段は、胸部圧迫が事前に設定された数値範囲内に収まっているかどうかを示すフィードバックを提供可能であることを特徴とする請求項4に記載の装置。 - プロセッサはさらに胸部圧迫の割合を測定可能であり、前記ユーザフィードバック手段はさらに胸部圧迫の割合を表示可能であることを特徴とする請求項6に記載の装置。
- 前記プロセッサはさらに胸部圧迫のデューティサイクルを測定可能であり、前記ユーザフィードバック手段はさらに胸部圧迫のデューティサイクルを表示可能であることを特徴とする請求項6に記載の装置。
- 心肺蘇生中に患者の換気を行うことができる換気手段をさらに備えることを特徴とする請求項1に記載の装置。
- 前記換気手段は電気的換気を実施する手段からなることを特徴とする請求項9に記載の装置。
- 胸部圧迫を実施するための装置であって、
患者の胸部圧迫を実施する手段と、
胸部圧迫の加速度に相応する加速度信号を生成可能な加速度測定器と、
前記加速度測定器に接続され、胸部圧迫の測定深度に相応する測定深度信号を生成可能な、前記加速度信号を積分する積分手段と、
前記積分手段と前記胸部圧迫を実施する手段とに接続され、前記加速度信号を積分して算出された深度信号の自動回帰移動平均を計算することにより胸部圧迫の推定の実際深度に相応する推定の実際深度信号を生成可能なプロセッサとを備え、
前記胸部圧迫を実施する手段は前記推定の実際深度信号に基づいて胸部圧迫の深度を調整可能であることを特徴とする装置。 - 前記胸部圧迫を実施する手段は自動胸部圧迫装置からなることを特徴とする請求項11に記載の装置。
- 実際成分のほかにノイズ成分が含まれている患者の心電図信号を測定する手段と、
前記心電図信号を測定するための手段と前記プロセッサとに接続され、前記心電図信号のノイズ成分を推定する手段とをさらに備え、
前記プロセッサは、前記心電図信号のノイズ成分が予め定められている範囲内になったとき、推定の実際深度信号を生成するようさらにプログラムされていることを特徴とする請求項11に記載の装置。 - 前記胸部圧迫を実施する手段は自動胸部圧迫装置からなることを特徴とする請求項13に記載の装置。
- 心肺蘇生中に患者の換気を行うことができる換気手段をさらに備えていることを特徴とする請求項11に記載の装置。
- 前記換気手段は電気的換気を実施する手段からなることを特徴とする請求項15に記載の装置。
- 前記プロセッサに接続されたディスプレイをさらに備え、前記ディスプレイは推定の実際深度信号を表示可能であることを特徴とする請求項11に記載の装置。
- 前記プロセッサに接続されたユーザフィードバック手段をさらに備え、前記ユーザフィードバック手段は、胸部圧迫が事前に設定された数値範囲内に収まっているかどうかを示すフィードバックを提供可能であることを特徴とする請求項11に記載の装置。
- 前記プロセッサはさらに胸部圧迫の割合を測定可能であり、前記ユーザフィードバック手段はさらに胸部圧迫の割合を表示可能であることを特徴とする請求項18に記載の装置。
- 前記プロセッサはさらに胸部圧迫のデューティサイクルを測定可能であり、前記ユーザフィードバック手段はさらに胸部圧迫のデューティサイクルを表示可能であることを特徴とする請求項18に記載の装置。
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