WO2017008202A1 - 一种监护系统、方法及装置 - Google Patents

一种监护系统、方法及装置 Download PDF

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Publication number
WO2017008202A1
WO2017008202A1 PCT/CN2015/083766 CN2015083766W WO2017008202A1 WO 2017008202 A1 WO2017008202 A1 WO 2017008202A1 CN 2015083766 W CN2015083766 W CN 2015083766W WO 2017008202 A1 WO2017008202 A1 WO 2017008202A1
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WIPO (PCT)
Prior art keywords
atrial
ventricle
systolic
module
information
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Ceased
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PCT/CN2015/083766
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English (en)
French (fr)
Inventor
张晓毳
韩怡
刘硕
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Shenzhen Mindray Bio Medical Electronics Co Ltd
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Shenzhen Mindray Bio Medical Electronics Co Ltd
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Application filed by Shenzhen Mindray Bio Medical Electronics Co Ltd filed Critical Shenzhen Mindray Bio Medical Electronics Co Ltd
Priority to PCT/CN2015/083766 priority Critical patent/WO2017008202A1/zh
Priority to CN202010955265.2A priority patent/CN112043259B/zh
Priority to CN201580081329.8A priority patent/CN107708570B/zh
Publication of WO2017008202A1 publication Critical patent/WO2017008202A1/zh
Priority to US15/863,363 priority patent/US10918358B2/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A61B8/5261—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image combining images from different diagnostic modalities, e.g. ultrasound and X-ray
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/339—Displays specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Clinical applications
    • A61B8/0883—Clinical applications for diagnosis of the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/467—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient characterised by special input means
    • A61B8/468—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient characterised by special input means allowing annotation or message recording
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5207—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of raw data to produce diagnostic data, e.g. for generating an image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5223—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for extracting a diagnostic or physiological parameter from medical diagnostic data
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
    • 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
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7285—Specific aspects of physiological measurement analysis for synchronizing or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography
    • A61B8/14—Echo-tomography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/486—Diagnostic techniques involving arbitrary m-mode
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5284—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving retrospective matching to a physiological signal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/54—Control of the diagnostic device
    • A61B8/543—Control of the diagnostic device involving acquisition triggered by a physiological signal

Definitions

  • the present invention relates to a medical device, and more particularly to a monitoring system for monitoring periodic motion of the heart.
  • the heart's periodic motion is monitored by an electrocardiographic monitoring device, and the patient is diagnosed based on an electrocardiogram, such as a diagnosis of arrhythmia, cardiac capture, and electromechanical separation.
  • an electrocardiogram such as a diagnosis of arrhythmia, cardiac capture, and electromechanical separation.
  • ECG monitoring has inaccuracies in the monitoring of arrhythmia. For example, when a patient has atrial fibrillation, there may be disturbances in clutter, resistance, and position changes, which in turn increases the inaccuracy of ECG monitoring.
  • the black marks are pacing signals, and the subsequent waveforms are It is not the captured QRS wave; however, since the pace wave is very close to this wave, it is easily misunderstood as the QRS complex generated by the capture, which in turn causes the heart to be misjudged. Therefore, relying on ECG cannot accurately determine the seizure of the heart.
  • the patient's cardiac electrical activity can be directly displayed by the electrocardiogram, and the mechanical activity of the patient's heart is indirectly displayed through the patient's physical signs.
  • pulse, respiration, and blood pressure can be monitored by the patient monitor, while the heart sound depends on the doctor's auscultation.
  • Judge. Judging based on these methods that indirectly reflect cardiac mechanical activity may result in delays in the diagnosis and treatment of patients with EMD.
  • an embodiment provides a monitoring system including an ultrasound imaging module, an ECG monitoring module, a data processing module, and an output module;
  • the ultrasound imaging module includes:
  • an image processing unit receives the ultrasonic echo outputted by the probe, processes the echo, and generates an ultrasonic image, where the ultrasonic image includes an echocardiogram reflecting the cardiac information;
  • the electrical monitoring module is configured to monitor the ECG signal and generate ECG information that varies with the daytime;
  • the input end of the data processing module is respectively connected with the signal output unit and the output end of the ECG monitoring module
  • the data processing module for receiving an echocardiogram and obtaining a mechanical motion indication of the atria and the ventricle according to the echocardiogram, and the data processing module outputs the mechanical motion identification and the electrocardiographic information of the atrium and the ventricle to the output module for presentation.
  • an embodiment provides a cardiac periodic motion monitoring method, including:
  • an embodiment provides a cardiac periodic motion monitoring apparatus, including: [0023] an ultrasound echo with cardiac information reflected from a heart of a body to be tested collected by a probe Wave unit
  • an image processing unit configured to receive an ultrasound echo with heart information reflected from a heart of the body to be tested collected by the probe, and generate an echocardiogram based on the ultrasound echo;
  • a data processing module configured to obtain a mechanical motion identification of the atria and the ventricle according to the echocardiogram, and output the mechanical motion identifier of the atrium and the ventricle and the electrocardiogram information to the output module for presentation.
  • 1 is an electrocardiogram with external pacing
  • FIG. 3 is a flow chart of monitoring periodic motion of the heart in an embodiment
  • FIG. 4 is a flow chart of calculating cardiac parameters in an embodiment
  • FIG. 5 is a schematic view showing a systolic phase and a three-way diagram of a central room and a ventricle;
  • FIG. 6 is a first schematic diagram showing a comparative analysis of systolic and electrocardiograms of the atria and ventricles;
  • FIG. 7 is a second schematic diagram showing a comparative analysis of systolic and electrocardiograms of the atria and ventricles;
  • FIG. 8 is a third schematic diagram showing a comparative analysis of systolic and electrocardiograms of the atria and ventricles;
  • FIG. 9 is a fourth schematic diagram showing a comparative analysis of systolic and electrocardiograms of the atria and ventricles;
  • FIG. 10 is a schematic diagram showing the actual data of increasing the diameter of the heart chamber in the first analysis chart
  • FIG. 11 is a schematic view showing an atrial and ventricular systolic phase using an upright histogram
  • FIG. 12 is a schematic view showing the mechanical movement of the atria and the ventricle using a pie chart
  • FIG. 13 is a schematic diagram showing cardiac mechanical motion using a cardiac image.
  • the idea of the present invention is to use ultrasonic monitoring means to reflect the mechanical activity of the heart, ECG monitoring is used to obtain the ECG signal, and the mechanical activity of the heart is compared with the ECG signal to reflect the heart in an intuitive manner. Electro-mechanical activities.
  • the monitoring system includes an ultrasound imaging module 10, an ECG monitoring module 11, a data processing module 12, and an output module 13.
  • the ultrasound imaging module 10 includes a probe 101, an image processing unit 102, and a transmitting circuit 103.
  • the transmitting circuit 103 is connected to the probe 101, the input end of the image processing unit 102 is connected to the probe 101, and the input end of the data processing module 12 is connected to the output of the image processing unit 102 and the ECG monitoring module 11, respectively.
  • the data processing module The output of 12 is connected to the output module 13 signal.
  • the signal connection may be a direct connection or a processed connection of the intermediate component, and may be a wireless communication connection or a wired connection.
  • the probe 101 is configured to scan the surface of the body to be tested, transmit ultrasonic waves to the tissue to be tested, and receive ultrasonic echoes with tissue information reflected from the body tissue to be tested.
  • the probe 10 can be adapted to the actual requirements.
  • the probe 101 is coupled to the transmitting circuit 103 by means of a switching 104, under the control of the transmitting circuit 103, transmitting ultrasonic waves to the body of the body under test, and on the other hand being coupled to the image processing unit 102, the ultrasonic waves to be received The echo is output to the image processing unit 102.
  • the probe 10 is configured to emit ultrasound waves to the heart site and receive ultrasound echoes with cardiac tissue information reflected from the heart tissue.
  • the probe can continuously monitor the heart.
  • the probe can be configured to fit the structure and/or shape of the long body to the body surface of the body to be tested.
  • the transmitting circuit 103 is configured to generate a transmit logic sequence as needed, output a transmit logic sequence to the probe 101, and the probe 101 converts the transmit logic sequence into an ultrasonic wave.
  • the transmitting circuit 103 also controls the probe to continuously scan the body tissue under test in the set interval.
  • the transmitting circuit 103 can also control the probe to pause for a period of time after each continuous monitoring of the set interval, the scanning interval length and the scanning period are long. It can be set by the doctor, for example, every five minutes, one minute for each scan.
  • the image processing unit 102 is configured to process ultrasonic echoes, such as beamforming, demodulation, image processing, etc., and finally generate ultrasound images in accordance with the required ultrasound image mode.
  • the ultrasound images may be various patterns of cardiograms.
  • Image processing unit 102 may be an integrated circuit or a circuit of discrete components. In some embodiments, image processing unit 102 may be a processing chip.
  • the ECG monitoring module 11 typically includes a number of leads and processing circuitry for contacting the body surface of the heart attachment of the subject to be sensed to sense electrical signals conducted by the heart chamber.
  • the processing circuit is configured to process the electrical signal, such as amplification, filtering, analog to digital conversion, etc., and then output the processed ECG information to the data processing module 12.
  • the data processing module 12 is configured to process various information, and may also send control signals to various components of the monitoring system to control components, and may also be used to store information to the storage module 14 and/or from The information read or used in the storage module 14 can also be used to output the information to the output module 13 for presentation.
  • the end signal connection is used for receiving the echocardiogram output by the image processing unit 102 and the electrocardiogram information output by the ECG monitoring module 11, and detecting the mechanical motion of the atrium and the ventricle according to the echocardiogram, and The stage of the mechanical movement is marked to obtain the mechanical movement indication of the atrium and the ventricle, and then the mechanical movement indication and the electrocardiographic information of the atrium and the ventricle are output to the output module 13 for display or presentation for inspection by an inspector or a doctor.
  • the mechanical motion signature of the atrium and ventricle and the electrocardiographic information may be practical to output the mechanical motion signature of the atrium and ventricle and the electrocardiographic information to the output module 13 for display or presentation, for example, to perform an effective monitoring of the monitored subject.
  • the mechanical motion identification and the electrocardiographic information of the atrium and the ventricle are output to the output module 13 for display or presentation.
  • the mechanical motion identification and the ECG information of the atrium and the ventricle may be stored in the monitoring. In the system, it is then output to the output module 13 when needed, so that the doctor can perform subsequent, offline or non-on-site observation and analysis on the condition of the monitored object.
  • the mechanical motion signature of the atrium and ventricle may be output to the output module 13 for display or presentation in a comparable manner.
  • the contrast includes visual contrast, auditory contrast, and a combination of the two.
  • the visual mode can include images and light signals
  • the auditory modes include sounds, such as processing the mechanical motion markers of the atria and ventricles and the ECG information into a visual image. Or set the color of the flashing light signal, or process the mechanical motion identification of the atrium, ventricle and ECG information into a sound signal. Since the echocardiographic ECG information has temporal consistency in the acquisition and processing process, the mechanical motion markers of the atrium and ventricle can be compared with the individual ECGs in the ECG information.
  • the data processing module 12 can be an integrated circuit or a circuit composed of discrete components. In some embodiments, the data processing module 12 can be a microprocessor. In this embodiment, the data processing module 12 and the image processing unit 102 may be independent modules, or may be integrated into one module, or part of the functions of the data processing module 12 may be transformed into the image processing unit 102, or vice versa.
  • the output module 13 is used to present the signal output by the data processing module 12, the output module 13 may be a display, a light emitting module or a speaker.
  • the data processing module 12 processes the mechanical motion identification as a visual identifier.
  • the ECG information is processed into an electrocardiogram, and then the mechanical motion logo of the atrium and the ventricle and the ECG information are output to the display along the same inter-axis axis for display.
  • the output module 13 is a light emitting module or a speaker
  • the data processing module 12 processes the mechanical motion identifier as an optical signal or a sound signal, and correspondingly processes the ECG information into an optical signal or a sound signal, and then the atrium and the ventricle.
  • the mechanical motion indicator and the ECG information are output to the light emitting module or the speaker along the same axis, and the light emitting module emits light according to the light signal, and the speaker plays the sound according to the sound signal.
  • Can pass light The color and different sounds distinguish the atrial, ventricular mechanical movements and ECG information.
  • FIG. 3 Based on the monitoring system for monitoring the periodic motion of the heart, a monitoring method thereof is shown in FIG. 3, and includes the following steps:
  • Step 20 Receive ultrasound echoes with cardiac information reflected from the heart of the body to be tested collected by the probe.
  • the ultrasonic probe can be attached to the body surface of the patient for a long period of time, and intermittent continuous monitoring is performed, that is, continuous ultrasonic transmission and echo reception are performed for a period of time between intervals.
  • Step 21 Receive ECG information that varies with the turnout output by the ECG monitoring module.
  • Step 22 generating an echocardiogram based on the ultrasound echo; in this embodiment, the echocardiogram is an M-mode echocardiogram, and in other embodiments, the echocardiogram may also be a two-dimensional echocardiography, contrast ultrasound Cardiograms, etc., in some embodiments, echocardiography is optional, for example, echocardiography defaults to some type of echocardiogram, and allows the user to modify the type of echocardiogram to generate a user's choice after user selection. The type of selection.
  • Step 23 Calculate the cardiac parameters of the actual sputum according to the echocardiogram, the cardiac parameters including the atrial diastolic stenosis, the ventricular end diastolic sacral point, the atrial systolic intercondylar point, the ventricular end-systolic intercondylar point, and the atrial diastolic Interannual length, ventricular diastolic dip length, atrial systolic intercondylar length, ventricular systolic intercondylar length, atrial diastolic diameter, ventricular end diastolic diameter, atrial contraction inner diameter, and ventricular end systolic diameter.
  • the echocardiogram pattern can be identified, and the features in the echocardiogram can be extracted according to the mode, such as the left ventricle posterior wall, the interventricular septum, and the left atrial wall.
  • the cardiac parameters are calculated based on the information of these features.
  • FIG. 4 Taking the M-mode echocardiogram (also referred to as M map) of the left atrium as an example, a specific calculation process is shown in FIG. 4, which includes the following steps:
  • Step 231 spatially smoothing the M-mode echocardiogram of the left atrium to eliminate noise interference.
  • Step 232 Perform edge extraction on the smoothed image to identify the left atrium cavity.
  • the left atrium can be identified based on the relative positions of the aortic cavity and the left atrium.
  • the latitudinal cavity in the lower cavity region is the left atrium cavity 31, and the upper cavity region is the aortic lumen 32.
  • Step 233 Obtain an inner diameter of the left atrium according to a motion track of the edge position of the left atrium, and a longitudinal distance between the upper and lower edges of the left atrium.
  • Step 234 comparing the inner diameter of the left atrium cavity between the intercondylar points, obtaining a characteristic of the atrial motor cycle, the interatrial point of the atrial motor cycle, including the atrial diastolic intercondylar point and the atrial contraction, the atrium At the end of the diastole, the maximum diameter of the atrium is shown in Figure 5, labeled T1 ⁇ T4 ⁇ T7.
  • the atrial contraction is the smallest at the end of the atrium, as shown in Figure 5, ⁇ 2 ⁇ 5 ⁇ 8.
  • Step 235 Obtain a cardiac parameter according to a characteristic of the atrial motion cycle.
  • the cardiac parameters of the atrium can be obtained according to the characteristics of the atrial motor cycle.
  • the point between the ⁇ 1 ⁇ 4 ⁇ 7 is the atrial diastolic stenosis, and the ⁇ 2 ⁇ 5 ⁇ 8 is the atrial contraction.
  • the length of the atrial diastolic sacral point to the atrial systolic sacral point is the length of the atrial systole, the atrial contraction and the end of the atrial diastolic
  • the length of the ankle between the diurnal points is the interatrial diastolic period
  • the atrial diameter at the end of the atrial diastolic apex is the atrial end diastolic diameter
  • the atrial diameter at the end of the atrial contraction is the atrial systolic diameter.
  • the left ventricle is spatially smoothed to eliminate noise interference; edge extraction is performed to obtain the edge position motion trajectory of the left ventricular cavity 33, as shown in FIG. 5; and the inner diameter size, that is, the upper and lower edges of the left ventricular cavity are obtained.
  • ventricular circulatory cycle characteristic ⁇ inter-day point ventricular motion cycle characteristics inter-temporal point including ventricular end-diastolic intercondylar point and ventricular end-systolic intercondylar point, ventricular end-diastolic inter-temporal point, ie, the inner diameter of the heart is the largest and the initial change At the small inflection point, see the mark ⁇ 2 ⁇ 5 ⁇ 8 in Figure 5, and the end point of the ventricular end-systole is the smallest point of the inner diameter of the heart, as shown in Figure 5, ⁇ 3 ⁇ 6 ⁇ 9.
  • the cardiac parameters of the ventricle can also be obtained.
  • ⁇ 2 ⁇ 5 ⁇ 8 ⁇ is the ventricular end-diastolic intercondylar point
  • ⁇ 3 ⁇ 6 ⁇ 9 is the ventricular end-systolic uterus.
  • the point between the end of the ventricular end diastolic sac and the end point of the ventricular end systole is the ventricular contraction, the ventricular contraction, and the ventricular end-systolic sacral point to the ventricular end-diastolic
  • the length of the iliac crest between the points is the interventricular diastolic period
  • the intraventricular diameter at the end of the ventricular end diastolic sac is the ventricular end diastolic diameter
  • the intraventricular diameter at the end point of the ventricular end systole is the ventricular end systolic diameter.
  • Step 24 obtaining a systolic period of the atrium and the ventricle according to the cardiac parameters of the heart.
  • the atrial systolic phase can be obtained according to the atrial diastolic stenosis, the atrial contraction, and the atrial systole, depending on the end of ventricular end diastolic ventricle, ventricular end-systolic intercondylar point, and ventricular systole. Get the systole of the ventricle.
  • Step 25 generating a mechanical motion marker corresponding to the systolic phase of the atria and the ventricle.
  • the mechanical movement indication corresponding to the systolic phase of the atria and the ventricle is a visual indication, for example, using a histogram to represent The systolic phase of the atria and ventricles, the column length of the histogram indicates the systolic length of the chamber corresponding to the histogram. In the form of presentation, it can be presented in the form of a "three-way diagram" below. As shown in Fig.
  • a horizontal histogram is used to indicate the systolic phase of the atria and the ventricle, and a histogram 34 in the first line is shown in the first line, which represents the atrial contraction process;
  • Figure 35 represents the ventricular systole.
  • the column length direction of the histogram 34 and the histogram 35 is parallel to the inter-turn axis T, and the two ends of the column length of the column diagram 34 correspond to the atrial diastolic stenosis point T1 ⁇ T4 ⁇ T7 and the end of the contraction Point T2 ⁇ T5 ⁇ T8, the length of the column is expressed as the length of the atrial systole.
  • the end line of the column length of the columnar column 35 corresponds to the ventricular end diastolic sputum point ⁇ 2 ⁇ 5 ⁇ 8 and the end of the contraction point ⁇ 3 ⁇ 6 ⁇ 9, and the column length is expressed as the ventricular systolic length.
  • a histogram indicating atrial systole and ventricular systole has a spacing perpendicular to the intercondylar axis, forming a second map between the first map and the third map, located in the second map region
  • the connection connects the diastolic sacral points of the two histograms.
  • This line represents the sequential conduction and also represents the interventricular phase of atrial and ventricular contractions. The steeper the slope of the line, indicating the transit from the atrium to the ventricles The shorter, the faster the heart beats.
  • the three-way diagram in this embodiment includes both sequential conduction information and room contraction information.
  • Step 26 The systolic identifier and the electrocardiogram information of the atrium and the ventricle are output to the output module in a comparable manner. As shown in Figure 6-9, the data processing module outputs the systolic sign of the atrium and ventricle and the electrocardiogram along the same axis to the display for display.
  • Step 27 combining the atrial and ventricular systolic markers and the electrocardiogram.
  • the analysis process can be completed by a doctor.
  • the doctor can judge whether the atrial and ventricular electrical signals (both chopping and QRS waves) detected in the electrocardiogram follow the mechanical activity of the corresponding heart chamber through the visual display image, so that the doctor can judge
  • the method is more direct and intuitive, avoiding the doctor's misjudgment due to lack of experience.
  • the analysis process can also be automatically performed by the monitoring system, and the data processing module determines whether the chopping and QRS waves in the electrocardiographic information and the systolic identifiers of the corresponding chambers are consistent in rhythm and frequency, that is, chopping occurs. ⁇ , the systolic sign of the atrium should appear in the same place, and the QRS wave appears ⁇ , and the systolic sign of the ventricle should appear in the same place. When it is judged that the rhythm and frequency of the two are inconsistent, an alarm message is output.
  • the automatic analysis method eliminates the doctor's judgment, and can directly obtain the judgment result and alarm according to the result.
  • the monitor can give a corresponding alarm prompt.
  • the ECG monitors an electrical signal and the echocardiogram does not detect any mechanical activity, as shown in Figure 6, the heart rate signal is detected in the dotted box of the ECG, and no mechanical beat is detected in the echocardiogram, indicating that the heart The electrical signal failed to cause Effective heartbeat, that is, conduction block is considered; for example, ECG detects heart rate and echocardiography cannot detect mechanical activity ⁇ , as shown in Figure 7, heart rate signal is continuously detected in the dotted line of ECG, and echocardiogram It shows that the heart is in a state of cessation of pulsation, that is, mechanical stoppage is considered; for example, the heart rate detected by the electrocardiogram is faster than the mechanical activity frequency detected by the echocardiogram, as shown in Fig.
  • the electrocardiogram detects five electrical signals
  • the echocardiogram only detects 4 mechanical signals
  • the mechanical signal and the electrical signal are performed at their respective frequencies, that is, frequency separation is considered to occur.
  • this function can also be used to more intuitively determine the results of ECG diagnosis to ensure the accuracy and rationality of the diagnosis.
  • this function can also be used to more accurately determine the cardiac capture. As shown in Figure 9, it is confirmed by the three-pass graph that there is a valid QRS complex after each pacing wave. Judging that the heart was captured.
  • This embodiment uses the means of ultrasonic monitoring to directly reflect the mechanical activity of the heart, and the signs of passing the patient.
  • the mechanical motion marker in this embodiment is a cardiac chamber systolic marker, including an atrial systolic marker and a ventricular systolic marker.
  • the mechanical motion marker may also be a cardiac chamber diastolic marker.
  • Atrial diastolic markers including atrial diastolic markers and ventricular diastolic markers.
  • presentations that may also be employed visually represent the mechanical motion of the atria and ventricles, as well as the conduction information between the two.
  • the systolic phase of the atria and ventricles is represented by an upright histogram.
  • the two histograms are shown in the same column.
  • the column length is perpendicular to the intercondylar axis.
  • the column length of the histogram is expressed as the contraction of the chamber corresponding to the histogram.
  • the bar graph A indicates the atrial systolic phase marker
  • the histogram V indicates the ventricular systolic phase marker.
  • the distance between the two columns in the vertical direction of the intercondylar axis and the interventricular conduction is the correlation between the two columns.
  • a pie chart is used to represent the mechanical movement of the atria and the ventricle, and the pie chart changes with the turn of the day. Refresh around the center of the circle.
  • Each refreshing week represents a cardiac cycle; the atrial contraction information, the interventricular interval information, and the ventricular contraction information are sequentially refreshed; in the figure, the sector A represents the atrial systolic marker, and the sector V represents the ventricular systolic marker, and the size of the fan angle represents The length of the day, AV means atrioventricular conduction.
  • the mechanical contraction of the atrium and the ventricle is represented by a cardiac contraction diagram, and the cardiac contraction information obtained by the echocardiography can be used to restore the iconic contraction and relaxation of the heart. This presentation mode can be more intuitive. The mechanical movement of the heart is presented to the user.
  • the sound information sensed by the ultrasound can also be used to reflect the information of the atrioventricular contraction, relaxation, and interphase, for example, the "beep” is used to reflect the sound of the mechanical movement of the heart, and the " ⁇ " is used to reflect the heart of the heart. electric signal.
  • the use of sound to display so that medical staff can use the sound to more intuitively identify changes in the patient's heart function.
  • one of the two may be sounded and the other may be displayed by an image.

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Abstract

一种监护系统、方法及装置，包括超声成像模块(l0)、心电监护模块(11)、数据处理模块(12)和输出模块(13)，超声成像模块(l0)用于得到心脏的超声心动图，数据处理模块(12)用于接收超声心动图并根据超声心动图得到心房和心室的机械运动标识，数据处理模块(12)将心房、心室的机械运动标识与心电信息以可对比的方式实时输出至输出模块(13)进行呈现。由于采用超声监护的手段来反映心脏的机械活动，并将心脏的机械活动进行标识化，以可对比的方式与心电监测获得的心电图数据进行对比分析，判断发生电-机械活动不匹配的情况，判断过程更加直接、直观和及时，减少了对医生专业技能和经验的依赖，使得对心脏周期性运动情况的判断更加容易和准确。

Description

一种监护系统、 方法及装置 技术领域
[0001] 本发明涉及一种医疗设备， 尤其涉及一种用于对心脏的周期性运动进行监测的 监护系统。
[0002]
[0003] 背景技术
[0004] 通常情况下， 通过心电监护设备来监测心脏的周期性运动情况， 并根据心电图 对患者进行诊断， 例如对心律失常、 心脏夺获以及电机械分离的诊断。 但在临 床发现以下问题：
[0005] 心电监护在心律失常的监护方面存在不准确性， 比如当病人发生房颤吋， 可能 存在杂波、 电阻以及体位变动的干扰， 进而加大了心电监护的不准确性。
[0006] 在一些特殊情况下， 如体外起搏吋， 单纯的依靠心电图对心脏的夺获情况判断 不准确。 因为体外起搏的心电信号电压高低不一， 电压较低的 QRS波容易被漏检 ； 电压过高吋则存在过感知的问题， 比如当出现高大的 T波吋， 甚至可能导致心 率的翻倍； 另外， 一些起搏波与后续波相距很近， 后续波可能被误读为心脏夺 获产生的 QRS波 （如图 1所示） ， 图中黑色标记处为起搏信号， 后面的波形不是 夺获产生的 QRS波； 但是， 由于起搏波与此波相距很近， 因此容易被误读为夺获 产生的 QRS波群， 进而造成心脏被夺获的误判。 因此， 依靠心电无法准确判断心 脏的夺获情况。
[0007] 另外， 临床对于电机械分离 (Electrical mechanical dissociation, EMD) 的诊断
， 主要是结合病人的体征 （如无心音、 脉搏、 呼吸和血压等） 以及心电图的表 现 （如窦性、 规律的、 P-QRS-T顺序发生的各吋段、 电压正常的心电图形等） 进 行综合判定。 病人心脏电活动可以通过心电图直接显示， 而病人心脏的机械活 动情况则是通过病人的体征间接显示， 例如脉搏、 呼吸和血压可以通过病人监 护仪进行实吋监测， 而心音则依靠医生的听诊来判断。 基于这些间接反映心脏 机械活动的方法的判断， 可能造成医生对病人 EMD诊治的延迟。 [0008]
[0009] 发明内容
[0010] 根据第一方面， 一种实施例中提供一种监护系统,包括超声成像模块、 心电监护 模块、 数据处理模块和输出模块；
[0011] 所述超声成像模块包括：
[0012] 探头， 用于向受测机体组织发射超声波， 并接收从受测机体组织反射回来的带 有组织信息的超声回波， 所述受测机体组织包括心脏； 和
[0013] 图像处理单元， 其输入端和探头信号连接， 接收探头输出的超声回波， 对回波 进行处理， 生成超声影像， 所述超声影像包括反映心脏信息的超声心动图； [0014] 心电监护模块用于监测心电信号， 生成随吋间变化的心电信息；
[0015] 数据处理模块的输入端分别和图像处理单元和心电监护模块的输出端信号连接
， 用于接收超声心动图并根据超声心动图得到心房和心室的机械运动标识， 数 据处理模块将心房和心室的机械运动标识与心电信息输出至输出模块进行呈现
[0016] 根据第二方面， 一种实施例中提供一种心脏周期性运动监测方法， 包括：
[0017] 接收探头收集的从受测机体的心脏反射回来的带有心脏信息的超声回波；
[0018] 基于超声回波生成超声心动图；
[0019] 根据超声心动图得到心房和心室的机械运动标识；
[0020] 接收心电监护模块输出的随吋间变化的心电信息；
[0021] 显示心房和心室的机械运动标识和心电信息。
[0022] 根据第三方面， 一种实施例中提供一种心脏周期性运动监测装置， 包括： [0023] 用于接收探头收集的从受测机体的心脏反射回来的带有心脏信息的超声回波的 单元；
[0024] 用于接收心电监护模块输出的随吋间变化的心电信息的单元；
[0025] 图像处理单元， 用于接收探头收集的从受测机体的心脏反射回来的带有心脏信 息的超声回波， 并基于超声回波生成超声心动图；
[0026] 数据处理模块， 用于根据超声心动图得到心房和心室的机械运动标识， 将心房 和心室的机械运动标识以及心电信息输出至输出模块进行呈现。 [0027]
[0028] 附图说明
[0029] 图 1为具有体外起搏的心电图；
[0030] 图 2为一种实施例的结构示意图；
[0031] 图 3为一种实施例中对心脏周期性运动进行监测的流程图；
[0032] 图 4为一种实施例中计算心动参数的流程图；
[0033] 图 5为一种实施例中心房和心室的收缩期和三道图示意图；
[0034] 图 6为将心房和心室的收缩期和心电图对比分析的第一种示意图；
[0035] 图 7为将心房和心室的收缩期和心电图对比分析的第二种示意图；
[0036] 图 8为将心房和心室的收缩期和心电图对比分析的第三种示意图；
[0037] 图 9为将心房和心室的收缩期和心电图对比分析的第四种示意图；
[0038] 图 10为在第一种分析图中增加心脏腔室内径的实吋数据的示意图；
[0039] 图 11为采用直立的柱状图表示心房和心室收缩期的示意图；
[0040] 图 12为采用饼图表示心房和心室机械运动的示意图；
[0041] 图 13为采用心脏图像表示心脏机械运动的示意图。
[0042]
[0043] 具体实施方式
[0044] 本发明的构思是采用超声监护的手段来反映心脏的机械活动， 采用心电监护来 得到心电信号， 并将心脏的机械活动与心电信号进行对比分析， 以直观的方式 反映心脏的电 -机械活动。
[0045] 下面通过具体实施方式结合附图对本发明作进一步详细说明。
[0046] 请参考图 2， 监护系统包括超声成像模块 10、 心电监护模块 11、 数据处理模块 1 2和输出模块 13， 超声成像模块 10包括探头 101、 图像处理单元 102和发射电路 10 3， 发射电路 103与探头 101信号连接， 图像处理单元 102的输入端和探头 101信号 连接， 数据处理模块 12的输入端分别和图像处理单元 102和心电监护模块 11的输 出端信号连接， 数据处理模块 12的输出端和输出模块 13信号连接。 信号连接可 以是直接的连接， 也可以通过中间元器件的处理后的连接， 可以是无线通信方 式的连接， 也可以是有线连接。 [0047] 探头 101用于在受测机体组织表面扫描， 向受测机体组织发射超声波， 并接收 从受测机体组织反射回来的带有组织信息的超声回波。 探头 10可以根据实际要 求采用合适的探头。 在具体实施例中， 探头 101通过切换幵关 104—方面耦合到 发射电路 103， 在发射电路 103的控制下向受测机体组织发射超声波， 另一方面 耦合到图像处理单元 102， 将接收的超声回波输出到图像处理单元 102。 本实施 例中， 探头 10用于向心脏部位发射超声波， 并接收从心脏组织反射回来的带有 心脏组织信息的超声回波。 本实施例中， 探头可连续对心脏进行监测， 为便于 探头连续监测， 探头可以是适合长吋间贴合在受测机体体表的结构和 /或形状。
[0048] 发射电路 103用于根据需要生成发射逻辑序列， 将发射逻辑序列输出到探头 101 ， 探头 101将发射逻辑序列转换成超声波。 本实施例中， 发射电路 103还控制探 头在设定吋间段内对受测机体组织连续扫描。 另一些实施例中， 为防止探头连 续发射超声波导致温度上升， 发射电路 103也可以控制探头在每完成一个设定吋 间段的连续监测后间歇一段吋间， 扫描间隔吋长和扫描周期吋长可以由医生设 置， 例如每五分钟启动一次扫描， 每次扫描进行一分钟。
[0049] 图像处理单元 102用于对超声回波进行处理， 例如波束合成、 解调、 图像处理 等， 最后按照要求的超声图像模式生成超声影像。 本实施例中， 超声影像可以 为各种模式心动图。 图像处理单元 102可以是集成电路， 也可以是分立元件组成 的电路， 在某些实施例中， 图像处理单元 102可以是处理芯片。
[0050] 心电监护模块 11通常包括若干导联和处理电路， 导联用于与受测机体的心脏附 件的体表接触， 感应心脏腔室传导的电信号。 处理电路用于对电信号进行处理 ， 例如放大、 滤波、 模数转换等处理， 然后将处理后的心电信息输出到数据处 理模块 12。
[0051] 数据处理模块 12用于对各种信息进行处理， 也可以向监护系统的各部件发送控 制信号， 以对各部件进行控制， 也可以用于将信息存储到存储模块 14和 /或从存 储模块 14中读取或使用信息， 还可以用于将信息输出到输出模块 13进行呈现， 本实施例中， 数据处理模块 13的输入端分别和图像处理单元 102和心电监护模块 11的输出端信号连接， 用于接收图像处理单元 102输出的超声心动图和心电监护 模块 11输出的心电信息， 根据超声心动图检测心房和心室的机械运动， 并对发 生机械运动的吋期进行标识， 得到心房和心室的机械运动标识， 然后将心房和 心室的机械运动标识与心电信息输出至输出模块 13进行显示或呈现， 以供检査 人员或者医生观察。
[0052] 本发明的一些实施例中， 将心房和心室的机械运动标识与心电信息输出至输出 模块 13进行显示或呈现可以是实吋的， 例如以便对监护对象进行实吋监护。 另 一些实施例中， 将心房和心室的机械运动标识与心电信息输出至输出模块 13进 行显示或呈现可以是非实吋， 例如该心房和心室的机械运动标识以及心电信息 可以先存储于监护系统中， 然后在需要的吋候输出至输出模块 13， 以便医生对 监护对象的情况进行后续的、 离线的或者非在现场的观察和分析。
[0053] 一些实施例中， 可以将心房和心室的机械运动标识与心电信息以可对比的方式 输出至输出模块 13进行显示或呈现。 可对比包括视觉上的对比、 听觉上的对比 以及两者的组合， 视觉方式又可以包括图像和光信号， 听觉方式包括声音， 例 如将心房、 心室的机械运动标识与心电信息处理成可视化的图像或设定颜色的 闪烁光信号， 或将心房、 心室的机械运动标识与心电信息处理成声音信号。 由 于超声心动图心电信息在采集和处理过程具有吋间上的一致性， 因此， 可对心 房、 心室的机械运动标识与心电信息中的各个心电波在吋间上进行对比。 数据 处理模块 12可以是集成电路， 也可以是分立元件组成的电路， 在某些实施例中 ， 数据处理模块 12可以是微处理器。 本实施例中， 数据处理模块 12与图像处理 单元 102可以是各自独立的模块， 也可以集成为一个模块， 或数据处理模块 12的 部分功能变换到图像处理单元 102中， 反之亦可。
[0054] 输出模块 13用于呈现数据处理模块 12输出的信号， 输出模块 13可以是显示器、 光发射模块或扬声器， 当输出模块 13是显示器吋， 数据处理模块 12将机械运动 标识处理为可视化标识， 将心电信息处理为心电图， 然后将心房、 心室的机械 运动标识与心电信息沿同一吋间轴实吋输出到显示器进行显示。 当输出模块 13 是光发射模块或扬声器吋， 数据处理模块 12将机械运动标识对应地处理为光信 号或声音信号， 将心电信息也对应地处理为光信号或声音信号， 然后将心房、 心室的机械运动标识与心电信息沿同一吋间轴实吋输出到光发射模块或扬声器 ， 光发射模块根据光信号发射光， 扬声器根据声音信号播放声音。 可以通过光 的颜色和不同的声音来区别心房、 心室的机械运动和心电信息。
[0055] 基于上述监护系统对心脏周期性运动进行监测吋， 其一种监测方法如图 3所示 ， 包括以下步骤：
[0056] 步骤 20， 接收探头收集的从受测机体的心脏反射回来的带有心脏信息的超声回 波。 本实施例中超声探头可以长吋间贴合在病人体表， 进行间歇式连续监测， 即每隔一段间歇期进行一段吋间的连续超声波发射和回波接收。
[0057] 步骤 21， 接收心电监护模块输出的随吋间变化的心电信息。
[0058] 步骤 22， 基于超声回波生成超声心动图； 本实施例中， 超声心动图为 M型超声 心动图， 在其他实施例中， 超声心动图也可以为二维超声心动图、 造影超声心 动图等， 在有些实施例中， 超声心动图是可选的， 例如超声心动图默认为某种 类型的超声心动图， 另外还允许用户修改超声心动图的类型， 在用户选择后生 成用户所选的类型。
[0059] 步骤 23， 根据超声心动图计算实吋的心动参数， 心动参数包括心房舒张末吋间 点、 心室舒张末吋间点、 心房收缩末吋间点、 心室收缩末吋间点、 心房舒张期 吋间长、 心室舒张期吋间长、 心房收缩期吋间长、 心室收缩期吋间长、 心房舒 张末内径、 心室舒张末内径、 心房收缩末内径和心室收缩末内径。 在计算心动 参数前可以先识别超声心动图的模式， 根据模式将超声心动图中的特征提取出 来， 例如左室后壁、 室间隔、 左房腔壁等。 根据这些特征的信息计算出心动参 数。
[0060] 以左心房的 M型超声心动图 （也可简称为 M图） 为例， 一种具体的计算过程如 图 4所示， 包括以下步骤：
[0061] 步骤 231， 对左心房的 M型超声心动图进行空间平滑，以消除噪声干扰。
[0062] 步骤 232， 对平滑后的图像进行边缘提取， 识别出左房腔。 由于进行边缘提取 后会得到主动脉腔以及左房腔的边缘位置运动轨迹， 请参考图 5。 因此可根据主 动脉腔以及左房腔的相对位置识别出左房腔， 如图 5所示， 纵坐标在下方的空腔 区域为左房腔 31， 上方的空腔区域为主动脉腔 32。
[0063] 步骤 233， 根据左房腔边缘位置的运动轨迹获取左房腔内径尺寸， 左房腔内径 尺寸即左房腔上下边缘之间的纵向距离。 [0064] 步骤 234， 比较各吋间点的左房腔内径尺寸， 得到心房运动周期特征吋间点， 心房运动周期特征吋间点包括心房舒张末吋间点和心房收缩末吋间点， 心房舒 张末吋间点即心房内径最大处， 见图 5的标记 T1\T4\T7， 心房收缩末吋间点即心 房内径最小处， 见图 5的标记 Τ2\Τ5\Τ8。
[0065] 步骤 235， 根据心房运动周期特征吋间点得到心动参数。 如图 5所示， 根据心房 运动周期特征吋间点可得到心房的心动参数， 图 5中， Τ1\Τ4\Τ7吋间点为心房舒 张末吋间点， Τ2\Τ5\Τ8为心房收缩末吋间点， 心房舒张末吋间点到紧随其后的心 房收缩末吋间点之间的吋长为心房收缩期吋间长， 心房收缩末吋间点到紧随其 后的心房舒张末吋间点之间的吋长为心房舒张期吋间长， 心房舒张末吋间点处 的心房内径为心房舒张末内径， 心房收缩末吋间点处的心房内径为心房收缩末 内径。
[0066] 同理对左心室的 Μ图进行空间平滑， 消除噪声干扰； 进行边缘提取， 得到左室 腔 33的边缘位置运动轨迹， 请见图 5 ; 获取内径尺寸， 即左室腔上下边缘之间的 纵向距离； 得到心室运动周期特征吋间点， 心室运动周期特征吋间点包括心室 舒张末吋间点和心室收缩末吋间点， 心室舒张末吋间点即心室内径最大且幵始 变小的拐点处， 见图 5中的标记 Τ2\Τ5\Τ8， 心室收缩末吋间点即心室内径最小处 ， 见图 5中的标记 Τ3\Τ6\Τ9。 同理， 根据心室运动周期特征吋间点也可得到心室 的心动参数， 图 5中， Τ2\Τ5\Τ8吋间点为心室舒张末吋间点， Τ3\Τ6\Τ9为心室收 缩末吋间点， 心室舒张末吋间点到紧随其后的心室收缩末吋间点之间的吋长为 心室收缩期吋间长， 心室收缩末吋间点到紧随其后的心室舒张末吋间点之间的 吋长为心室舒张期吋间长， 心室舒张末吋间点处的心室内径为心室舒张末内径 ， 心室收缩末吋间点处的心室内径为心室收缩末内径。
[0067] 步骤 24， 根据心脏的心动参数得到实吋的心房和心室的收缩期。 根据心房舒张 末吋间点、 心房收缩末吋间点和心房收缩期吋间长可得到心房的收缩期， 根据 心室舒张末吋间点、 心室收缩末吋间点和心室收缩期吋间长可得到心室的收缩 期。
[0068] 步骤 25， 生成心房和心室的收缩期对应的机械运动标识。 本实施例中， 心房和 心室的收缩期对应的机械运动标识为可视化标识， 例如， 采用柱状图分别表示 心房和心室的收缩期， 柱状图的柱长表示该柱状图所对应腔室的收缩期吋长。 在呈现形式上， 可以通过以下类似于 "三道图"的形式进行呈现。 如图 5中所示， 采用水平的柱状图表示心房和心室的收缩期， 位于第一道的以斜线填充的柱状 图 34代表了心房收缩过程； 位于第三道的以点状填充的柱状图 35代表了心室收 缩期。 本实施例中， 柱状图 34和柱状图 35的柱长方向与吋间轴 T平行， 柱状图 34 柱长的两端边线分别对应心房舒张末吋间点 T1\T4\T7和收缩末吋间点 T2\T5\T8， 柱长表示为心房收缩期吋长。 柱状图 35柱长的两端边线分别对应心室舒张末吋 间点 Τ2\Τ5\Τ8和收缩末吋间点 Τ3\Τ6\Τ9， 柱长表示为心室收缩期吋长。 表示心房 收缩期和心室收缩期的柱状图之间在垂直于吋间轴方向上具有间距， 形成位于 第一道图和第三道图之间的第二道图， 位于第二道图区域的连线连接两柱状图 的舒张末吋间点， 该连线代表了顺序传导， 也代表了心房与心室收缩的房室间 期， 连线的斜率越陡， 说明从心房传到心室的吋间越短， 心脏跳动得越快。 本 实施例中的三道图方式既包括了顺序传导信息， 也包括了房室收缩吋间信息。
[0069] 步骤 26， 将心房、 心室的收缩期标识与心电信息以可对比的方式实吋输出至输 出模块。 如图 6-9所示， 数据处理模块将心房、 心室的收缩期标识与心电图沿同 一吋间轴实吋输出到显示器进行显示。
[0070] 步骤 27， 将心房、 心室的收缩期标识和心电图联合分析。 该分析过程可由医生 完成， 医生可通过直观的显示图像判断心电图中检测到的心房、 心室电信号 （ 分别是 Ρ波和 QRS波） 之后是否跟随有对应心脏腔室的机械活动， 使医生的判断 方式更直接、 直观， 避免了医生因缺乏经验而导致误判。
[0071] 该分析过程也可由监护系统自动完成， 由数据处理模块判断心电信息中的 Ρ波 和 QRS波和其对应腔室的收缩期标识在节律和频率上是否保持一致， 即 Ρ波出现 吋， 应同吋出现心房的收缩期标识， QRS波出现吋， 应同吋出现心室的收缩期标 识。 在判断两者的节律和频率不一致吋输出报警信息。 自动分析的方式更免去 了医生判断， 可直接得到判断结果并根据结果进行报警， 例如当发生电-机械活 动不匹配的情况吋， 监护仪可以给予相应报警提示。 如心电图监测到某个电信 号而超声心动图未检测到任何机械活动吋， 如图 6所示， 心电图虚线方框中检测 到心率信号， 而超声心动图中未检测到机械搏动， 表明该心电信号未能引起有 效的心脏搏动， 即认为发生了传导阻滞； 例如心电图检测到心率而超声心动图 无法探测到机械活动吋， 如图 7所示， 心电图虚线方框中持续检测到心率信号， 而超声心动图中显示心脏已处于停止搏动状态， 即认为发生了机械停博； 例如 心电图检测到的心率快于超声心动图探测到的机械活动频率吋， 如图 8所示， 心 电图检测到 5个电信号， 而超声心动图仅检测到 4个机械信号， 机械信号与电信 号以各自的频率进行， 即认为出现了频率分离。 在发生心律失常或特殊情况吋 ， 也可以使用该功能更加直观的对心电诊断的结果进行确定， 从而确保诊断的 准确及合理性。 在体外起搏的情况下， 也可以使用该功能更加准确地判断心脏 夺获情况， 如图 9所示， 通过三道图进行确认每一个起搏波之后都有有效的 QRS 波群， 因此可判断对心脏进行了夺获。
[0072] 为更详细显示心脏腔室的内径变化， 还可以在三道图附件显示心脏腔室的实吋 内径， 如图 10所示。
[0073] 本实施例采用超声监护的手段来直接反映心脏的机械活动， 与通过病人的体征
(如无心音、 脉搏、 呼吸和血压等） 间接反映心脏机械活动的方案相比更直接
、 直观和及吋。 并将心脏的机械活动进行标识化， 以可对比的方式与心电监测 获得的心电图数据进行对比分析， 判断发生电 -机械活动不匹配的情况， 使得判 断过程更加直观、 减少了对医生专业技能和经验的依赖， 进而使得对心脏周期 性运动情况的判断更加容易和准确。
[0074] 本实施例中机械运动标识为心脏腔室收缩期标识， 包括心房收缩期标识和心室 收缩期标识， 在其它的实施例中， 机械运动标识也可以为心脏腔室舒张期标识
， 包括心房舒张期标识和心室舒张期标识。
[0075] 在其它实施例中， 也可以采用的展现方式直观地表现心房和心室的机械运动以 及二者之间的传导信息。 例如图 11所示， 采用直立的柱状图表示心房和心室的 收缩期， 两柱状图显示在同列， 柱长方向与吋间轴垂直， 柱状图的柱长表示为 柱状图所对应腔室的收缩期吋长， 图中， 柱状图 A表示心房收缩期标识， 柱状图 V表示心室收缩期标识， 两柱状图在与吋间轴垂直方向上的间距 A-V与房室传导 的吋间关联， 间距越大反映房室传导越慢， 间距越大反映房室传导越快。 又例 如图 12所示， 采用饼图表示心房和心室的机械运动， 饼图随着吋间的推移， 围 绕圆心刷新。 每刷新一周， 代表一个心动周期； 依次刷新出心房收缩信息、 房 室间期信息、 心室收缩信息； 图中， 扇形 A表示心房收缩期标识， 扇形 V表示心 室收缩期标识， 扇形角度的大小代表了吋间的长短， A-V表示房室传导。 再例如 图 13所示， 采用心脏收缩示意图表示心房和心室的机械运动， 可根据超声心动 图所获得的心脏径线信息， 还原心脏收缩、 舒张的图示， 这种呈现方式可更加 直观的将心脏的机械运动展现给用户。
[0076] 此外， 还可以通过超声感受到的声音信息， 来反映房室收缩、 舒张， 及其间期 有关的信息， 例如采用"嘟"反映心脏机械运动的声音， 采用"哔"反映心脏的心电 信号。 使用声音的方式进行展示， 使得医护人员可以通过声音， 更加直观的辨 别患者心脏功能的变化情况。 另外， 也可将两者中的一者采用声音， 另一采用 图像显示。
[0077] 本领域技术人员可以理解， 上述实施方式中各种方法的全部或部分步骤可以通 过程序来指令相关硬件完成， 该程序可以存储于一计算机可读存储介质中， 存 储介质可以包括： 只读存储器、 随机存储器、 磁盘或光盘等。
[0078] 以上应用了具体个例对本发明进行阐述， 只是用于帮助理解本发明而并不用以 限制本发明。 对于本领域的一般技术人员， 依据本发明的思想， 可以对上述具 体实施方式进行变化。
技术问题
问题的解决方案
发明的有益效果

Claims

权利要求书
[权利要求 1] 一种监护系统，其特征在于包括超声成像模块、 心电监护模块、 数据 处理模块和输出模块；
所述超声成像模块包括：
探头， 用于向受测机体组织发射超声波， 并接收从受测机体组织反射 回来的带有组织信息的超声回波， 所述受测机体组织包括心脏； 和 图像处理单元， 其输入端和探头信号连接， 接收探头输出的超声回波 ， 对回波进行处理， 生成超声影像， 所述超声影像包括反映心脏信息 的超声心动图；
心电监护模块用于监测心电信号， 生成随吋间变化的心电信息； 数据处理模块的输入端分别和图像处理单元和心电监护模块的输出端 信号连接， 用于接收超声心动图并根据超声心动图得到心房和心室的 机械运动标识， 并将心房和心室的机械运动标识以及心电信息输出至 输出模块进行呈现。
[权利要求 2] 如权利要求 1所述的监护系统， 其特征在于： 数据处理模块将心房和 心室的机械运动标识与心电信息以可对比的方式输出至输出模块进行 呈现。
[权利要求 3] 如权利要求 2所述的监护系统， 其特征在于， 所述输出模块包括显示 器， 所述机械运动标识为可视化标识， 所述数据处理模块将心房和心 室的机械运动标识与心电信息沿同一吋间轴输出到显示器进行显示。
[权利要求 4] 如权利要求 3所述的监护系统， 其特征在于， 所述数据处理模块还用 于判断心电信息中心房和心室的电信号和其机械运动标识在节律和频 率上是否保持一致， 并在判断不一致吋输出报警信息。
[权利要求 5] 如权利要求 1或者 2或 3所述的监护系统， 其特征在于， 所述机械运动 标识为心脏腔室收缩期标识， 包括心房收缩期标识和心室收缩期标识
[权利要求 6] 如权利要求 5所述的监护系统， 其特征在于， 所述心房收缩期标识和 心室收缩期标识分别为柱状图， 所述数据处理模块将柱状图的柱长表 示为柱状图所对应腔室的收缩期吋长。
如权利要求 6所述的监护系统， 其特征在于， 表示心房收缩期和心室 收缩期的柱状图的柱长方向与吋间轴平行， 柱长的两端边线分别对应 其所对应腔室的舒张末吋间点和收缩末吋间点。
如权利要求 7所述的监护系统， 其特征在于， 表示心房收缩期和心室 收缩期的柱状图之间在垂直于吋间轴方向上具有间距， 所述数据处理 模块在显示器的显示界面上显示跨越间距区域连接两柱状图的舒张末 吋间点的连线。
如权利要求 6所述的监护系统， 其特征在于， 表示心房收缩期和心室 收缩期的柱状图的柱长方向与吋间轴垂直， 所述数据处理模块将两柱 状图显示在同列， 且使两柱状图在与吋间轴垂直方向上的间距大小与 房室传导的吋间关联。
如权利要求 1所述的监护系统， 其特征在于， 所述输出模块包括扬 声器， 所述机械运动标识为声音标识， 所述数据处理模块将与心电信 息和心房及心室的机械运动分别对应的声音信号输出到扬声器。 如权利要求 1至 10中任一项所述的监护系统， 其特征在于超声成像 模块还包括发射电路， 发射电路的输出端耦合到探头， 用于根据需要 生成发射逻辑序列， 并控制探头在设定吋间段内对受测机体组织连续 监测。
如权利要求 11所述的监护系统， 其特征在于,所述发射电路控制探 头在每完成一个设定吋间段的连续监测后间歇一段吋间。
如权利要求 1至 12中任一项所述的监护系统， 其特征在于， 数据处 理模块用于根据超声心动图得到心房和心室的边缘运动轨迹， 根据心 房和心室的边缘运动轨迹得到心房和心室的内径尺寸， 根据内径尺寸 得到心房和心室的运动周期特征吋间点， 根据运动周期特征吋间点得 到心房和心室的收缩期， 根据心房和心室的收缩期得到对应的机械运 动标识。
如权利要求 13所述的监护系统， 其特征在于， 所述超声心动图为 M 型超声心动图。
一种心脏周期性运动监测方法， 其特征在于包括：
接收探头收集的从受测机体的心脏反射回来的带有心脏信息的超声回 波；
基于超声回波生成超声心动图； 根据超声心动图得到心房和心室的机械运动标识；
接收心电监护模块输出的随吋间变化的心电信息；
显示心房和心室的机械运动标识以及心电信息。
如权利要求 15所述的方法， 其特征在于， 所述显示心房和心室的机 械运动标识和心电信息包括： 以将心房和心室的机械运动标识与心电 信息以可对比的方式呈现。
如权利要求 15所述的方法， 其特征在于， 所述机械运动标识为可视 化标识， 将心房和心室的机械运动标识与心电信息沿同一吋间轴显示 在显示器的显示界面上。
一种心脏周期性运动监测装置， 其特征在于包括：
用于接收探头收集的从受测机体的心脏反射回来的带有心脏信息的超 声回波的单元；
用于接收心电监护模块输出的随吋间变化的心电信息的单元； 图像处理单元， 用于接收探头收集的从受测机体的心脏反射回来的带 有心脏信息的超声回波， 并基于超声回波生成超声心动图； 数据处理模块， 用于根据超声心动图得到心房和心室的机械运动标识
， 将心房和心室的机械运动标识以及心电信息输出至输出模块进行呈 现。
如权利要求 18所述的装置， 其特征在于， 所述数据处理模块将心房 和心室的机械运动标识与心电信息以可对比的方式输出至输出模块进 行呈现。
如权利要求 19所述的装置， 其特征在于， 所述机械运动标识为可视 化标识， 所述数据处理模块将心房和心室的机械运动标识与心电信息 沿同一吋间轴实吋输出到显示器进行显示。
[权利要求 21] 如权利要求 20所述的装置， 其特征在于， 所述机械运动标识为心脏 腔室收缩期标识， 包括心房收缩期标识和心室收缩期标识。
[权利要求 22] 如权利要求 20所述的装置， 其特征在于， 所述心房收缩期标识和心 室收缩期标识分别为柱状图， 所述数据处理模块将柱状图的柱长表示 为柱状图所对应腔室的收缩期吋长。
[权利要求 23] 如权利要求 18至 22中任一项所述的装置， 其特征在于， 所述超声心 动图为 M型超声心动图。
[权利要求 24] 如权利要求 23所述的装置， 其特征在于， 数据处理模块用于根据超 声心动图计算实吋的心动参数， 根据心动参数得到心房和心室的收缩 期， 生成心房和心室的收缩期对应的机械运动标识， 所述心动参数包 括心房舒张末吋间点、 心室舒张末吋间点、 心房收缩末吋间点、 心室 收缩末吋间点、 心房舒张期吋间长、 心室舒张期吋间长、 心房收缩期 吋间长、 心室收缩期吋间长、 心房舒张末内径、 心室舒张末内径、 心 房收缩末内径和心室收缩末内径。
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