WO2020199102A1 - 一种液体反应性的检测装置和方法 - Google Patents

一种液体反应性的检测装置和方法 Download PDF

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Publication number
WO2020199102A1
WO2020199102A1 PCT/CN2019/080882 CN2019080882W WO2020199102A1 WO 2020199102 A1 WO2020199102 A1 WO 2020199102A1 CN 2019080882 W CN2019080882 W CN 2019080882W WO 2020199102 A1 WO2020199102 A1 WO 2020199102A1
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Prior art keywords
variation
signal
breathing
target object
respiratory
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PCT/CN2019/080882
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English (en)
French (fr)
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孙白雷
韩飞
张飞
谢春柳
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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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Priority to CN201980093763.6A priority Critical patent/CN113543700B/zh
Priority to PCT/CN2019/080882 priority patent/WO2020199102A1/zh
Publication of WO2020199102A1 publication Critical patent/WO2020199102A1/zh
Priority to US17/489,966 priority patent/US12569147B2/en
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    • 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 for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/02028—Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
    • 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 for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
    • 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 for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
    • 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 for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/026—Measuring blood flow
    • A61B5/029—Measuring blood output from the heart, e.g. minute volume
    • 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 for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/026—Measuring blood flow
    • A61B5/0295—Measuring blood flow using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Measuring devices for evaluating the respiratory organs
    • A61B5/083—Measuring rate of metabolism by using breath test, e.g. measuring rate of oxygen consumption
    • A61B5/0836—Measuring rate of CO2 production
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Measuring devices for evaluating the respiratory organs
    • A61B5/087—Measuring breath flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Measuring devices for evaluating the respiratory organs
    • A61B5/091—Measuring volume of inspired or expired gases, e.g. to determine lung capacity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
    • 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
    • A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2560/00—Constructional details of operational features of apparatus; Accessories for medical measuring apparatus
    • A61B2560/02—Operational features
    • A61B2560/0266—Operational features for monitoring or limiting apparatus function

Definitions

  • the embodiments of the present application relate to the field of medical electronics technology, for example, to a liquid reactivity detection device and method.
  • volume expansion therapy is a common method to maintain or improve organ perfusion, and fluid reactivity is good for volume expansion.
  • the basic premise of treatment only when the left and right ventricles are in the ascending branch of the cardiac function curve, the cardiac output can be significantly increased by increasing the cardiac preload through expansion therapy, that is, the fluid responsiveness is good; and when a certain ventricle is in cardiac function In the curve plateau branch, increasing the cardiac preload is difficult to further increase the cardiac output, that is, the fluid reactivity is poor, and blind volume expansion treatment may increase the risk of pulmonary edema.
  • SPV systolic blood pressure variation
  • PPV Pulse Pressure Variation
  • SVV Stroke Volume Variation
  • inferior or superior vena cava diameter respiratory variation during breathing Rate transesophageal or thoracic echocardiography (Transesophagealechocardiography/Transthoracicechocardiography, TEE/TTE)
  • aortic peak blood velocity variation rate ⁇ peak transesophageal ultrasound
  • PEPV pre-ejection period variation
  • the current clinical application of dynamic preload has restrictive conditions, that is, under the restriction of constant tidal volume (8-12ml/kg) and complete mechanical ventilation without arrhythmia.
  • the above-mentioned method for predicting liquid reactivity has severe constraints and narrow application range.
  • the embodiments of the present application provide a liquid reactivity detection device and method, so as to realize liquid reactivity detection in any breathing mode.
  • an embodiment of the present application provides a liquid reactivity detection device, including: a breathing signal acquisition module, a blood flow signal acquisition module, and a liquid reactivity detection module; wherein the breathing signal acquisition module and the blood
  • the blood flow signal acquisition module works when the target object is in any of the following breathing modes: spontaneous breathing mode, spontaneous breathing and machine-controlled breathing mode, and machine-controlled breathing mode;
  • the blood flow signal acquisition module is set as the acquisition target At least one blood flow signal of the subject;
  • the breathing signal acquisition module is configured to acquire at least one breathing signal of the target object;
  • the liquid reactivity detection module is configured to determine according to the breathing signal and the blood flow signal The liquid reactivity of the target object.
  • the respiratory signal includes a respiratory cycle.
  • the respiration signal further includes respiration amplitude.
  • the breathing signal acquisition module is further configured to collect the breathing state parameters of the target object, and extract the breathing signal of the target object according to the collected breathing state parameters, where the breathing state parameters include breath. At least one of tract pressure, airway flow, carbon dioxide flow, tidal volume, chest impedance signal, magnetic signal, or respiratory acoustic signal.
  • the breathing signal acquisition module is further configured to determine the breathing envelope of the blood flow signal according to the collected blood flow signal, and extract the breathing signal of the target object according to the breathing envelope.
  • the blood flow signal includes central venous pressure (CVP), ventricular stroke volume (Stroke Volume, SV), pulse plethysmograph amplitude (Pulse Oximetry Plethysmograph, POP), perfusion index ( Perfusion Index, PI), Systolic Arterial Pressure (SAP), Pulse Pressure (PP), Pre-Ejection Period (PEP), diameter of the inferior or superior vena cava, and aorta At least one of the blood flow rate.
  • CVP central venous pressure
  • SV ventricular stroke volume
  • POP pulse plethysmograph amplitude
  • perfusion index Perfusion Index
  • SAP Systolic Arterial Pressure
  • PP Pulse Pressure
  • PEP Pre-Ejection Period
  • diameter of the inferior or superior vena cava aorta At least one of the blood flow rate.
  • the liquid reactivity detection module is further configured to determine the respiration variation of the target object according to the respiration period, determine the blood movement variation of the target object according to the respiration period, and The variation and the blood movement variation determine the fluid reactivity of the target subject.
  • the respiratory variation includes a respiratory variation trend, a respiratory variation rate, and a respiratory variation value
  • the blood movement variation includes a blood movement variation trend, a blood movement variation rate, and a blood movement variation value
  • the liquid reactivity detection module is further configured to perform one of the following operations: determine the liquid reactivity of the target object according to the respiratory variation trend and the blood movement variation trend; and according to the respiratory variation rate and the The blood variability rate determines the fluid reactivity of the target object; and the fluid reactivity of the target object is determined based on the respiratory variation value and the blood variability value.
  • the liquid reactivity detection module is further configured to determine the target object's performance when it is determined that the blood movement variation and the respiration variation satisfy the condition of correlation of the variation of the blood movement signal and the respiration signal.
  • the liquid reactivity is good; in the case where it is determined that the blood movement variation and the respiration variation do not satisfy the correlation condition of the variation of the blood movement signal and the respiration signal, it is determined that the liquid reactivity of the target object is poor.
  • the liquid reactivity detection module is further configured to determine the variation of the breathing amplitude of the target object according to the breathing cycle, determine the blood movement variation of the target object according to the breathing cycle, and The variation in respiratory amplitude and the variation in blood movement determine the fluid reactivity of the target subject.
  • the embodiment of the present application also provides a method for detecting liquid reactivity, including: collecting a target object in any breathing mode among spontaneous breathing mode, spontaneous breathing and machine-controlled breathing mode, and machine-controlled breathing mode Obtain at least one respiration signal of the target object; determine the liquid reactivity of the target object according to the blood flow signal and the respiration signal.
  • the breathing signal includes a breathing cycle; correspondingly, determining the liquid reactivity of the target object according to the blood flow signal and the breathing signal includes: determining the target object according to the breathing cycle Determine the blood movement variation of the target object according to the breathing cycle; determine the liquid reactivity of the target object according to the breathing variation and the blood movement variation.
  • the respiration signal further includes a respiration amplitude. Accordingly, determining the liquid reactivity of the target object according to the blood flow signal and the respiration signal includes: determining the target according to the respiration period The variation of the breathing amplitude of the subject; the blood movement variation of the target object is determined according to the breathing cycle; the liquid reactivity of the target object is determined according to the breathing amplitude variation and the blood movement variation.
  • determining the fluid reactivity of the target object according to the respiratory variation of the blood flow signal includes: determining that the blood movement variation and the respiratory variation satisfy the variation of the blood movement signal and the respiratory signal In the case of correlation conditions, it is determined that the liquid reactivity of the target object is good; when it is determined that the blood movement variation and the respiration variation do not satisfy the correlation conditions of the variation of the blood movement signal and the respiration signal, the liquid of the target object is determined Poor reactivity.
  • the respiratory variation includes a respiratory variation trend, a respiratory variation rate, and a respiratory variation value
  • the blood movement variation includes a blood movement variation trend, a blood movement variation rate, and a blood movement variation value.
  • Figure 1 is a schematic structural diagram of a liquid reactivity detection device provided by this application.
  • FIG. 2 is a schematic diagram of an arterial pressure signal provided by the present application.
  • FIG. 3 is a schematic diagram of a waveform of a respiratory signal provided by an embodiment of the present application.
  • Fig. 4 is a schematic flow chart of a method for detecting liquid reactivity in an embodiment of the present application.
  • FIG. 1 is a schematic structural diagram of a liquid reactivity detection device provided by this application.
  • the device includes: a breathing signal acquisition module 110, a blood flow signal acquisition module 120 and a liquid reactivity detection module 130.
  • the blood flow signal acquisition module 120 is configured to collect at least one blood flow signal of the target object
  • the breathing signal acquisition module 110 is configured to acquire at least one breathing signal of the target object
  • the liquid reactivity detection module 130 is configured to collect at least one blood flow signal of the target object.
  • the blood flow signal determines the fluid reactivity of the target object.
  • the target object can include all creatures with pulse signals, such as humans and animals.
  • the breathing signal acquisition module and the blood flow signal acquisition module work when the target object is in any of the following breathing modes: spontaneous breathing mode, spontaneous breathing and machine-controlled breathing mode, and Control breathing mode.
  • spontaneous breathing mode is for the target object to breathe without the assistance of mechanical breathing equipment
  • spontaneous breathing and machine-controlled breathing mode is the target for breathing with the assistance of mechanical breathing equipment.
  • the gas that the target object breathes Including the oxygen provided by mechanical breathing equipment and the air that the user breathes spontaneously, the machine-controlled breathing mode is that when the target object cannot breathe spontaneously, the oxygen for the target object to breathe is completely provided by the mechanical breathing equipment, and in this machine-controlled breathing mode ,
  • the tidal volume is not limited to a fixed tidal volume range and can be adjusted according to needs.
  • each breath of the target object can be different, which can accurately reflect the normal breathing state of the target object.
  • the blood flow signal of the target object is collected in any of the above modes, and the changing Blood movement information under breathing state.
  • the breathing signal acquisition module 110 and the blood flow signal acquisition module 120 work synchronously, and simultaneously collect the breathing signal and blood flow signal of the target object.
  • the breathing pattern for liquid reactivity detection may be determined according to the breathing pattern of the target object when the volume expansion treatment is performed on the target object.
  • the breathing mode of the target object in the process of liquid reactivity detection, the breathing mode of the target object may be switched, and the breathing signal and blood flow signal of the target object may be acquired in different breathing modes, and the target object may be further detected in different breathing modes.
  • the liquid reactivity of the object is tested comprehensively to improve the accuracy of liquid reactivity detection.
  • the technical solution of this embodiment breaks the limitation of the traditional breathing mode when detecting liquid reactivity, and determines the liquid reactivity when the target object can perform spontaneous breathing or adjustable machine-controlled breathing, thereby improving the applicability of liquid reactivity detection. And accuracy.
  • the blood movement signal collection module 120 includes a device or sensor configured to collect blood movement signals.
  • the blood flow signal includes central venous pressure CVP, ventricular stroke volume SV, pulse plethysmograph wave amplitude POP, perfusion index PI, arterial systolic pressure SAP, pulse pressure PP, pre-ejection period PEP, and At least one of the diameter of the lumen or superior vena cava, and the aortic blood flow rate.
  • the blood flow signal acquisition module 120 may include settings to collect central venous pressure CVP, ventricular stroke volume SV, pulse plethysmograph amplitude POP, perfusion index PI, arterial systolic pressure SAP, pulse pressure PP, and pre-ejection respectively.
  • the blood flow signal acquisition module 120 may include a blood pressure measuring instrument configured to measure arterial pressure.
  • central venous pressure CVP central venous pressure
  • ventricular stroke volume SV pulse plethysmographic wave amplitude POP
  • perfusion index PI perfusion index PI
  • arterial systolic pressure SAP arterial systolic pressure SAP
  • pulse pressure PP pulse pressure PP
  • pre-ejection period PEP lower or upper cavity
  • the devices or sensors for at least one of the vein diameter and the aortic blood flow rate may be independent, or two or more signal acquisition functions may be integrated into the same device.
  • FIG. 2 is a schematic diagram of an arterial pressure signal provided by this application.
  • Figure 2 includes arterial pressure signals that vary with respiration, where each signal wave is an arterial pressure signal. Due to the respiration of the target object, the arterial pressure signal is a dynamic signal, and the signal size is variable with respiration.
  • the breathing signal is used to describe the breathing state of the target object, including but not limited to the breathing cycle and the breathing amplitude, where the breathing cycle is the time for the target object to complete a breath-inspiration action when breathing, and the breathing amplitude is used In order to characterize the breathing intensity of the target object, for example, the greater the breathing intensity, that is, the more air is inhaled or exhaled, the greater the breathing amplitude.
  • the breathing signal can also be other signals that can describe the breathing state of the target object, such as but not limited to airway pressure, airway flow, carbon dioxide flow, tidal volume, chest impedance signal, magnetic signal, and breathing The acoustic signal is not limited.
  • the breathing signal acquisition module 110 is configured to acquire the above-mentioned breathing signal.
  • the breathing signal is extracted from breathing state parameters, that is, the breathing signal acquisition module 110 is also set to acquire the breathing state parameters of the target object, according to the collected
  • the breathing state parameter extracts the breathing signal of the target object, where the breathing state parameter includes at least one of airway pressure, airway flow, carbon dioxide flow, tidal volume, chest impedance signal, magnetic signal, and respiratory acoustic signal .
  • the respiratory signal acquisition module 110 may include a device or sensor configured to collect respiratory state parameters and a data processing unit configured to extract respiratory signals.
  • the equipment set to collect respiratory state parameters may include, but is not limited to, a ventilator, an anesthesia machine, a respiratory impedance detector, a respiratory induction plethysmography system, and a respiratory acoustic detection system.
  • the respiratory signal acquisition module 110 is configured to determine the rate of change of the respiratory state parameter, and determine the critical point of exhalation and inhalation according to the rate of change, for example, determine the node with a positive or negative change in the rate of change as exhalation and inhalation.
  • the critical point of breath, the adjacent time period of inhalation and exhalation is determined as the breathing cycle, and the difference between the maximum and minimum values in a breathing cycle is determined as the respiratory amplitude.
  • Fig. 3 is a schematic diagram of a waveform of a respiratory signal provided by an embodiment of the present application.
  • the peaks and troughs are critical points at which the rate of change of the respiratory state parameter changes positively or negatively, for example,
  • the peak is the critical point for switching from inhalation to exhalation
  • the trough is the critical point for switching from exhalation to inhalation.
  • One exhalation and one inhalation form a breathing cycle (RESPamp), that is, the time period of adjacent peaks or adjacent troughs Determined as the respiratory cycle (RESPtime).
  • the respiratory signal acquisition module 110 is configured to generate respiratory waveforms according to respiratory state parameters, determine the respiratory cycle according to the time between two adjacent peaks or two adjacent valleys, and determine the respiratory cycle according to the parameters of adjacent peaks and valleys. The difference determines the breathing amplitude. Exemplarily, see Fig. 3, which will not be repeated here.
  • the respiratory signal acquisition module 110 is further configured to extract the envelope of the respiratory state parameter that changes with time, and determine the respiratory amplitude according to the parameter difference between the peak and trough of the respiratory state parameter in the envelope. The time between two adjacent peaks or two adjacent troughs determines the breathing cycle.
  • the respiration signal may be determined based on the blood movement signal.
  • the breathing signal acquisition module 110 is further configured to determine the breathing envelope of the blood flow signal according to the collected blood flow signal, and extract the breathing signal of the target object according to the breathing envelope.
  • the respiration signal acquisition module 110 receives the blood movement signal collected by the blood movement signal acquisition module 120, determines the respiration envelope of the blood movement signal, and determines the respiration envelope of the blood movement signal according to the difference between two adjacent peaks or two adjacent troughs in the respiration envelope.
  • the respiration period is determined by the time between, and the respiration amplitude is determined according to the parameter difference between the peak and the trough, where the respiration amplitude may be positively correlated with the parameter difference between the peak and the trough.
  • the respiration signal acquisition module 110 is connected to the liquid reactivity detection module 130 to send the acquired respiration signal to the liquid reactivity detection module 130
  • the blood movement signal acquisition module 120 is connected to the liquid reactivity detection module 130 to send the collected blood movement signal To the liquid reactivity detection module 130.
  • both the blood movement signal and the respiration signal carry a time stamp
  • the liquid reactivity detection module 130 aligns the respiration signal and blood movement signal according to the time stamp, and processes the respiration signal and blood movement signal with the same time stamp. Compare, or compare the respiration signal and the blood movement signal within the same time stamp range (for example, within the respiratory cycle), and determine the liquid reactivity according to the correspondence between the respiration signal and the blood movement signal.
  • the liquid reactivity detection module 130 is further configured to determine the respiratory variation of the target object according to the respiratory cycle, determine the blood movement variation of the target object according to the respiratory cycle, and determine the blood movement variation of the target object according to the respiratory variation and the blood movement variation. Determine the liquid reactivity of the target object.
  • the respiratory variation is the change of the respiratory signal or the respiratory state parameter in different respiratory cycles.
  • the respiratory variation includes a respiratory variation trend, a respiratory variation rate, and a respiratory variation value.
  • the respiratory variability values in adjacent cycles are determined sequentially (for example, the variability of tidal volume or the variability of carbon dioxide flow, etc.), and the respiratory variability trend can be determined according to the positive or negative of the respiratory variability, such as the respiratory variability. If it is positive, the respiratory variation trend is increasing, the respiratory variation value is negative, and the respiratory variation trend is decreasing.
  • the respiratory variance rate can be determined according to the ratio of the respiratory variance value to the respiratory signal value of the respiratory cycle. Exemplarily, referring to Fig. 3, the respiratory amplitude in Fig.
  • Blood movement variation is the change of blood movement signal in different respiratory cycles.
  • blood movement variation includes blood movement variation trend, blood movement variation rate, and blood movement variation value. Since multiple blood flow signals may be included in one breathing cycle, the average or median value of multiple blood flow signals in one breathing cycle may be used to characterize the blood flow signal value of the breathing cycle. Determine the blood movement variation value according to the blood movement signal value of the adjacent respiratory cycle, and determine the respiratory variation trend according to the positive or negative blood movement variation value. For example, the blood movement variation value is positive, the blood movement variation trend is increasing, and the blood movement variation value is If it is negative, the blood movement variation trend is decreasing.
  • the blood movement variation rate is determined according to the ratio of the blood movement variation value to the blood movement signal value of the respiratory cycle.
  • the liquid reactivity detection module 130 is further configured to perform one of the following operations: determine the liquid reactivity of the target object according to the respiratory variation trend and the blood movement variation trend; The kinematic variation rate determines the liquid reactivity of the target object; and, the liquid reactivity of the target object is determined based on the respiratory variation value and the blood movement variation value. In the case where it is determined that the blood movement variation and the respiratory variation satisfy the condition of correlation of the variation of the blood movement signal and the respiratory signal, it is determined that the liquid reactivity of the target object is good; when the blood movement variation and the respiratory variation are determined In the case where the condition of correlation between the variation of the blood movement signal and the breathing signal is not satisfied, it is determined that the liquid reactivity of the target object is poor.
  • the mutation correlation condition is determined according to the blood flow signal and the breathing signal used for the comparison, and the blood flow signal and the breathing signal used for the comparison can be different at the same time.
  • the liquid reactivity detection module 130 is further configured to determine the variation in the breathing amplitude of the target object according to the breathing cycle, and to determine according to the breathing cycle
  • the fluid reactivity of the target object is determined based on the variation of the respiratory amplitude and the variation of the arterial pressure.
  • the fluid reactivity of the target object is determined according to the respiratory variation trend and the blood movement variation trend, and when the respiration amplitude variation trend is the same as the arterial pressure variation trend, it is determined that the liquid reactivity of the target object is good When the variation trend of respiratory amplitude is different from or opposite to the variation trend of arterial pressure, it is determined that the target object's fluid reactivity is poor. In some embodiments, determining the fluid reactivity of the target object based on the respiratory variation rate and the blood variability rate may be determining whether the blood variability rate corresponds to the blood variability in the same respiratory cycle.
  • the blood movement variation rate range corresponding to the respiratory variation rate may be determined according to the accuracy of the liquid reactivity detection, and may be preset.
  • the respiration variation is the change of adjacent respiration signals
  • the respiration variation trend of the respiration signal in a preset time period is determined according to the adjacent respiration signal values
  • the respiration variation trend of the respiration signal in the preset time period is determined according to the variation value of the adjacent respiration signal values.
  • Respiratory variation rate of the respiratory signal is the change of adjacent blood movement signals.
  • the blood movement variation trend of the blood movement signal in the adjacent preset time period is determined according to the adjacent blood movement signal value
  • the blood movement variation rate of the blood movement signal in the preset time period is determined according to the variation value of the adjacent blood movement signal value.
  • the respiratory variation trend in each respiratory cycle in Figure 3 first increases and then decreases;
  • Figure 2 determines the blood movement variation trend of adjacent blood signals (PPV1, PPV2, PPV3 and PPV4), it can be seen that the trend of blood movement variation in each respiratory cycle increases first and then decreases.
  • the liquid reactivity detection module 130 may determine the liquid reactivity according to the respiratory variation and blood movement variation corresponding to the respiratory cycle.
  • the liquid reactivity of the target object may be determined according to the respiratory variation trend and blood movement variation trend of the corresponding respiratory cycle, or the target may be determined according to the respiratory variation rate and blood movement variation rate of the corresponding respiratory cycle.
  • the liquid reactivity of the subject, or the liquid reactivity of the target subject is determined according to the respiratory variation value and blood movement variation value corresponding to the respiratory cycle.
  • it may be to adjust the airway flow of the machine-controlled airway from normal mode to breathing When the airway flow is 0, then switch to the normal mode to determine the respiratory variability (such as respiratory variability trend, respiratory variability or respiratory variability), or switch from normal mode to respiratory tidal volume by adjusting the machine-controlled respiratory tidal volume to 8ml /kg mode and then switch to the normal mode to determine the respiratory variation and the corresponding blood movement variation value (PPVn-PPVm), where PPVn and PPVm correspond to blood movement and breathing variation in different breathing states.
  • the respiratory variability such as respiratory variability trend, respiratory variability or respiratory variability
  • PPVn-PPVm blood movement variation value
  • the respiration variation and blood movement variation of the preset time period both satisfy the correlation conditions of the blood movement signal and the respiration signal variation, it is determined that the liquid reactivity of the target object is good.
  • the respiration variation of any breathing cycle or a preset number of breathing cycles is When the blood movement variation does not meet the condition of the variation correlation between blood movement signal and breathing signal, it is determined that the target object has poor fluid reactivity.
  • any respiratory signal respiratory amplitude, airway pressure, airway flow, carbon dioxide flow, tidal volume, chest impedance signal, magnetic signal, and respiratory acoustic signal
  • any blood movement signal Central venous pressure CVP, heart stroke volume SV, pulse plethysmograph amplitude POP, perfusion index PI, arterial systolic pressure SAP, pulse pressure PP, pre-ejection period PEP, diameter of inferior or superior vena cava, and aortic blood Flow rate
  • the determined liquid reactivity can be verified according to the breathing signal and blood flow signal of other combinations.
  • the breathing signal and blood flow signal of other combinations can be selected to re-determine the liquid reactivity of the target object to avoid inspection errors caused by accidental events .
  • the technical solution provided in this embodiment collects the dynamic blood flow signal and dynamic breathing signal of the target object in spontaneous breathing mode, spontaneous breathing and machine-controlled breathing mode, or machine-controlled breathing mode, and determines jointly based on the blood flow signal and the breathing signal
  • the liquid reactivity of the target object breaks the breathing limitation in the traditional test process, determines the liquid reactivity of the target object in the real breathing state, and improves the use scene range and accuracy of the measured liquid reactivity.
  • Fig. 4 is a method for detecting liquid reactivity provided by an embodiment of the present application.
  • the method is suitable for detecting liquid reactivity in a breathing model of spontaneous breathing mode, spontaneous breathing and machine-controlled breathing mode, or machine-controlled breathing mode.
  • the method includes step S410 to step S430.
  • step S410 at least one blood movement signal of the target object is collected.
  • step S420 at least one breathing signal of the target object is acquired.
  • step S430 the liquid reactivity of the target object is determined according to the blood movement signal and the respiration signal.
  • the dynamic respiration signal and the dynamic blood flow signal that change with the respiration signal are collected, wherein the blood flow signal and the respiration signal both carry a time stamp, which is determined according to the time stamp. Comparing the blood movement signal and respiration signal of the same time stamp or the same time stamp range, and determine the liquid reactivity of the target object according to the comparison result.
  • the blood flow signal may be collected by a blood flow signal acquisition device, and the breathing signal may be collected by the respiratory state parameters of the target object, and extracted according to the collected respiratory state parameters, where the respiratory state parameters include airway pressure At least one of airway flow, carbon dioxide flow, tidal volume, chest impedance signal, magnetic signal, and respiratory acoustic signal.
  • the respiration signal may also be obtained by determining the respiration envelope of the blood movement signal according to the collected blood movement signal, and extracting it according to the respiration envelope.
  • the respiration signal includes a respiration period
  • determining the liquid reactivity of the target object according to the blood flow signal and the respiration signal includes: determining the target object according to the respiration period Determine the blood movement variation of the target object according to the breathing cycle; determine the liquid reactivity of the target object according to the breathing variation and the blood movement variation.
  • the breathing variation may be the tidal volume variation, carbon dioxide flow variation, airway pressure variation, airway flow variation, chest impedance signal variation, magnetic signal variation, or respiratory acoustic signal variation of the target object between adjacent breathing cycles.
  • the blood variability can be central venous pressure variation ( ⁇ CVP), ventricular stroke volume variation (SVV), pulse plethysmograph amplitude variation POPV, perfusion index variation PVI, arterial systolic pressure variation SPV,
  • ⁇ CVP central venous pressure variation
  • SVV ventricular stroke volume variation
  • POPV pulse plethysmograph amplitude variation
  • PVI perfusion index variation
  • SPV arterial systolic pressure variation SPV
  • the variation of dynamic parameters such as pulse pressure variation PPV, pre-ejection variation PEPV, inferior or superior vena cava diameter variation dIVC/dSVC, and aortic blood flow rate variation ⁇ Vpeak.
  • the respiratory variation includes respiratory variation trend, respiratory variation rate, and respiratory variation value
  • the blood movement variation includes blood movement variation trend, blood movement variation rate, and blood movement variation value.
  • it may be based on Any one of the above-mentioned respiratory variation trends and any one of the blood movement variation trends determines the liquid reactivity of the target object, or the liquid reactivity of the target object is determined based on any one of the above-mentioned respiratory variation rates and any one blood movement variation rate, or based on any of the above respirations
  • the variation value and any blood movement variation value determine the fluid reactivity of the target object.
  • determining the fluid reactivity of the target object according to the respiratory variation of the blood flow signal includes: determining that the blood movement variation and the respiratory variation satisfy the variation of the blood movement signal and the respiratory signal In the case of correlation conditions, it is determined that the liquid reactivity of the target object is good; when it is determined that the blood movement variation and the respiration variation do not satisfy the correlation conditions of the variation of the blood movement signal and the respiration signal, the liquid of the target object is determined Poor reactivity.
  • the mutation correlation condition is related to the blood movement signal and the respiratory signal that determine the fluid reactivity. The combination of the blood movement signal and the respiratory signal is different, and the mutation correlation condition can be different.
  • the respiration signal further includes a respiration amplitude. Accordingly, determining the liquid reactivity of the target object according to the blood flow signal and the respiration signal includes: determining the target according to the respiration period The variation of the breathing amplitude of the subject; the blood movement variation of the target object is determined according to the breathing cycle; the liquid reactivity of the target object is determined according to the breathing amplitude variation and the blood movement variation.
  • the liquid reactivity of the target object is good under at least one of the following conditions: it is determined that the blood movement variation trend and the respiration amplitude variation trend satisfy the variation correlation condition of the blood movement signal and the respiration signal; the blood movement variation rate and respiration When the amplitude variation rate satisfies the variation correlation condition of the blood movement signal and the respiratory signal; and the blood movement variation value and the respiratory amplitude variation value satisfy the variation correlation condition of the blood movement signal and the respiratory signal.
  • the technical solution provided by this embodiment collects the dynamic respiration signal of the target object and the dynamic blood flow signal that changes with the respiration signal in the spontaneous breathing mode, the spontaneous breathing and machine-controlled breathing mode, or the machine-controlled breathing mode.
  • the signal and respiration signal jointly determine the liquid reactivity of the target object in the above-mentioned breathing mode.
  • the liquid reactivity obtained by monitoring the real breathing state of the target object expands the scope of the use of the measured liquid reactivity and improves the liquid response.
  • the detection accuracy of sex breaks the application limitation of traditional liquid reactivity measurement.

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Abstract

一种液体反应性的检测装置和方法。其中液体反应性的检测装置包括：呼吸信号获取模块、血动信号采集模块和液体反应性检测模块；其中，所述呼吸信号获取模块和所述血动信号采集模块在所述目标对象处于如下任一呼吸模式的情况下进行工作：自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式；所述血动信号采集模块，设置为采集目标对象的至少一个血动信号；所述呼吸信号获取模块，设置为获取所述目标对象的至少一个呼吸信号；所述液体反应性检测模块，设置为根据所述呼吸信号和所述血动信号确定所述目标对象的液体反应性。

Description

一种液体反应性的检测装置和方法 技术领域
本申请实施例涉及医用电子技术领域，例如涉及一种液体反应性的检测装置和方法。
背景技术
在临床手术或者对重症患者的循环支持中，容量状态的判断非常重要，临床面对急性循环衰竭或者组织灌注不足时，扩容治疗是维持或者改善器官灌注的常用手段，而液体反应性好是扩容治疗的基本前提。其中，根据Frank-Starling机制，只有在左右心室均处于心功能曲线上升支时，通过扩容治疗增加心脏前负荷，才能显著提高心输出量，即液体反应性好；而当某一心室处于心功能曲线平台支时，增加心脏前负荷则难以进一步增加心输出量，即液体反应性差，而且盲目的扩容治疗可能增加肺水肿的风险。
目前，临床上通过监测呼吸过程中收缩压变异(Systolic Blood Pressure Variability，SPV)、(Pulse Pressure Variation，PPV)、每搏量变异(Stroke Volume Variation，SVV)、下腔或上腔静脉直径呼吸变异率(经食管或胸腔超声心动图(Transesophagealechocardiography/Transthoracicechocardiography，TEE/TTE))和主动脉峰值血流速变异率Δpeak(经食管超声)、射血前期变异率(Pre-Ejection Period Variation，PEPV)等动态前负荷参数预测液体反应性，同时目前的动态前负荷临床应用存在制约条件，即在恒定潮气量(8-12ml/kg)完全机械通气且无心律失常的限制条件下。上述液体反应性的预测方法存在严苛的条件限制，应用范围窄。
发明内容
以下是对本文详细描述的主题的概述。本概述并非是为了限制权利要求的保护范围。
本申请实施例提供一种液体反应性的检测装置和方法，以实现在任意呼吸模式下进行液体反应性的检测。
第一方面，本申请实施例提供了一种液体反应性的检测装置，包括：呼吸 信号获取模块、血动信号采集模块和液体反应性检测模块；其中，所述呼吸信号获取模块和所述血动信号采集模块在所述目标对象处于如下任一呼吸模式的情况下进行工作：自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式；所述血动信号采集模块，设置为采集目标对象的至少一个血动信号；所述呼吸信号获取模块，设置为获取所述目标对象的至少一个呼吸信号；所述液体反应性检测模块，设置为根据所述呼吸信号和所述血动信号确定所述目标对象的液体反应性。
在一些实施例中，所述呼吸信号包括呼吸周期。
在一些实施例中，所述呼吸信号还包括呼吸幅度。
在一些实施例中，所述呼吸信号获取模块：还设置为采集所述目标对象的呼吸状态参数，根据采集的呼吸状态参数提取所述目标对象的呼吸信号，其中，所述呼吸状态参数包括气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号或呼吸声学信号中的至少一项。
在一些实施例中，所述呼吸信号获取模块，还设置为根据采集的血动信号确定所述血动信号的呼吸包络，根据所述呼吸包络提取所述目标对象的呼吸信号。
在一些实施例中，所述血动信号包括中心静脉压(Central Venous Pressure，CVP)、心室每搏量(Stroke Volume，SV)、脉搏容积描记波幅度(Pulse Oximetry Plethysmograph，POP)、灌注指数(Perfusion Index，PI)、动脉收缩压(Systolic Arterial Pressure，SAP)、脉压(Pulse Pressure，PP)、预射血期(Pre-Ejection Period，PEP)、下腔或上腔静脉直径，以及主动脉血流速率中的至少一项。
在一些实施例中，所述液体反应性检测模块，还设置为根据所述呼吸周期确定所述目标对象的呼吸变异，根据所述呼吸周期确定所述目标对象的血动变异，根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。
在一些实施例中，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值，所述血动变异包括血动变异趋势、血动变异率和血动变异值；
所述液体反应性检测模块，还设置为执行以下之一的操作：根据所述呼吸变异趋势和所述血动变异趋势确定所述目标对象的液体反应性；根据所述呼吸变异率和所述血动变异率确定所述目标对象的液体反应性；以及，根据所述呼吸变异值和所述血动变异值确定所述目标对象的液体反应性。
在一些实施例中，所述液体反应性检测模块，还设置为在确定所述血动变异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性差。
在一些实施例中，所述液体反应性检测模块，还设置为根据所述呼吸周期确定所述目标对象的呼吸幅度变异，根据所述呼吸周期确定所述目标对象的血动变异，根据所述呼吸幅度变异和所述血动变异确定所述目标对象的液体反应性。
第二方面，本申请实施例还提供了一种液体反应性的检测方法，包括：在自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式中的任一呼吸模式下：采集目标对象的至少一个血动信号；获取所述目标对象的至少一个呼吸信号；根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性。
在一些实施例中，所述呼吸信号包括呼吸周期；相应的，根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：根据所述呼吸周期确定所述目标对象的呼吸变异；根据所述呼吸周期确定所述目标对象的血动变异；根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。
在一些实施例中，所述呼吸信号还包括呼吸幅度，相应的，根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：根据所述呼吸周期确定所述目标对象的呼吸幅度变异；根据所述呼吸周期确定所述目标对象的血动变异；根据所述呼吸幅度变异和所述血动变异确定所述目标对象的液体反应性。
在一些实施例中，根据所述血动信号的呼吸变异确定所述目标对象的液体反应性，包括：在确定所述血动变异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性差。
在一些实施例中，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值，所述血动变异包括血动变异趋势、血动变异率和血动变异值。
在阅读并理解了附图和详细描述后，可以明白其他方面。
附图说明
图1为本申请提供的一种液体反应性的检测装置的结构示意图；
图2是本申请提供的一种动脉压信号的示意图；
图3是本申请实施例提供的一种呼吸信号的波形示意图；
图4是本申请实施例中的一种液体反应性的检测方法的流程示意图。
具体实施方式
下面结合附图和实施例对本申请作进一步的详细说明。可以理解的是，此处所描述的具体实施例仅仅用于解释本申请，而非对本申请的限定。另外还需要说明的是，为了便于描述，附图中仅示出了与本申请相关的部分而非全部结构。
图1为本申请提供的一种液体反应性的检测装置的结构示意图，如图1所示，该装置包括：呼吸信号获取模块110、血动信号采集模块120和液体反应性检测模块130。其中，血动信号采集模块120，设置为采集目标对象的至少一个血动信号；呼吸信号获取模块110，设置为获取目标对象的至少一个呼吸信号；液体反应性检测模块130，设置为根据呼吸信号和血动信号确定目标对象的液体反应性。
其中，目标对象可包括一切有脉搏信号的生物，如人、动物等。
在本实施例中，所述呼吸信号获取模块和所述血动信号采集模块在所述目标对象处于如下任一呼吸模式的情况下进行工作：自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式。其中，自主呼吸模式为目标对象在无机械呼吸设备辅助的情况下进行呼吸，自主呼吸兼机控呼吸模式为目标用于在机械呼吸设备辅助的情况下进行的呼吸，其中，目标对象呼吸的气体包括机械呼吸设备提供的氧气和用户自主呼吸的空气，机控呼吸模式为在目标对象无法自主呼吸的情况下，完全由机械呼吸设备提供目标对象呼吸的氧气，其中，在该机控呼吸模式下，潮气量不限定在固定的潮气量范围，可根据需求进行调节。在上述任一呼吸模式下，目标对象的每一次呼吸都可以是不同的，可准确反映目标对象正常的呼吸状态，同时在上述任一模式下采集目标对象的血动信号，可得到在变化的呼吸状态下的血动信息。其中，呼吸信号获取模块110和血动信号采 集模块120同步工作，同时采集目标对象的呼吸信号和血动信号。在一些实施例中，可以是根据对目标对象进行扩容治疗时目标对象的呼吸模式确定进行液体反应性检测时的呼吸模式。在一些实施例中，还可以是在进行液体反应性检测过程中，切换目标对象的呼吸模式，在不同的呼吸模式下获取目标对象的呼吸信号与血动信号，进一步检测在不同呼吸模式下目标对象的液体反应性，全面性检测液体反应性，以提高液体反应性检测的准确度。本实施例的技术方案，打破了传统检测液体反应性时对呼吸模式的限定，在目标对象可进行自主呼吸或可调的机控呼吸下确定液体反应性，提高了液体反应性检测的适用性和准确度。
示例性的，血动信号采集模块120包括设置为采集血动信号的设备或者传感器。在一些实施例中，所述血动信号包括中心静脉压CVP、心室每搏量SV、脉搏容积描记波幅度POP、灌注指数PI、动脉收缩压SAP、脉压PP、预射血期PEP、下腔或上腔静脉直径，以及主动脉血流速率中的至少一项。相应的，血动信号采集模块120可以是包括分别设置为采集中心静脉压CVP、心室每搏量SV、脉搏容积描记波幅度POP、灌注指数PI、动脉收缩压SAP、脉压PP、预射血期PEP、下腔或上腔静脉直径，以及主动脉血流速率中至少一项的设备或者传感器。例如，血动信号采集模块120可以是包括设置为测量动脉压的血压测量仪。需要说明的是，设置为采集中心静脉压CVP、心室每搏量SV、脉搏容积描记波幅度POP、灌注指数PI、动脉收缩压SAP、脉压PP、预射血期PEP、下腔或上腔静脉直径，以及主动脉血流速率中的至少一项的设备或者传感器可以是分别独立的，还可以两个或两个以上的信号采集功能集成于同一设备中。
示例性的，参加图2，图2是本申请提供的一种动脉压信号的示意图。图2中包括随呼吸变化的动脉压信号，其中，每一个信号波为一个动脉压信号，由于目标对象的呼吸变化，动脉压信号为动态信号，其信号大小随呼吸可变。
在一些实施例中，所述呼吸信号用于描述目标对象呼吸状态，包括但不限于呼吸周期和呼吸幅度，其中，呼吸周期为目标对象进行呼吸时完成一呼一吸动作的时间，呼吸幅度用于表征目标对象的呼吸强度，示例性的，呼吸强度越大，即吸入气体或呼出气体越多，呼吸幅度越大。在本实施例中，呼吸信号还可以是其他能够描述目标对象呼吸状态的信号，例如可以是但不限于气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号，以及呼吸声学信 号，对此不作限定。
呼吸信号获取模块110设置为获取上述呼吸信号，在一些实施例中，呼吸信号为从呼吸状态参数中提取，即呼吸信号获取模块110还设置为采集所述目标对象的呼吸状态参数，根据采集的呼吸状态参数提取所述目标对象的呼吸信号，其中，所述呼吸状态参数包括气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号，以及呼吸声学信号中的至少一项。相应的，呼吸信号获取模块110可以是包括设置为采集呼吸状态参数的设备或者传感器以及设置为提取呼吸信号的数据处理单元。其中，设置为采集呼吸状态参数的设备例如可以包括但不限于呼吸机、麻醉机、呼吸阻抗检测仪、呼吸感应体积描记系统和呼吸声学检测系统等。在一些实施例中，呼吸信号获取模块110设置为确定呼吸状态参数的变化率，根据变化率确定呼气和吸气的临界点，例如将变化率发生正负变化的节点确定为呼气和吸气的临界点，将相邻的吸气和呼气的时间周期确定为呼吸周期，将一个呼吸周期中最大值和最小值的差值确定为呼吸幅度。示例性的，参见图3，图3是本申请实施例提供的一种呼吸信号的波形示意图，在图3中，波峰和波谷为呼吸状态参数的变化率发生正负变化的临界点，例如，波峰为吸气切换为呼气的临界点，波谷为呼气切换为吸气的临界点，一次呼气和一次吸气形成一个呼吸周期(RESPamp)，即相邻波峰或者相邻波谷的时间周期确定为呼吸周期(RESPtime)。
在一些实施例中，呼吸信号获取模块110设置为根据呼吸状态参数生成呼吸波形，根据相邻两个波峰或相邻两个波谷之间的时间确定呼吸周期，根据相邻的波峰和波谷的参数差值确定呼吸幅度。示例性的，参见图3，此处不再赘述。
在一些实施例中，呼吸信号获取模块110还设置为提取随时间变化的呼吸状态参数的包络，将根据包络中呼吸状态参数的波峰和波谷的参数差值确定呼吸幅度，根据包络中相邻两个波峰或相邻两个波谷之间的时间确定呼吸周期。
在一些实施例中，呼吸信号可以是基于血动信号确定。相应的，呼吸信号获取模块110，还设置为根据采集的血动信号确定所述血动信号的呼吸包络，根据所述呼吸包络提取所述目标对象的呼吸信号。在一些实施例中，呼吸信号获取模块110接收血动信号采集模块120采集的血动信号，确定血动信号的呼吸包络，根据呼吸包络中相邻两个波峰或相邻两个波谷之间的时间确定呼吸周期，根据波峰和波谷的参数差值确定呼吸幅度，其中，呼吸幅度可以是与波峰和波 谷的参数差值成正相关。
呼吸信号获取模块110和液体反应性检测模块130连接，将获取的呼吸信号发送至液体反应性检测模块130，血动信号采集模块120和液体反应性检测模块130连接，将采集的血动信号发送至液体反应性检测模块130。需要说明的是，血动信号和呼吸信号中均携带有时间戳，液体反应性检测模块130根据时间戳将呼吸信号和血动信号进行对齐，将具有同一时间戳的呼吸信号和血动信号进行比对，或者将同一时间戳范围(例如呼吸周期内)的呼吸信号和血动信号进行比对，根据呼吸信号和血动信号的对应关系确定液体反应性。
液体反应性检测模块130，还设置为根据所述呼吸周期确定所述目标对象的呼吸变异，根据所述呼吸周期确定所述目标对象的血动变异，根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。
在一些实施例中，呼吸变异为不同呼吸周期中呼吸信号或者呼吸状态参数的变化。在一些实施例中，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值。在一些实施例中，依次确定相邻周期中呼吸变异值(例如可以是潮气量的变异值或者二氧化碳流量的变异值等)，可根据呼吸变异值的正负确定呼吸变异趋势，例如呼吸变异值为正，呼吸变异趋势为增大，呼吸变异值为负，呼吸变异趋势为减小。可根据呼吸变异值相对于该呼吸周期的呼吸信号值的比例确定呼吸变异率。示例性的，参见图3，图3中随着呼吸周期的变化呼吸幅度依次增大，可确定图3中呼吸变异趋势为逐渐增大。血动变异为不同呼吸周期中血动信号的变化，在一些实施例中，血动变异包括血动变异趋势、血动变异率和血动变异值。由于在一个呼吸周期中可包括多个血动信号，可以是将一个呼吸周期中的多个血动信号的均值或者中值表征该呼吸周期的血动信号值。根据相邻呼吸周期血动信号值确定血动变异值，可根据血动变异值的正负确定呼吸变异趋势，例如血动变异值为正，血动变异趋势为增大，血动变异值为负，血动变异趋势为减小。根据血动变异值相对于该呼吸周期的血动信号值的比例确定血动变异率。
液体反应性检测模块130，还设置为执行以下之一的操作：根据所述呼吸变异趋势和所述血动变异趋势确定所述目标对象的液体反应性；根据所述呼吸变异率和所述血动变异率确定所述目标对象的液体反应性；以及，根据所述呼吸变异值和所述血动变异值确定所述目标对象的液体反应性。在确定所述血动变 异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性差。根据用于进行比对的血动信号和呼吸信号确定变异关联条件，用于进行比对的血动信号和呼吸信号不同时变异关联条件可以是不同的。示例性的，当血动信号为动脉压，呼吸信号为呼吸幅度时，液体反应性检测模块130，还设置为根据所述呼吸周期确定所述目标对象的呼吸幅度变异，根据所述呼吸周期确定所述目标对象的动脉压变异，根据所述呼吸幅度变异和所述动脉压变异确定所述目标对象的液体反应性。在一些实施例中，根据所述呼吸变异趋势和所述血动变异趋势确定所述目标对象的液体反应性，当呼吸幅度变异趋势与动脉压变异趋势相同时，确定目标对象的液体反应性良好，当呼吸幅度变异趋势与动脉压变异趋势不同或者相反时，确定目标对象的液体反应性差。在一些实施例中，根据所述呼吸变异率和所述血动变异率确定所述目标对象的液体反应性，可以是确定同一呼吸周期中血动变异率是否在呼吸变异率对应的血动变异率范围中，若是，则确定目标对象的液体反应性良好，若否，则确定目标对象的液体反应性差。其中，呼吸变异率对应的血动变异率范围可根据液体反应性检测精度确定，可以是预先设置的。
在一些实施例中，呼吸变异为相邻呼吸信号的变化，根据相邻的呼吸信号值确定预设时段内呼吸信号的呼吸变异趋势，根据相邻的呼吸信号值的变异值确定预设时段内呼吸信号的呼吸变异率。相应的，血动变异为相邻血动信号的变化。根据相邻的血动信号值确定相邻的预设时段内血动信号的血动变异趋势，根据相邻的血动信号值的变异值确定预设时段内血动信号的血动变异率。示例性的，图3中在每一个呼吸周期中呼吸变异趋势为先增大，再减小；图2中在每一个呼吸周期中确定相邻血动信号的血动变异趋势(PPV1、PPV2、PPV3和PPV4)，可知，每一个呼吸周期血动变异趋势为先增大在减小。液体反应性检测模块130可以是将对应呼吸周期的呼吸变异和血动变异确定液体反应性。在一些实施例中，可以是根据对应呼吸周期的呼吸变异趋势和血动变异趋势确定所述目标对象的液体反应性，或者是根据对应呼吸周期的呼吸变异率和血动变异率确定所述目标对象的液体反应性，或者是根据对应呼吸周期的呼吸变异值和血动变异值确定所述目标对象的液体反应性，示例性的，可以是调节机控呼吸 气道流量由正常模式切换到呼吸气道流量为0的模式再切换到正常模式过程中确定呼吸变异(如呼吸变异趋势、呼吸变异率或呼吸变异值)，或者通过调节机控呼吸潮气量由正常模式切换到呼吸潮气量为8ml/kg的模式后再切换至至正常模式过程中确定呼吸变异，以及相应的血动变异值(PPVn-PPVm)，其中PPVn和PPVm分别对应不同呼吸状态下的血动呼吸变异。当预设时段的呼吸变异和血动变异均满足血动信号与呼吸信号的变异关联条件时，确定目标对象的液体反应性良好，当任一呼吸周期或者预设数量的呼吸周期的呼吸变异和血动变异不满足血动信号与呼吸信号的变异关联条件时，确定目标对象的液体反应性差。
在一些实施例中，可以是基于任一呼吸信号(呼吸幅度、气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号，以及呼吸声学信号)和任一血动信号(中央静脉压CVP、心脏每搏输出量SV、脉搏容积描记波幅度POP、灌注指数PI、动脉收缩压SAP、脉压PP、预射血期PEP、下腔或上腔静脉直径，以及主动脉血流速率)确定液体反应性。本实施例中，当其中任一呼吸信号和血动信号确定目标对象的液体反应性后，可根据其他组合方式的呼吸信号和血动信号对确定的液体反应性进行校验。示例性的，当根据呼吸幅度和动脉压确定目标对象的液体反应性差时，可选择多个其他组合方式的呼吸信号和血动信号重新确定目标对象的液体反应性，避免偶发事件导致的检查误差。
本实施例提供的技术方案，通过在自主呼吸模式、自主呼吸兼机控呼吸模式或者机控呼吸模式下，采集目标对象的动态血动信号和动态呼吸信号，根据血动信号和呼吸信号联合确定目标对象的液体反应性，打破了传统测试过程中的呼吸限制，确定目标对象的真实呼吸状态下的液体反应性，提高了测量得到的液体反应性的使用场景范围以及准确性。
图4是本申请实施例提供的一种液体反应性的检测方法，该方法适用于在自主呼吸模式、自主呼吸兼机控呼吸模式或者机控呼吸模式的呼吸模型进行液体反应性的检测。在自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式中的任一呼吸模式下，该方法包括步骤S410至步骤S430。
在步骤S410中，采集目标对象的至少一个血动信号。
在步骤S420中，获取所述目标对象的至少一个呼吸信号。
在步骤S430中，根据所述血动信号和所述呼吸信号确定所述目标对象的液 体反应性。
在本实施例中，在目标对象呼吸可变的情况下，采集动态的呼吸信号以及随呼吸信号变化的动态血动信号，其中，血动信号和呼吸信号均携带有时间戳，根据时间戳确定同一时间戳或同一时间戳范围的血动信号和呼吸信号的比对，根据比对结果确定目标对象的液体反应性。
其中，血动信号可以是通过血动信号采集设备采集得到，呼吸信号可以是采集所述目标对象的呼吸状态参数，根据采集的呼吸状态参数提取得到，其中，所述呼吸状态参数包括气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号，以及呼吸声学信号中的至少一项。呼吸信号还可以是根据采集的血动信号确定所述血动信号的呼吸包络，根据所述呼吸包络提取得到。
在一些实施例中，所述呼吸信号包括呼吸周期，相应的，根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：根据所述呼吸周期确定所述目标对象的呼吸变异；根据所述呼吸周期确定所述目标对象的血动变异；根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。示例性的，呼吸变异可以是目标对象的相邻呼吸周期的潮气量变异、二氧化碳流量变异、气道压变异、气道流量变异、胸阻抗信号变异、磁力信号变异或呼吸声学信号变异等。相应的，血动变异可以是相邻呼吸周期的中心静脉压变异(△CVP)、心室每搏量变异(SVV)、脉搏容积描记波幅度变异POPV、灌注指数变异PVI、动脉收缩压变异SPV、脉压变异PPV、预射血期变异PEPV、下腔或上腔静脉直径变异dIVC/dSVC和主动脉血流速率变异△Vpeak等动态参数的变异。基于上述任一呼吸变异和任一血动变异确定目标对象的液体反应性。在一些实施例中，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值，所述血动变异包括血动变异趋势、血动变异率和血动变异值，相应的，可以是基于上述任一呼吸变异趋势和任一血动变异趋势确定目标对象的液体反应性，或者基于上述任一呼吸变异率和任一血动变异率确定目标对象的液体反应性，或者基于上述任一呼吸变异值和任一血动变异值确定目标对象的液体反应性。
在一些实施例中，根据所述血动信号的呼吸变异确定所述目标对象的液体反应性，包括：在确定所述血动变异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情 况下，确定目标对象的液体反应性差。其中，变异关联条件与确定液体反应性的血动信号和呼吸信号相关，血动信号和呼吸信号的组合方式不同，变异关联条件可以是不同。
在一些实施例中，所述呼吸信号还包括呼吸幅度，相应的，根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：根据所述呼吸周期确定所述目标对象的呼吸幅度变异；根据所述呼吸周期确定所述目标对象的血动变异；根据所述呼吸幅度变异和所述血动变异确定所述目标对象的液体反应性。相应的，在以下至少之一的情况下确定目标对象的液体反应性良好：确定血动变异趋势与呼吸幅度变异趋势满足所述血动信号与呼吸信号的变异关联条件；血动变异率与呼吸幅度变异率满足所述血动信号与呼吸信号的变异关联条件时；以及血动变异值与呼吸幅度变异值满足所述血动信号与呼吸信号的变异关联条件。
本实施例提供的技术方案，通过在自主呼吸模式、自主呼吸兼机控呼吸模式或者机控呼吸模式下，采集目标对象的动态的呼吸信号以及随呼吸信号变化的动态血动信号，根据血动信号和呼吸信号联合确定目标对象在上述呼吸模式下的液体反应性，通过监控目标对象的真实呼吸状态获得的液体反应性，扩大了测量得到的液体反应性的使用场景范围，同时提高了液体反应性的检测准确度，打破了传统测量的液体反应性的应用局限。

Claims (15)

  1. 一种液体反应性的检测装置，包括：呼吸信号获取模块、血动信号采集模块和液体反应性检测模块；其中，所述呼吸信号获取模块和所述血动信号采集模块在目标对象处于如下任一呼吸模式的情况下进行工作：自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式；
    所述血动信号采集模块，设置为采集目标对象的至少一个血动信号；
    所述呼吸信号获取模块，设置为获取所述目标对象的至少一个呼吸信号；
    所述液体反应性检测模块，设置为根据所述呼吸信号和所述血动信号确定所述目标对象的液体反应性。
  2. 根据权利要求1所述的液体反应性的检测装置，其中，所述呼吸信号包括呼吸周期。
  3. 根据权利要求2所述的液体反应性的检测装置，所述呼吸信号还包括呼吸幅度。
  4. 根据权利要求2或3所述的液体反应性的检测装置，
    所述呼吸信号获取模块：还设置为采集所述目标对象的呼吸状态参数，根据采集的呼吸状态参数提取所述目标对象的呼吸信号，其中，所述呼吸状态参数包括气道压、气道流量、二氧化碳流量、潮气量、胸阻抗信号、磁力信号，以及呼吸声学信号中的至少一项。
  5. 根据权利要求2或3所述的液体反应性的检测装置，
    所述呼吸信号获取模块，还设置为根据采集的血动信号确定所述血动信号的呼吸包络，根据所述呼吸包络提取所述目标对象的呼吸信号。
  6. 根据权利要求1所述的液体反应性的检测装置，其中，所述血动信号包括中心静脉压CVP、心室每搏量SV、脉搏容积描记波幅度POP、灌注指数PI、动脉收缩压SAP、脉压PP、预射血期PEP、下腔或上腔静脉直径，以及主动脉血流速率中的至少一项。
  7. 根据权利要求2所述的液体反应性的检测装置，所述液体反应性检测模块，还设置为根据所述呼吸周期确定所述目标对象的呼吸变异，根据所述呼吸周期确定所述目标对象的血动变异，根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。
  8. 根据权利要求7所述的液体反应性的检测装置，，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值，所述血动变异包括血动变异趋势、血 动变异率和血动变异值；
    所述液体反应性检测模块，还设置为执行以下之一的操作：
    根据所述呼吸变异趋势和所述血动变异趋势确定所述目标对象的液体反应性；
    根据所述呼吸变异率和所述血动变异率确定所述目标对象的液体反应性；以及，
    根据所述呼吸变异值和所述血动变异值确定所述目标对象的液体反应性。
  9. 根据权利要求7所述的液体反应性的检测装置，所述液体反应性检测模块，还设置为在确定所述血动变异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；
    在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性差。
  10. 根据权利要求4所述的液体反应性的检测装置，所述液体反应性检测模块，还设置为根据所述呼吸周期确定所述目标对象的呼吸幅度变异，根据所述呼吸周期确定所述目标对象的血动变异，根据所述呼吸幅度变异和所述血动变异确定所述目标对象的液体反应性。
  11. 一种液体反应性的检测方法，包括：
    在自主呼吸模式、自主呼吸兼机控呼吸模式、机控呼吸模式中的任一呼吸模式下：
    采集目标对象的至少一个血动信号；
    获取所述目标对象的至少一个呼吸信号；
    根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性。
  12. 根据权利要求11所述的方法，其中，所述呼吸信号包括呼吸周期；根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：
    根据所述呼吸周期确定所述目标对象的呼吸变异；
    根据所述呼吸周期确定所述目标对象的血动变异；
    根据所述呼吸变异和所述血动变异确定所述目标对象的液体反应性。
  13. 根据权利要求12所述的方法，其中，所述呼吸信号还包括呼吸幅度；根据所述血动信号和所述呼吸信号确定所述目标对象的液体反应性，包括：
    根据所述呼吸周期确定所述目标对象的呼吸幅度变异；
    根据所述呼吸周期确定所述目标对象的血动变异；
    根据所述呼吸幅度变异和所述血动变异确定所述目标对象的液体反应性。
  14. 根据权利要求12或13所述的方法，其中，根据所述血动信号的呼吸变异确定所述目标对象的液体反应性，包括：
    在确定所述血动变异与所述呼吸变异满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性良好；
    在确定所述血动变异与所述呼吸变异不满足所述血动信号与呼吸信号的变异关联条件的情况下，确定目标对象的液体反应性差。
  15. 根据权利要求12或13所述的方法，其中，所述呼吸变异包括呼吸变异趋势、呼吸变异率和呼吸变异值，所述血动变异包括血动变异趋势、血动变异率和血动变异值。
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