TW202308557A - A measurement method of hemadynamics platform - Google Patents
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Abstract
Description
本發明涉及一種量測的方法，尤其涉及一種血流動力學平臺量測方法。The invention relates to a measurement method, in particular to a hemodynamic platform measurement method.
血流動力學的監測是心臟血管疾病非常重要的治療活動，其參數比如心輸出量（CO）是指單側心室每分鐘射出的總血量，為心律（HR）與心搏量（SV）的乘積，是反應心臟功能的重要指標；透過血流動力學監測，能夠提供臨床醫護人員早期鑑別疾病的原因，及時給予病人適當的醫療處置，降低心臟病人的死亡率。The monitoring of hemodynamics is a very important therapeutic activity for cardiovascular diseases. Its parameters such as cardiac output (CO) refer to the total blood volume ejected by a single ventricle per minute, which is heart rate (HR) and stroke volume (SV). The product of is an important indicator of heart function; through hemodynamic monitoring, it can provide clinical medical staff with early identification of the cause of the disease, give patients appropriate medical treatment in time, and reduce the mortality of heart disease patients.
目前心輸出量的監測技術包含侵入式與非侵入式兩種類型的技術，侵入式的心輸出量檢測技術例如心肺容積監測（PiCCO），原理是利用經肺溫度稀釋法和脈搏曲線分析法，在人體內放置中心靜脈導管與動脈導管，由中心靜脈端注入定量的冰水，在動脈端測量溫度與時間變化線，藉此測量得出心輸出量。At present, cardiac output monitoring technologies include invasive and non-invasive technologies. Invasive cardiac output detection technologies such as cardiopulmonary volume monitoring (PiCCO) are based on the principle of using transpulmonary temperature dilution method and pulse curve analysis method. Place a central venous catheter and an arterial catheter in the human body, inject a certain amount of ice water from the central venous end, and measure the temperature and time change line at the arterial end, so as to measure the cardiac output.
非侵入式的心輸出量檢測技術例如心阻抗血流圖（ICG），是於組織胸腔的兩端設置電極量測得出心阻抗血流圖，將其中的參數代入kubicek心搏量公式計算心輸出量（CO）；非侵入式心輸出量檢測還有基於脈搏波的方法，是基於彈性臟器模型（Windkessel Model），利用壓力脈搏裝置得到脈搏波後，利用脈搏波信號、波形與波形的特徵點計算心輸出量（CO）。上述非侵入式的量測方法與侵入式相較，具有無創傷、安全與簡便等優點，但利用脈搏波計算心輸出量的方法，其脈搏波的波形是否典型顯出各特徵點，與壓脈帶受壓的壓力有關，因此選擇適當的平台壓力來測量脈搏波對於量測結果十分重要，過高或者過低都會降低準確度，並使可利用此法量測的人數減少。Non-invasive cardiac output detection technology such as impedance cardiogram (ICG), is to set electrodes at both ends of the tissue chest to measure the cardiac impedance blood flow, and substitute the parameters into the kubicek stroke volume formula to calculate the cardiac output. Output (CO); non-invasive cardiac output detection also has a method based on pulse wave, which is based on the elastic organ model (Windkessel Model). After using the pressure pulse device to obtain the pulse wave, the pulse wave signal, waveform and waveform The characteristic points calculate the cardiac output (CO). Compared with the invasive measurement method, the above-mentioned non-invasive measurement method has the advantages of non-invasiveness, safety and simplicity. Therefore, it is very important to select the appropriate platform pressure to measure the pulse wave. Too high or too low will reduce the accuracy and reduce the number of people who can use this method to measure.
由於現有利用脈搏波計算心輸出量的方法的準確性與選擇量測平台的壓力有關。為此，本發明在一較佳的壓力區間設置量測平台，在該量測平台以固定的壓力對待測者量測脈搏波，達到提升量測結果的準確度，降低無法量測人數的比例。Because the accuracy of the existing method for calculating cardiac output by using the pulse wave is related to the pressure of the selected measurement platform. For this reason, the present invention sets a measurement platform in a preferred pressure range, and measures the pulse wave of the person to be measured with a fixed pressure on the measurement platform, so as to improve the accuracy of the measurement results and reduce the proportion of people who cannot be measured .
為達到上述創作目的，本發明提供一種血流動力學平臺量測方法，其方法的步驟包括：In order to achieve the above creation purpose, the present invention provides a hemodynamic platform measurement method, the steps of which method include:
量測平台量測脈搏波：將一電子血壓計的壓脈帶充氣至壓力介於55至70毫米汞柱的量測平台，以固定壓力在該量測平台保持一設定時間，對待測者進行脈搏波的量測，由量測到的多個脈搏波中擷取至少一脈搏波，各脈搏波的波形依時間順序具有最高點、最大斜率點、轉折點以及最低點等特徵點；Measuring platform to measure pulse wave: Inflate the cuff of an electronic sphygmomanometer to a measuring platform with a pressure between 55 and 70 mmHg, and maintain a fixed pressure on the measuring platform for a set period of time. The measurement of the pulse wave is to extract at least one pulse wave from the measured pulse waves, and the waveform of each pulse wave has characteristic points such as the highest point, the largest slope point, the turning point, and the lowest point in time order;
量測血壓：量測待測者血壓的收縮壓與舒張壓；以及Blood pressure measurement: measure the systolic and diastolic blood pressure of the subject; and
應用量測參數計算心搏量：以各脈搏波的波形與該波形各特徵點的參數配合收縮壓與舒張壓的數據計算心搏量。Calculation of heart stroke volume by using measurement parameters: Calculate heart stroke volume by using the waveform of each pulse wave and the parameters of each characteristic point of the waveform together with the data of systolic blood pressure and diastolic blood pressure.
進一步，本發明於該量測平台量測脈搏波的步驟之後，該電子血壓計保持該壓脈帶的壓力繼續向該壓脈帶充氣，對該待測者進行該量測血壓的步驟。Further, in the present invention, after the step of measuring the pulse wave by the measuring platform, the electronic sphygmomanometer maintains the pressure of the cuff and continues to inflate the cuff, and performs the step of measuring the blood pressure of the subject.
進一步，本發明該量測血壓的步驟先於該量測平台量測脈搏波的步驟，於該量測血壓的步驟完成後接著進行該量測平台量測脈搏波的步驟。Further, in the present invention, the step of measuring the blood pressure is prior to the step of measuring the pulse wave by the measuring platform, and the step of measuring the pulse wave by the measuring platform is performed after the step of measuring the blood pressure is completed.
更進一步，本發明進一步包括一量測心跳的步驟，量測待測者的心跳速率，並在該應用量測參數計算心搏量的步驟中，將心搏量乘以心跳速率得即得出待測者的心輸出量。Furthermore, the present invention further includes a step of measuring the heartbeat, measuring the heartbeat rate of the person to be tested, and in the step of calculating the stroke volume by applying the measured parameters, multiplying the stroke volume by the heartbeat rate to obtain The subject's cardiac output.
本發明量測脈搏波的量測平台為55至70毫米汞柱的適當區間，量測時能配合不同待測者的舒張壓、生理狀況與電子血壓計的信號品質來改變量測平台的壓力，讓各待測者能於適當的量測平台量測取得典型的脈搏波形，達到提高量測結果的準確度，降低無法量測人數的比例的功效。The measurement platform of the present invention for measuring the pulse wave is an appropriate interval of 55 to 70 mmHg, and the pressure of the measurement platform can be changed in accordance with the diastolic pressure, physiological condition and signal quality of the electronic sphygmomanometer of different subjects during the measurement , so that each person to be measured can measure and obtain a typical pulse waveform on an appropriate measurement platform, so as to improve the accuracy of the measurement results and reduce the proportion of the number of people who cannot be measured.
本發明的量測血壓步驟可以緊接量測平台量測脈搏波的步驟，也可以將此兩步驟分開在不同時間進行或前後順序對調進行，本發明的進一步功效在於，若是在量測平台量測脈搏波的步驟後緊接著對壓脈帶充氣，進行量測血壓步驟，則能在壓脈帶一次的充氣、洩氣的循環量測所需計算的脈搏波波形參數、心律與血壓，加快量測心搏量的效率。The step of measuring blood pressure in the present invention can be followed by the step of measuring the pulse wave on the measuring platform, or the two steps can be separated and performed at different times or reversed in sequence. The step of measuring the pulse wave is followed by inflating the cuff and measuring the blood pressure. Then the pulse wave waveform parameters, heart rate and blood pressure needed to be calculated can be measured in the cycle of inflating and deflating the cuff once, and the blood pressure can be accelerated. Efficiency in measuring stroke volume.
為能詳細瞭解本發明的技術特徵及實用功效，並可依照說明書的內容來實施，進一步以如圖式所示的較佳實施例，詳細說明如下。In order to understand the technical features and practical functions of the present invention in detail, and implement them according to the contents of the description, a preferred embodiment as shown in the drawings is further described in detail as follows.
如圖1所示的步驟流程圖，本發明的較佳實施例提供一種血流動力學平臺量測方法，其方法的步驟包括：As shown in the flow chart of steps in Figure 1, a preferred embodiment of the present invention provides a method for measuring a hemodynamic platform, the steps of which include:
（S01）量測平台量測脈搏波：如圖2所示，是將一電子血壓計的壓脈帶充氣至壓力介於55至70毫米汞柱（mmHg）的量測平台X，在本較佳實施例中，是選擇65毫米汞柱為量測平台X，以此65毫米汞柱的平台壓力在該量測平台X保持一設定時間，例如8秒，在此設定時間內對待測者進行脈搏波的量測；由量測到的連續多個脈搏波中擷取至少一脈搏波，在本較佳實施例中是擷取其中一具有典型波形的脈搏波，該脈搏波以橫軸為單位時間、縱軸為壓力繪製的波形如圖3所示，該脈搏波的波形前、後分為對應心臟收縮期與舒張期的主波A與重搏波B，並且依時間順序具有位於主波A頂端的最高點T sys、波形中斜率最大的最大斜率點T inst、位於主波A與重搏波B之間的轉折點T dic，以及位於重搏波B末端的最低點T dia等特徵點。 (S01) Measuring platform for measuring pulse wave: as shown in Figure 2, the cuff of an electronic sphygmomanometer is inflated to a measuring platform X with a pressure between 55 and 70 millimeters of mercury (mmHg). In a preferred embodiment, 65 mm Hg is selected as the measurement platform X, so that the platform pressure of 65 mm Hg is maintained on the measurement platform X for a set time, such as 8 seconds, and the subject to be tested is tested within this set time. Measurement of the pulse wave; at least one pulse wave is extracted from the measured continuous multiple pulse waves. In this preferred embodiment, one of the pulse waves with a typical waveform is extracted. The waveform drawn per unit time and the vertical axis as pressure is shown in Figure 3. The pulse wave is divided into the main wave A and the dicrotic wave B corresponding to the systole and diastole before and after the pulse wave. The highest point T sys at the top of wave A, the maximum slope point T inst with the largest slope in the waveform, the turning point T dic between main wave A and dicrotic wave B, and the lowest point T dia at the end of dicrotic wave B, etc. point.
所述典型的脈搏波是指主波A與重搏波B之間的轉折點T dic處具有明顯的轉折，當該電子血壓機的該壓脈帶選定的充氣壓力接近70毫米汞柱甚至超過70毫米汞柱的壓力時，該電子血壓機所量測的脈搏波的轉折點Tdic會逐漸趨於平緩接近曲線，此種變形的脈搏波不適合用於計算心輸出量（CO），而當壓脈帶充氣的壓力低於55毫米汞柱時，相關脈搏波的特徵點可能消失或者不明顯，增加計算後的誤差。 The typical pulse wave means that there is an obvious turning point at the turning point T dic between the main wave A and the dicrotic wave B. When the inflation pressure selected by the cuff of the electronic blood pressure machine is close to 70 mm Hg or even exceeds 70 mmHg pressure, the turning point Tdic of the pulse wave measured by the electronic blood pressure machine will gradually become gentle and close to the curve. This kind of deformed pulse wave is not suitable for calculating cardiac output (CO), and when the cuff When the inflation pressure is lower than 55 mmHg, the characteristic points of the relevant pulse wave may disappear or not be obvious, which increases the error after calculation.
（S02）量測血壓：在本較佳實施例中，如圖2、圖3所示，是於該量測平台X量測脈搏波的步驟之後，該電子血壓計保持該壓脈帶的壓力，也就是保持65毫米汞柱的壓力並繼續向該壓脈帶充氣，對該待測者進行該量測血壓的步驟，量測該待測者血壓的收縮壓與舒張壓，如本較佳實施例中量測到的收縮壓和舒張壓分別為106毫米汞柱以及68毫米汞柱。在其他的較佳實施例中可以先進行量測血壓的步驟再進行量測平台量測脈搏波，這時該量測血壓的步驟可以與該量測平台量測脈搏波的步驟接連進行或者間隔一段時間地分開進行；相對上來說，本較佳實施例接連進行量測平台量測脈搏波的步驟以及該量測血壓的步驟的優點在於可以於同次壓脈帶充氣、洩氣的循環量測得出心輸出量（CO），並且最大程度地避免量測血壓的壓脈帶壓力影響血管彈性使接著量測的脈搏波失真，但接連進行量測血壓的步驟與量測平台量測脈搏波的步驟也能有百分之八十以上的準確度。(S02) Blood pressure measurement: In this preferred embodiment, as shown in Figure 2 and Figure 3, after the step of measuring the pulse wave on the measuring platform X, the electronic sphygmomanometer maintains the pressure of the cuff , that is to maintain a pressure of 65 mm Hg and continue to inflate the cuff, carry out the step of measuring the blood pressure of the subject, measure the systolic blood pressure and diastolic blood pressure of the subject, as this is better The systolic blood pressure and diastolic blood pressure measured in the embodiment are 106 mmHg and 68 mmHg, respectively. In other preferred embodiments, the step of measuring blood pressure can be carried out first, and then the measuring platform can measure the pulse wave. At this time, the step of measuring blood pressure can be carried out successively or separated from the step of measuring the pulse wave by the measuring platform. The time is separated; relatively speaking, the advantage of this preferred embodiment of successively performing the step of measuring the pulse wave on the measurement platform and the step of measuring the blood pressure is that it can be measured in the same cycle of inflation and deflation of the cuff Cardiac output (CO), and to the greatest extent avoid measuring the pressure of the blood pressure cuff from affecting the elasticity of blood vessels and distorting the pulse wave to be measured next. The steps can also have an accuracy of more than 80%.
（S03）量測心跳：在本較佳實施例中，是在該量測血壓的步驟的過程中量測待測者的心跳速率（HR），量測得出的數值為71下/分。在其他的較佳實施例中，可以在該量測平台量測脈搏波的步驟過程中量測心跳速率，或者在其他時間量測心跳速率。( S03 ) Measuring the heartbeat: In this preferred embodiment, the heartbeat rate (HR) of the subject is measured during the step of measuring the blood pressure, and the measured value is 71 beats/minute. In other preferred embodiments, the heartbeat rate can be measured during the step of measuring the pulse wave by the measuring platform, or the heartbeat rate can be measured at other times.
（S04）應用量測參數計算心搏量：以該脈搏波的波形、該波形的最高點T sys、最大斜率點T inst、轉折點T dic，最低點T dia的參數，配合收縮壓與舒張壓的數據，代入心搏量計算公式計算心搏量（CO）。 (S04) Calculating heart stroke volume by using measurement parameters: using the waveform of the pulse wave, the highest point T sys of the waveform, the maximum slope point T inst , the turning point T dic , and the lowest point T dia parameters, in conjunction with systolic blood pressure and diastolic blood pressure Substituting the data into the stroke volume calculation formula to calculate the stroke volume (CO).
請參看圖3的脈搏波的波形圖，其橫座標為單位時間，縱座標的壓力以收縮壓106毫米汞柱與舒張壓68毫米汞柱的數據進行數據歸一化，橫座標的原點0秒為該脈搏波的起始點，處理過後的波形各特徵點的座標為：最高點T sys（P sys,t sys）為（0.144,106）、最大斜率點T inst（P inst,t inst）為（0.272,96）、轉折點T dic（P dic,t dic）為（0.344,89），最低點T dia（P dia,t dia）為（0.800,68），上述參數與數據代入心搏量計算公式與計算過程說明如下： Please refer to the waveform diagram of the pulse wave in Figure 3, the abscissa is unit time, the pressure on the ordinate is normalized with the data of systolic pressure 106 mm Hg and diastolic pressure 68 mm Hg, and the origin of the abscissa is 0 second is the starting point of the pulse wave, and the coordinates of each feature point of the processed waveform are: the highest point T sys (P sys , t sys ) is (0.144, 106), the maximum slope point T inst (P inst , t inst ) is (0.272,96), the turning point T dic (P dic ,t dic ) is (0.344,89), the lowest point T dia (P dia ,t dia ) is (0.800,68), the above parameters and data are substituted into the heartbeat The quantity calculation formula and calculation process are explained as follows:
如公式1所示，心搏量（SV）等於收縮期波形下的面積A除以血管截面瞬時加速度的倒數Z，本較佳實施例的A為10.1256；如公式4所示，時間常數τ為該脈搏波在舒張期時間的常數，以舒張期的脈搏波的波形以曲線趨近法得出數值，本較佳實施例的τ為0.20671，C為動脈順應性（Arterial compliance），是每單位壓力變化時造成體積的變化量，體現動脈血管的緩衝能力，可透過控制量測法或模型估測法獲得，由於健康人群於相同壓脈帶的電子血壓計配合相同壓力的量測平台X時的C值相近，因此將此數值設定為常數，例如本較佳實施例的C值為0.20671，每個人脈搏波形不同因此τ的數值各不相同，R為總周邊血管阻力（Total peripherial resistance），將前述τ與C代入公式4求出本較佳實施例的R為6.36157*10 -4。 As shown in Formula 1, the stroke volume (SV) is equal to the area A under the systolic waveform divided by the reciprocal Z of the instantaneous acceleration of the blood vessel section, and A in this preferred embodiment is 10.1256; as shown in Formula 4, the time constant τ is The constant of the pulse wave in the diastolic period is obtained from the waveform of the pulse wave in the diastolic period by the curve approach method. The τ of this preferred embodiment is 0.20671, and C is the arterial compliance (Arterial compliance), which is per unit The amount of volume change caused by pressure changes reflects the buffering capacity of arteries, which can be obtained through control measurement methods or model estimation methods. When the electronic sphygmomanometer of the same cuff and the measurement platform X of the same pressure are used by healthy people The value of C is similar, so this value is set as a constant. For example, the value of C in this preferred embodiment is 0.20671. The pulse waveform of each person is different, so the value of τ is different. R is the total peripheral vascular resistance (Total peripheral resistance), Substituting the aforementioned τ and C into formula 4, the R of this preferred embodiment is obtained as 6.36157*10 -4 .
將上述各特徵點的座標參數代入公式3，計算得出dP為277.25，計算式為：
將A、R與dP的數據代入公式2，得出心搏量SV（ml）為57.41，計算式為：
本發明除前述較佳實施例，是以其中一脈搏波的波形參數計算心搏量（SV）、心輸出量（CO）以外，也可以取兩個以上脈搏波的波形參數分別計算心搏量（SV）、心輸出量（CO）的數值，再取算數平均數提升計算的心搏量（SV）、心輸出量（CO）準確性。In addition to the above-mentioned preferred embodiment, the present invention calculates the stroke volume (SV) and cardiac output (CO) using one of the pulse wave waveform parameters, and can also calculate the heart stroke volume by taking two or more pulse wave waveform parameters. (SV) and cardiac output (CO) values, and then take the arithmetic mean to improve the accuracy of the calculated stroke volume (SV) and cardiac output (CO).
以上所述僅為本發明的較佳實施例而已，並非用以限定本發明主張的權利範圍，凡其它未脫離本發明所揭示的精神所完成的等效改變或修飾，均應包括在本發明的申請專利範圍內。The above descriptions are only preferred embodiments of the present invention, and are not intended to limit the scope of rights claimed by the present invention. All other equivalent changes or modifications that do not deviate from the spirit disclosed in the present invention should be included in the present invention. within the scope of the patent application.
A:主波 B:重搏波 T sys:最高點 T inst:最大斜率點 T dic:轉折點 T dia:最低點 τ:時間常數 X:量測平台 S01-S04:步驟 A: main wave B: dicrotic wave T sys : highest point T inst : maximum slope point T dic : turning point T dia : lowest point τ: time constant X: measurement platform S01-S04: steps
圖1是本發明較佳實施例的步驟流程圖。 圖2是本發明較佳實施例量測平台與血壓量測的壓力時間座標圖。 圖3是本發明較佳實施例的脈搏波波形的壓力時間座標圖。 Fig. 1 is a flowchart of the steps of the preferred embodiment of the present invention. Fig. 2 is a pressure-time coordinate diagram of the measurement platform and blood pressure measurement in a preferred embodiment of the present invention. Fig. 3 is a pressure-time coordinate diagram of the pulse waveform in a preferred embodiment of the present invention.
S01-S04:步驟 S01-S04: Steps
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