基于脉搏波分析的麻醉手术中无创生理参数监测系统
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摘要
麻醉手术中的低血压及伤害感受的监测及预测是非常重要的,它可以帮助麻醉医生及时了解病人生理状态的变化。目前市场上已有的麻醉监测设备大多只能提供简单的测量参数显示和报警功能,这些设备中的参数虽多,但却没有建立起这些参数与生理状态之间的联系,也就难以发挥麻醉医生们的主观能动性。随着近几十年来对光电容积脉搏波(PPG)所做的大量临床研究,PPG已被广泛的用于麻醉生理参数监测,该方法安全无创、可靠性高,所以本论文根据PPG研究的生理学基础,设计了基于PPG的麻醉手术中无创生理参数监测系统。
本论文的主要研究工作如下：
1.设计了基于光电容积脉搏波的麻醉手术中无创生理参数监测系统,可以完成麻醉过程相关的心率(HR)、血氧饱和度(SpO2)、收缩压、舒张压、平均压、脉搏波传导时间(PTT)、衰减时间常数(RC)、光电容积脉搏波幅度(PPGA)、下降支面积比(ARD)等参数的同步实时监测。其中,RC和ARD均为本系统所独有的生理参数。
2.设计实现了以nRF24L01模块为核心的低功耗无线传输方案。该方案以nRF系列芯片内嵌的Enhanced ShockBurst协议为基础,设计开发了短距离无线传输网络协议(NWSN),实现了数据传输的低功耗。该方案与载波监听多路访问协议(CSMA)相比,极大地降低了数据收发的电流,总功耗约为后者的1/3。同时该方案利用了无线天然无漏电流、无需隔离的特点,节省了硬件成本,降低了设计复杂度。
3.提出了麻醉监测过程中脉搏波传导时间变异性(PTTV)的分析算法,并首次将其应用于麻醉手术中无创生理参数监测系统。本论文提出了一个新的光电容积脉搏波(PPG)信号特征点检测算法。此算法主要采用窗口化的局部查找方法,再与一阶导数和逻辑判断相结合来检测特征点。当接受区间为24.0ms时,该算法的检出率高于95%。由心电图(ECG)信号的R波和PPG信号的P波位置可以计算得到PTT,进而将其作为PTTV的原始输入,采用自回归(AR)模型建立PTTV分析算法。
4.首次将PTTV分析方法应用于麻醉低血压研究。在浙江大学医学院附属妇产科医院，经过24例临床实验,结果表明,甚低频与低频功率的比值(VLF/LF)以及低频功率与总功率的比值(LF/ALL)这两个参数的P值分别为：PVLf/LF=0.028、PLF/ALL=0.031,说明这两个参数在低血压组与正常组中有明显差异，具有预测麻醉低血压发生的可行性。
该系统被应用于麻醉低血压及伤害感受的临床研究,初步实现了对低血压及伤害感受的有效评估。本论文所设计之系统严格按照国家相关标准要求开发,具有很好的临床应用前景。
Hypotension and nociceptive monitoring in anesthesia is very important, which can help the anesthesiologist to keep abreast of changes in the patient's physiological state. Anesthesia monitoring equipments on the market are mostly only able to provide some simple parameters and alarm functions, which did not establish the link between parameters and physiological states. So it is difficult to play the subjective initiative of anesthesia doctors. In recent decades, a large number of clinical studies about photoplethysmography (PPG) were done, PPG has been extensive used in anesthesia physiological parameters monitoring. Based on these studies, a non-invasive physiological parameters monitoring system is designed.
The main research works are as follows:
A. A non-invasive physiological parameters monitoring system during anesthesia based on photoplethysmography is designed, which can monitor heart rate, oxygen saturation, systolic pressure, diastolic pressure, mean pressure, pulse wave conduction time, decay time constant. PPG amplitude, area ratio of descending limb and other parameters in the same time. Especially, decay time constant and area ratio of descending limb are the unique physiological parameters in this system.
B. A low power wireless transmission scheme based on nRF24L01module is designed. The scheme uses a wireless network protocol base on Enhanced ShockBurst. which is an on-chip Agreement of nRF series, to achieve low-power data transmission. The scheme greatly reduceed the current of the data sent and received. The total power consumption is about1/3of the carrier sense multiple access protocol (CSMA). The same time, because there is no leak current through wireless, so the scheme saved the hardware costs and reduced the design complexity.
C. A algorithm about monitoring pulse transmit time variability (PTTV) during anesthesia is proposed, which is applied to non-invasive physiological parameters monitoring system during anesthesia at the first time. Meanwhile, a new PPG signal feature detection algorithm is also proposed. This algorithm is the combination of the local search method in main window and first order derivative with logical judgment. When the acceptance interval is24.0ms. the detection rate of this algorithm is higher than95%. Pulse transmit time(PTT) can be calculated by the P wave position of PPG signal and the R wave position of electrocardiogram (ECG) signal, which is the original input of PTTV analysis algorithm. Finally, an auto regressive model is used in this algorithm. The algorithm has a reliable performance after the experiments.
D. The PTTV analysis method is the first time used in hypotension research during anesthesia.24cases of clinical trials have been done in Women's Hospital School of Medicine Zhejiang University. The results showed that the P value of the ratio of very low frequency power and low frequency power (VLF/LF) and the ratio of low-frequency power and total power (LF ALL) were:PVLF/LF=0.028. PLF/ALL=0.031. which indicates that these parameters have feasibility of anesthesia hypotension prediction.
The system was used in clinical research about hypotension and nociceptive during anesthesia, which realized the effective assessment of hypotension and nociceptive preliminarily. The system is strictly in accordance with the relevant national standards, and it also has high reliability and good prospects for clinical application.
本论文的主要研究工作如下：
1.设计了基于光电容积脉搏波的麻醉手术中无创生理参数监测系统,可以完成麻醉过程相关的心率(HR)、血氧饱和度(SpO2)、收缩压、舒张压、平均压、脉搏波传导时间(PTT)、衰减时间常数(RC)、光电容积脉搏波幅度(PPGA)、下降支面积比(ARD)等参数的同步实时监测。其中,RC和ARD均为本系统所独有的生理参数。
2.设计实现了以nRF24L01模块为核心的低功耗无线传输方案。该方案以nRF系列芯片内嵌的Enhanced ShockBurst协议为基础,设计开发了短距离无线传输网络协议(NWSN),实现了数据传输的低功耗。该方案与载波监听多路访问协议(CSMA)相比,极大地降低了数据收发的电流,总功耗约为后者的1/3。同时该方案利用了无线天然无漏电流、无需隔离的特点,节省了硬件成本,降低了设计复杂度。
3.提出了麻醉监测过程中脉搏波传导时间变异性(PTTV)的分析算法,并首次将其应用于麻醉手术中无创生理参数监测系统。本论文提出了一个新的光电容积脉搏波(PPG)信号特征点检测算法。此算法主要采用窗口化的局部查找方法,再与一阶导数和逻辑判断相结合来检测特征点。当接受区间为24.0ms时,该算法的检出率高于95%。由心电图(ECG)信号的R波和PPG信号的P波位置可以计算得到PTT,进而将其作为PTTV的原始输入,采用自回归(AR)模型建立PTTV分析算法。
4.首次将PTTV分析方法应用于麻醉低血压研究。在浙江大学医学院附属妇产科医院，经过24例临床实验,结果表明,甚低频与低频功率的比值(VLF/LF)以及低频功率与总功率的比值(LF/ALL)这两个参数的P值分别为：PVLf/LF=0.028、PLF/ALL=0.031,说明这两个参数在低血压组与正常组中有明显差异，具有预测麻醉低血压发生的可行性。
该系统被应用于麻醉低血压及伤害感受的临床研究,初步实现了对低血压及伤害感受的有效评估。本论文所设计之系统严格按照国家相关标准要求开发,具有很好的临床应用前景。
Hypotension and nociceptive monitoring in anesthesia is very important, which can help the anesthesiologist to keep abreast of changes in the patient's physiological state. Anesthesia monitoring equipments on the market are mostly only able to provide some simple parameters and alarm functions, which did not establish the link between parameters and physiological states. So it is difficult to play the subjective initiative of anesthesia doctors. In recent decades, a large number of clinical studies about photoplethysmography (PPG) were done, PPG has been extensive used in anesthesia physiological parameters monitoring. Based on these studies, a non-invasive physiological parameters monitoring system is designed.
The main research works are as follows:
A. A non-invasive physiological parameters monitoring system during anesthesia based on photoplethysmography is designed, which can monitor heart rate, oxygen saturation, systolic pressure, diastolic pressure, mean pressure, pulse wave conduction time, decay time constant. PPG amplitude, area ratio of descending limb and other parameters in the same time. Especially, decay time constant and area ratio of descending limb are the unique physiological parameters in this system.
B. A low power wireless transmission scheme based on nRF24L01module is designed. The scheme uses a wireless network protocol base on Enhanced ShockBurst. which is an on-chip Agreement of nRF series, to achieve low-power data transmission. The scheme greatly reduceed the current of the data sent and received. The total power consumption is about1/3of the carrier sense multiple access protocol (CSMA). The same time, because there is no leak current through wireless, so the scheme saved the hardware costs and reduced the design complexity.
C. A algorithm about monitoring pulse transmit time variability (PTTV) during anesthesia is proposed, which is applied to non-invasive physiological parameters monitoring system during anesthesia at the first time. Meanwhile, a new PPG signal feature detection algorithm is also proposed. This algorithm is the combination of the local search method in main window and first order derivative with logical judgment. When the acceptance interval is24.0ms. the detection rate of this algorithm is higher than95%. Pulse transmit time(PTT) can be calculated by the P wave position of PPG signal and the R wave position of electrocardiogram (ECG) signal, which is the original input of PTTV analysis algorithm. Finally, an auto regressive model is used in this algorithm. The algorithm has a reliable performance after the experiments.
D. The PTTV analysis method is the first time used in hypotension research during anesthesia.24cases of clinical trials have been done in Women's Hospital School of Medicine Zhejiang University. The results showed that the P value of the ratio of very low frequency power and low frequency power (VLF/LF) and the ratio of low-frequency power and total power (LF ALL) were:PVLF/LF=0.028. PLF/ALL=0.031. which indicates that these parameters have feasibility of anesthesia hypotension prediction.
The system was used in clinical research about hypotension and nociceptive during anesthesia, which realized the effective assessment of hypotension and nociceptive preliminarily. The system is strictly in accordance with the relevant national standards, and it also has high reliability and good prospects for clinical application.
引文
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