基于寸口脉搏波频谱分析的体外循环血液灌注效果研究
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摘要
目的:通过观察体外循环不同灌注模式寸口脉搏波频谱变化规律,建立基于"寸口"脉搏波监测的体外循环搏动灌注效果评价方法。方法:将92例需体外循环术治疗的心脏病患者按区组随机化分组方法分为搏动灌注组(PP组)和非搏动灌注组(NP组)各46例,应用PowerLab数据采集分析系统记录脉搏波指标,观察2组体外循环前、体外循环中脉搏波频域指标的变化。结果:PP组能检测到脉搏波,NP组未能检测到明显的脉搏波,脉搏波能量主要分布在0～5 Hz范围,PP组脉搏波能量显著高于NP组,PP组脉搏波能量传递的衰减度低于NP组;脉搏波传导的能量主要是低频能量,包含呼吸波的能量。结论:PP组能检测到寸口脉搏波,提示脉搏波可以作为体外循环搏动灌注的客观评价指标,搏动灌注产生的脉搏波能量高于非搏动灌注脉搏波能量,频域参数0～5 Hz谱能比值可以作为体外循环搏动灌注有效性的量化评价指标,低频的呼吸波参与脉搏波中的能量传递,佐证了中医诊脉独取手太阴肺经"寸口"的科学性。
Objective: By observing the changes of spectrum analysis and pulse wave index in different perfusion patterns in cardiopulmonary bypass( CPB),to establish the evaluation method of CPB pulsatile perfusion effect based on monitoring"Cunkou"pulse wave. Methods: 92 patients underwent open heart surgery were randomly divided into a pulsatile perfusion group( PP,n = 46) and a nonpulsatile perfusion group( NP,n = 46),recorded pulse wave index in " Cunkou" points,observed the changes of pulse wave spectrum indexes before and in vitro CPB in both groups by PowerLab 8/30 physiological system. Results: Patients in PP group were detected pulse wave in both " Cunkou" points,while patients in NP group were just found weak pulse wave in invasive side. Pulse wave energy was mainly distributed in the range of 0-5 Hz,which in PP group was significantly higher than that in NP group. Attenuation of pulse wave energy transfer in PP group was lower than that in NP group. Pulse wave energy was mainly low frequency energy,it contained the respiration wave energy. Conclusion: Pulsatile perfusion group were detected pulse wave in " Cunkou" point and pulse wave energy were significantly higher than that in nonpulsatile perfusion group,suggested the pulse wave can be used as an objective index to evaluate the effect of pulsatile perfusion in CPB. 0 ～ 5 Hz spectral energy ratio in pulse wave can be used as the quantitative evaluation index of the effectiveness of pulsatile perfusion in CPB. The low frequency breathing waves were involved in energy transfer in pulse wave,which was evidenced the scientific nature of traditional Chinese medical pulse diagnosis on taking " Cunkou" point in the lung meridian of hand-taiyin.
Objective: By observing the changes of spectrum analysis and pulse wave index in different perfusion patterns in cardiopulmonary bypass( CPB),to establish the evaluation method of CPB pulsatile perfusion effect based on monitoring"Cunkou"pulse wave. Methods: 92 patients underwent open heart surgery were randomly divided into a pulsatile perfusion group( PP,n = 46) and a nonpulsatile perfusion group( NP,n = 46),recorded pulse wave index in " Cunkou" points,observed the changes of pulse wave spectrum indexes before and in vitro CPB in both groups by PowerLab 8/30 physiological system. Results: Patients in PP group were detected pulse wave in both " Cunkou" points,while patients in NP group were just found weak pulse wave in invasive side. Pulse wave energy was mainly distributed in the range of 0-5 Hz,which in PP group was significantly higher than that in NP group. Attenuation of pulse wave energy transfer in PP group was lower than that in NP group. Pulse wave energy was mainly low frequency energy,it contained the respiration wave energy. Conclusion: Pulsatile perfusion group were detected pulse wave in " Cunkou" point and pulse wave energy were significantly higher than that in nonpulsatile perfusion group,suggested the pulse wave can be used as an objective index to evaluate the effect of pulsatile perfusion in CPB. 0 ～ 5 Hz spectral energy ratio in pulse wave can be used as the quantitative evaluation index of the effectiveness of pulsatile perfusion in CPB. The low frequency breathing waves were involved in energy transfer in pulse wave,which was evidenced the scientific nature of traditional Chinese medical pulse diagnosis on taking " Cunkou" point in the lung meridian of hand-taiyin.
引文
[1]刘樱,许家佗,李欣,等.“寸口”脉搏波图在体外循环搏动灌注中的应用[J].中华中医药杂志,2010,25(11):1866-1868.
[2]张志枫,全蝉兰,包怡敏,等.体外循环手术患者寸口脉搏波监测与分析[J].上海中医药杂志,2012,46(3):7-10.
[3]郭喆千,张志枫,许家佗,等.基于“寸口”脉搏波测控的体外循环搏动灌注模式探索[J].上海中医药杂志,2013,47(4):15-18.
[4]ZHIFENG ZHANG,JIATUO XU,ENYUAN ZHU,et al. Effect of pulsatile perfusionduring cardiopulmonary bypass in terms of radial artery sphygmogram[J].J Tradit chin med,2014,34(6):673-677.
[5]汤建国,张志枫,许家佗,等.基于脉搏波监测的体外循环搏动灌注效果评价研究[J].上海中医药杂志,2015,49(7):11-15.
[6]SHEPARD RB,SIMPSON DC,SHARP JF,et al. Energy equivalent pressure[J].Arch Surg,1966,93(11):730-740.
[7]TATLOR KM. Cardiopulmonary Bypass[M]. London:Chapman and Hall,1986:85-111.
[8]GRAVLEE GP. Cardiopulmonary Bypass[M]. Baltimore:Williams&Wilkins,1993:323-340.
[9]TAYLOR KM,BAIN WH,MAXTED KJ,et al. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass.I. Pulsatile system employed and its hematologic effects[J].J Thorac Cardiovasc Surg,1978,75(4):569-573.
[10]TAYLOR KM..Cardiopulmonary Bypass[M].Baltimore:Williams&Wilkins,1986:85-114.
[11]MATSUMOTO T,WOLFERTH CC JR,PERLMAN MH. Effects of pulsatile and non-pulsatile perfusion upon cerebral and conjunctival microcirculation in dogs[J]. Am Surg,1971,37(2):61-64.
[12]PHILBIN DM,LEVINE FH,KONO K,et al. Attenuation of the stress response to cardiopulmonary bypass by the addition of pulsatile flow[J]. Circulation,1981,64(4):808-812.
[13]TAYLOR KM,BAIN WH,MORTON JJ.The role of angiotensin II in the development of peripheral vasoconstriction during openheart surgery[J]. Am Heart J,1980,100(6):935-937.
[14]NDAR A,MASAI T,YANG SQ,et al. Global and regional cerebral blood flow in neonatal piglets undergoing pulsatile cardiopulmonary bypass with continuous perfusion at 25 degrees C and circulatory arrest at 18 degrees C[J]. Perfusion,2001,16(6):503-510.
[15]HASHIMOTO K, ONOGUCHI K, TAKAKURA H, et al.Beneficial effect of balloon-induced pulsatility on brain oxygenation in hypothermic cardiopulmonary bypass[J]. J Cardiovasc Surg(Torino),2001,42(5):587-593.
[16]NDAR A,EICHSTAEDT HC,FRAZIER OH,et al. Monitoring regional cerebral oxygen saturation using near-infrared spectroscopy during pulsatile hypothermic cardiopulmonary bypass in a neonatal piglet model[J]. ASAIO J,2000,46(1):103-106.
[17]MUTCH WA,WARRIAN RK,ESCHUN GM,et al. Biologically variable pulsation improves jugular venous oxygen saturation during rewarming[J]. Ann Thorac Surg,2000,69(2):491-497.
[18]GU YJ,DE KROON TL,ELSTRODT JM,et al.Augmentation of abdominal organ perfusion during cardiopulmonary bypass with a novel intra-aortic pulsatile catheter pump[J]. Int J Artif Organs,2005,28(1):35-43.
[19]MORI A, TABATA R, NAKAMURA Y, et al. Effects of pulsatile cardiopulmonary bypass on carbohydrate and lipid metabolism[J]. J Cardiovasc Surg,1987,28(6):621-626.
[20]MURRAY WR,MITTRA S,MITTRA D,et al. The amylasecreatinine clearance ratio following cardiopulmonary bypass[J]. J Thorac Cardiovasc Surg,1981,82(2):248-253.
[21]NAGAOKA H,INNAMI R,WATANABE M,et al.Preservation of pancreatic beta cell function with pulsatile cardiopulmonary bypass[J].Ann Thorac Surg,1989,48(6):798-802.
[22]NDAR A,MASAI T,BEYER EA,et al. Pediatric physiologic pulsatile pump enhances cerebral and renal blood flow during and after cardiopulmonary bypass[J]. Artif Organs,2002,26(11):919-923.
[23]KIM HK,SON HS,FANG YH,et al.The effects of pulsatile flow upon renal tissue perfusion during cardiopulmonary bypass:A comparative study of pulsatile and nonpulsatile flow[J]. ASAIO J,2005,51(1):30-36.
[24]OHRI SK, BOWLES CW, MATHIE RT, et al. Effect of cardiopulmonary bypass perfusion protocols on gut tissue oxygenation and blood flow[J]. Ann Thorac Surg,1997,64(1):163-170.
[25]ALKAN T,AKCEVIN A,NDAR A,et al. Benefits of Pulsatile Perfusion on Vital Organ Recovery During and After Pediatric Open Heart Surgery[J]. ASAIO Journal,2007,53(6):651-654.
[26]AKEVIN A,ALKAN-BOZKAYA T,QIU F,et al. Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass[J]. Artificial Organs,2010,34(11):879-884.
[27]NEUHOF C,WENDLING J,DAPPER F,et al. Endotoxemia and cytokine generation in cardiac surgery in relation to flow mode and duration of cardiopulmonary bypass[J]. Shock,2001,1(16Suppl):39-43.
[28]VEDRINNE C, TRONC F, MARTINOT S, et al. Better preservation of endothelial function and decreased activation of the fetal reninangiotensin pathway with the use of pulsatile flow during experimental fetal bypass[J]. J Thorac Cardiovasc Surg,2000,120(4):770-777.
[29]JU ZHAO,JIN-PING LIU,ZHENG-YI FENG,et al. Clinical Application of Pulsatile Perfusion During Cardiopulmonary Bypass In Pediatric Heart Surgery[J]. ASAIO Journal,2009,55(3):300-303.
[30]NDAR A,JI B.An Evaluation of the Benefits of Pulsatile versus Non-Pulsatile Perfusion during Cardiopulmonary Bypass Procedures in Pediatric and adult Cardiac Patients[J]. ASAIO Jounal,2006,52(4):357-361.
[31]张治国.脉诊信息分析和识别方法评析[J].中国中医药信息杂志,2010,17(8):109-112.
[32]瞿岳云,孙智山,顾星,等.冠心病心绞痛脉象脉图与证素相关性临床研究[J].湖南中医学院学报,2006,26(1):31-33.
[33]马科,保婧,江启中.中风证脉图参数变化分析[J].宁夏医学院学报,2007,29(3):283-286.
[34]刘艳玲,杨其华,史红斐,等.基于小波变换的心脑血管疾病脉搏信号分析方法[J].工业控制计算机,2009,22(11):108-109.
[35]太加斌,朱德增,凌昌全.原发性肝癌患者脉图变化特点及其机理分析[J].广州中医药大学学报,2007,24(4):263-267.
[36]许家佗,张志枫,孙鸿杰,等.力竭性运动前后的脉图观察研究[J].中国运动医学杂志,2002,21(1):44-47.
[37]费兆馥.亚健康状态的主要生理指标及图像法综合评估[J].上海中医药大学学报,2008,22(4):6-11.
[38]费兆馥.现代中医脉诊学[M].北京:人民卫生出版社,2003:224-225.
[39]王明三.“独取寸口”现代认识[J].山东中医杂志,2007,26(11):739-740.
[40]张志枫,李欣,许家佗,等.“寸口”脉搏波图在体外循环搏动灌注质量控制中的应用[J].上海中医药杂志,2009,43(2):42-46.
[2]张志枫,全蝉兰,包怡敏,等.体外循环手术患者寸口脉搏波监测与分析[J].上海中医药杂志,2012,46(3):7-10.
[3]郭喆千,张志枫,许家佗,等.基于“寸口”脉搏波测控的体外循环搏动灌注模式探索[J].上海中医药杂志,2013,47(4):15-18.
[4]ZHIFENG ZHANG,JIATUO XU,ENYUAN ZHU,et al. Effect of pulsatile perfusionduring cardiopulmonary bypass in terms of radial artery sphygmogram[J].J Tradit chin med,2014,34(6):673-677.
[5]汤建国,张志枫,许家佗,等.基于脉搏波监测的体外循环搏动灌注效果评价研究[J].上海中医药杂志,2015,49(7):11-15.
[6]SHEPARD RB,SIMPSON DC,SHARP JF,et al. Energy equivalent pressure[J].Arch Surg,1966,93(11):730-740.
[7]TATLOR KM. Cardiopulmonary Bypass[M]. London:Chapman and Hall,1986:85-111.
[8]GRAVLEE GP. Cardiopulmonary Bypass[M]. Baltimore:Williams&Wilkins,1993:323-340.
[9]TAYLOR KM,BAIN WH,MAXTED KJ,et al. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass.I. Pulsatile system employed and its hematologic effects[J].J Thorac Cardiovasc Surg,1978,75(4):569-573.
[10]TAYLOR KM..Cardiopulmonary Bypass[M].Baltimore:Williams&Wilkins,1986:85-114.
[11]MATSUMOTO T,WOLFERTH CC JR,PERLMAN MH. Effects of pulsatile and non-pulsatile perfusion upon cerebral and conjunctival microcirculation in dogs[J]. Am Surg,1971,37(2):61-64.
[12]PHILBIN DM,LEVINE FH,KONO K,et al. Attenuation of the stress response to cardiopulmonary bypass by the addition of pulsatile flow[J]. Circulation,1981,64(4):808-812.
[13]TAYLOR KM,BAIN WH,MORTON JJ.The role of angiotensin II in the development of peripheral vasoconstriction during openheart surgery[J]. Am Heart J,1980,100(6):935-937.
[14]NDAR A,MASAI T,YANG SQ,et al. Global and regional cerebral blood flow in neonatal piglets undergoing pulsatile cardiopulmonary bypass with continuous perfusion at 25 degrees C and circulatory arrest at 18 degrees C[J]. Perfusion,2001,16(6):503-510.
[15]HASHIMOTO K, ONOGUCHI K, TAKAKURA H, et al.Beneficial effect of balloon-induced pulsatility on brain oxygenation in hypothermic cardiopulmonary bypass[J]. J Cardiovasc Surg(Torino),2001,42(5):587-593.
[16]NDAR A,EICHSTAEDT HC,FRAZIER OH,et al. Monitoring regional cerebral oxygen saturation using near-infrared spectroscopy during pulsatile hypothermic cardiopulmonary bypass in a neonatal piglet model[J]. ASAIO J,2000,46(1):103-106.
[17]MUTCH WA,WARRIAN RK,ESCHUN GM,et al. Biologically variable pulsation improves jugular venous oxygen saturation during rewarming[J]. Ann Thorac Surg,2000,69(2):491-497.
[18]GU YJ,DE KROON TL,ELSTRODT JM,et al.Augmentation of abdominal organ perfusion during cardiopulmonary bypass with a novel intra-aortic pulsatile catheter pump[J]. Int J Artif Organs,2005,28(1):35-43.
[19]MORI A, TABATA R, NAKAMURA Y, et al. Effects of pulsatile cardiopulmonary bypass on carbohydrate and lipid metabolism[J]. J Cardiovasc Surg,1987,28(6):621-626.
[20]MURRAY WR,MITTRA S,MITTRA D,et al. The amylasecreatinine clearance ratio following cardiopulmonary bypass[J]. J Thorac Cardiovasc Surg,1981,82(2):248-253.
[21]NAGAOKA H,INNAMI R,WATANABE M,et al.Preservation of pancreatic beta cell function with pulsatile cardiopulmonary bypass[J].Ann Thorac Surg,1989,48(6):798-802.
[22]NDAR A,MASAI T,BEYER EA,et al. Pediatric physiologic pulsatile pump enhances cerebral and renal blood flow during and after cardiopulmonary bypass[J]. Artif Organs,2002,26(11):919-923.
[23]KIM HK,SON HS,FANG YH,et al.The effects of pulsatile flow upon renal tissue perfusion during cardiopulmonary bypass:A comparative study of pulsatile and nonpulsatile flow[J]. ASAIO J,2005,51(1):30-36.
[24]OHRI SK, BOWLES CW, MATHIE RT, et al. Effect of cardiopulmonary bypass perfusion protocols on gut tissue oxygenation and blood flow[J]. Ann Thorac Surg,1997,64(1):163-170.
[25]ALKAN T,AKCEVIN A,NDAR A,et al. Benefits of Pulsatile Perfusion on Vital Organ Recovery During and After Pediatric Open Heart Surgery[J]. ASAIO Journal,2007,53(6):651-654.
[26]AKEVIN A,ALKAN-BOZKAYA T,QIU F,et al. Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass[J]. Artificial Organs,2010,34(11):879-884.
[27]NEUHOF C,WENDLING J,DAPPER F,et al. Endotoxemia and cytokine generation in cardiac surgery in relation to flow mode and duration of cardiopulmonary bypass[J]. Shock,2001,1(16Suppl):39-43.
[28]VEDRINNE C, TRONC F, MARTINOT S, et al. Better preservation of endothelial function and decreased activation of the fetal reninangiotensin pathway with the use of pulsatile flow during experimental fetal bypass[J]. J Thorac Cardiovasc Surg,2000,120(4):770-777.
[29]JU ZHAO,JIN-PING LIU,ZHENG-YI FENG,et al. Clinical Application of Pulsatile Perfusion During Cardiopulmonary Bypass In Pediatric Heart Surgery[J]. ASAIO Journal,2009,55(3):300-303.
[30]NDAR A,JI B.An Evaluation of the Benefits of Pulsatile versus Non-Pulsatile Perfusion during Cardiopulmonary Bypass Procedures in Pediatric and adult Cardiac Patients[J]. ASAIO Jounal,2006,52(4):357-361.
[31]张治国.脉诊信息分析和识别方法评析[J].中国中医药信息杂志,2010,17(8):109-112.
[32]瞿岳云,孙智山,顾星,等.冠心病心绞痛脉象脉图与证素相关性临床研究[J].湖南中医学院学报,2006,26(1):31-33.
[33]马科,保婧,江启中.中风证脉图参数变化分析[J].宁夏医学院学报,2007,29(3):283-286.
[34]刘艳玲,杨其华,史红斐,等.基于小波变换的心脑血管疾病脉搏信号分析方法[J].工业控制计算机,2009,22(11):108-109.
[35]太加斌,朱德增,凌昌全.原发性肝癌患者脉图变化特点及其机理分析[J].广州中医药大学学报,2007,24(4):263-267.
[36]许家佗,张志枫,孙鸿杰,等.力竭性运动前后的脉图观察研究[J].中国运动医学杂志,2002,21(1):44-47.
[37]费兆馥.亚健康状态的主要生理指标及图像法综合评估[J].上海中医药大学学报,2008,22(4):6-11.
[38]费兆馥.现代中医脉诊学[M].北京:人民卫生出版社,2003:224-225.
[39]王明三.“独取寸口”现代认识[J].山东中医杂志,2007,26(11):739-740.
[40]张志枫,李欣,许家佗,等.“寸口”脉搏波图在体外循环搏动灌注质量控制中的应用[J].上海中医药杂志,2009,43(2):42-46.
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