脉搏波信号处理方法和临床实验研究
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摘要
近代,人们的物质生活变得越来粤丰厚,生活方式和饮食结构发生了越来越大的变化。同时,人类因各类疾病死亡率也越来越高。其中心脑血管类疾病严重地危害着人类的健康,是造成死亡的主要原因之一。高血压的致心脑血管病死亡率在各种疾病中高居首位,严重威胁着人类的生命健康,被称为“无形杀手”!近年来我国成年人发病率不断上升,达到了11.88%左右!我国目前高血压病患者已逾一亿。在高血压诊治方面,存在着“三高”——高发病率,高复发率,高致残率,“三低”——知晓率低,诊断率低,治疗率低。高血压病的严重并发症--高血压性心脏病、中风、心肌梗塞等更是极大地危害着人类。而我国高血压病人血压满意控制率不足5%!因此,专家指出高血压病的防治是防疗并重,防大于治!
研究表明:在当前的心血管状态检测技术中,普遍存在有创和可操作性差的问题,同时高昂的费用限制了患者或潜在发病者的预防性检测和及时就诊。因此研发和实现一个血压和心血管状态的安全、准确、方便且经济的检测方法,成为防治心血管病的当务之急。
本论文主要涉及以下六个方面的工作:
①查阅相关理论基础资料,研究示波法原理、弹性腔模型、脉搏波理论。
②研究血管硬度测量仪的硬件总体设计方案。
③在脉搏波速度检测方面,介绍了脉搏波速度的理论研究公式,总结了目前常用的测量方法及其各自的优缺点,着重介绍了两点无创测量脉搏波速度的方法,结合示波法原理提出了一种新的测量脉搏波速度的方法——双袖带法,该方法能够简捷、快速,并且准确可靠地测量脉搏波速度。
④在动脉顺应性检测方面,研究了其理论基础,在平面压力波法和压力振荡波分析法的基础上提出了压力曲线拟和法。临床结果证明了此测量方法的可靠性和有效性。
⑤用LABView语言编写了软件系统,实现了计算机与单片机数据的实时通讯、数据信号的预处理、各心血管参数的分析计算、测试结果的保存打印等功能。
⑥进行临床测试,用社会科学统计软件包(SPSS11.5)对测量结果进行分组对比分析,验证算法的有效性并改进之。
Recently,the material life of people is getting richer more and more, the fashion of life and the structure of bite and sup has changed a lot. Simultaneously, the death ratio of kinds of diseases ascends greatly, among which heart and brain vascular disease is the main reason for people’s death and are endangering human’s health heavily. The death ratio of hypertension places first in all the heart and brain diseases, thus, hypertension is names as“immaterial killer”of human health!The incidence of hypertension in adult, which has reached about 11.88%, has been boosting in china recently. The number of hypertension has passed 100 million. There are many problems in Hypertension’s diagnosis and treatment, such as three highness problem—high incidence, high recrudesce rate and high lameness rate, three lowness—low discover rate, low diagnosis rate and low cure rate. Hypertension’s syndrome, such as heart disease for hypertension, apoplexy and miocardial infarction etc are endangering human heavily. The satisfying controlling rate of hypertension in our country is less than 5%! Therefore, experts indicate that we should attach greater importance to the prevention than the treatment of hypertension.
However, all the current cardiovascular state monitoring technology is invasive and not easy to operate, and their high cost restrict potential suffers’in-time detection which can forecast the trend of cardiovascular diseases’occurance. Therefore, seeking one safe, accurate, convenient and economical monitoring algorithm has become one important task in urgent affairs.
This paper mainly involved six aspects work as follows:
①Study the oscillometric method, the Windkessel theory and the pulse wave’s transmission theory according to collected academic information,
②Design the hardware project as a whole for the measurement instrument of vascular rigidity.
③In the aspect of measuring pulse wave velocity, we summarized its normal noninvasive methods and their characteristics, on the base of which we propose a new method—double-cuff method, which has the advantages of simplicity, convenience and high speed. Clinical result indicates that the double-cuff method can measure pulse wave velocity accurately and reliably.
④Before measuring arterial compliance, we studied its academic foundation and introduced its normal method-- plane pressure wave method and pressure oscillometric analysis method, on the base of which we proposed pressure curve imitation method and apply it to measure arterial compliance in clinical tests. Clinical result indicates that this method’s accuration and reliability.
⑤We code the software system on the software plane LABView and has completed its real-time communication, pulse wave signal’s pre-treatment, the haemodynamics parameters’analyse and calculation, the results’saving and printing, etc.
⑥Additionally, we have arranged clinical tests and analysed the data by group by the software Statistics Processing of Social Science (SPSS) to validate and improve the algorithm.
研究表明:在当前的心血管状态检测技术中,普遍存在有创和可操作性差的问题,同时高昂的费用限制了患者或潜在发病者的预防性检测和及时就诊。因此研发和实现一个血压和心血管状态的安全、准确、方便且经济的检测方法,成为防治心血管病的当务之急。
本论文主要涉及以下六个方面的工作:
①查阅相关理论基础资料,研究示波法原理、弹性腔模型、脉搏波理论。
②研究血管硬度测量仪的硬件总体设计方案。
③在脉搏波速度检测方面,介绍了脉搏波速度的理论研究公式,总结了目前常用的测量方法及其各自的优缺点,着重介绍了两点无创测量脉搏波速度的方法,结合示波法原理提出了一种新的测量脉搏波速度的方法——双袖带法,该方法能够简捷、快速,并且准确可靠地测量脉搏波速度。
④在动脉顺应性检测方面,研究了其理论基础,在平面压力波法和压力振荡波分析法的基础上提出了压力曲线拟和法。临床结果证明了此测量方法的可靠性和有效性。
⑤用LABView语言编写了软件系统,实现了计算机与单片机数据的实时通讯、数据信号的预处理、各心血管参数的分析计算、测试结果的保存打印等功能。
⑥进行临床测试,用社会科学统计软件包(SPSS11.5)对测量结果进行分组对比分析,验证算法的有效性并改进之。
Recently,the material life of people is getting richer more and more, the fashion of life and the structure of bite and sup has changed a lot. Simultaneously, the death ratio of kinds of diseases ascends greatly, among which heart and brain vascular disease is the main reason for people’s death and are endangering human’s health heavily. The death ratio of hypertension places first in all the heart and brain diseases, thus, hypertension is names as“immaterial killer”of human health!The incidence of hypertension in adult, which has reached about 11.88%, has been boosting in china recently. The number of hypertension has passed 100 million. There are many problems in Hypertension’s diagnosis and treatment, such as three highness problem—high incidence, high recrudesce rate and high lameness rate, three lowness—low discover rate, low diagnosis rate and low cure rate. Hypertension’s syndrome, such as heart disease for hypertension, apoplexy and miocardial infarction etc are endangering human heavily. The satisfying controlling rate of hypertension in our country is less than 5%! Therefore, experts indicate that we should attach greater importance to the prevention than the treatment of hypertension.
However, all the current cardiovascular state monitoring technology is invasive and not easy to operate, and their high cost restrict potential suffers’in-time detection which can forecast the trend of cardiovascular diseases’occurance. Therefore, seeking one safe, accurate, convenient and economical monitoring algorithm has become one important task in urgent affairs.
This paper mainly involved six aspects work as follows:
①Study the oscillometric method, the Windkessel theory and the pulse wave’s transmission theory according to collected academic information,
②Design the hardware project as a whole for the measurement instrument of vascular rigidity.
③In the aspect of measuring pulse wave velocity, we summarized its normal noninvasive methods and their characteristics, on the base of which we propose a new method—double-cuff method, which has the advantages of simplicity, convenience and high speed. Clinical result indicates that the double-cuff method can measure pulse wave velocity accurately and reliably.
④Before measuring arterial compliance, we studied its academic foundation and introduced its normal method-- plane pressure wave method and pressure oscillometric analysis method, on the base of which we proposed pressure curve imitation method and apply it to measure arterial compliance in clinical tests. Clinical result indicates that this method’s accuration and reliability.
⑤We code the software system on the software plane LABView and has completed its real-time communication, pulse wave signal’s pre-treatment, the haemodynamics parameters’analyse and calculation, the results’saving and printing, etc.
⑥Additionally, we have arranged clinical tests and analysed the data by group by the software Statistics Processing of Social Science (SPSS) to validate and improve the algorithm.
引文
[1] 王宏宇,倪永斌,龚兰生,张维忠,胡大一.老年高血压患者大动脉弹性研究.中国老年学杂志,2003,23:11-13
[2] Cohn J, Finkelstein S, McVeigh G. Noninvasive pulse wave analysis for the early detection of the vascular disease[J] .Hypertens,1993,26 (3): 503-508
[3] 王宏宇,张维思,龚兰生等.高血压合并动脉粥样硬化与大动脉缓冲功能关系的研究[J] .中华心血管病杂志,2001,4(29):206～209
[4] 柳兆荣.桡动脉压力波随生理参数的变化.力学学报,1982,(3):244～250
[5] 柳兆荣.关于脉图的分析.中国科学(B 辑),1983, 2:131～138
[6] 柳兆荣.心血管流体力学.复旦大学出版社,1986 年
[7] Masanorl M,Nobuhoko I,Tohru N,et al. Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens ,2003,16:653-657
[8] 王炳和,杨禺页.一种无创测定桡动脉脉搏波速度的方法及影响脉搏波速度的因素.生物医学工程学杂志,2000,17(2):179-182
[9] 罗志昌,张松,杨文鸣.脉搏波波形特征信息的研究.北京工业大学学报,1996,20(1):71-79
[10] 骆 璇,常昌远,魏同立.脉搏波的解析模型及初步临床应用研究.数理医药学杂志,1999,12(4):293-295
[11] J.N.Amoore.The Effects of Pulse Rate Artefact and Pulse Strength on Oscillometric Non-invasive Blood Pressure Measurements.Engineering in Medicine and Biology Society.1996,Bridging Disciplines for Biomedicine,Proceedings of the 18th Annual International Conference of the IEEE,1996, 5(11):1977-1978
[12] 柳兆荣,李惜惜.血流动力学原理与方法[M] .复旦大学出版社,1997,168-196
[13] Wu SG, Lee GC. Theoretical and Computational Investigations of Nonlinear Wave Propogations in Arteries(Ⅰ )——A Theoretical Model of Nonlinear Pulse Wave Propgations. Science in China,Series B,1989,32:711
[14] Wu SC, Lee GC. Theoretical model of nonlinear wave propogations in arteries with circumferential tissues. Journal of Beijing Polytechnic Universisty, 1986,12:1
[15] Wu SG, Lee GC, Tseng NT. Nonlinear elastic analysis of blood vessels.J Biomech Engng,1984,106:376
[16] 柳兆荣,李惜惜.弹性腔理论及其在心血管系统分析中的应用.科学出版社,1987 年
[17] 许怀湘,房兴业.采用示波法原理间接测量血压方法的进展.航天医学与医学工程,2000,13(3)
[18] 何庆华,廖维宏.振动法无创血压测量.医疗卫生装备,1997,6:17-19
[19] 孙问钦.振荡法无创血压测量原理.医疗设备信息,1994,4:61-62
[20] J.C.T.B.Moraes. A Strategy for Determination of Systolic, Mean and Diastolic Blood Pressures from Oscillometric Pulse Profiles, Computers in Cardiology,2000:211-214
[21] 赵富强,张 旭,王齐琳.对波动法血压无创自动测量技术原理及测量准确性的实验分析.中国医学物理学杂志,1997,14(3):182-184
[22] 全晓莉,何 为,张维维.利用示波法原理测量血压的一种新方法.航天医学与医学工程,2006,19(1):71-73
[23] 张维维 , 何 为 , 全晓莉 . 应用示波法计算血压方法的改进与实现 . 医疗卫生装备,2005,26(11):5-6
[24] 张维忠.动脉弹性功能检测的理论与实践(上)[J] .心脑血管病防治,2003,8(3):1-2
[25] 王宏宇.脉搏波传导速度测定的新认识[J] .国外医学·心血管疾病分册,2000,27(2):70-72
[26] Suneo Takenaka, Kenji Kobayashi, Hiromichi Suzuki. Pulse wave velocity as an indicator of arteriosclerosis in hemodialysis patients[J]. Atherosclerosis,2004,176:405-409
[27] Rabhakar Viswanathan, M.B.B.S, M.Tech, et al. Noninvasive Assessment of age-related Changes in Vascular Elasticity and Pulse Wave Velocity Spectrum[J].IEEE, 1998:104-106
[28] Harada, T. Okada, M. Sugawara, K. Niki, Development of a non-invasive real-time measurement system of wave intensity, in Proceedings of IEEE Ultrasonics Symposium,2000:1517-1520
[29] Harada, A.; Okada, T.; Niki, K.; Dehua Chang; Sugawara, M New Methods of One-point Measurement of Pulse Wave Velocity Ultrasonics Symposium, Proceedings. IEEE,2002,2:1835 - 1838
[30] 罗志昌,张 松,杨益民等.光电容积脉搏波描记法原理及其在临床上的应用[J] .世界医疗器械,2000,16(9):41-47
[31] R.S. Gupta, L. Shila Devi. Pulse wave velocities in the aorta under radial periodic motion. Proceeding RC IEEE-EMBS& 14 th BMESI,1995:289-290
[32] 林启万,罗增成,邱绪荣等. 24 小时可移动式血压测量仪的使用评估.台湾大学医院医学工程学研究所
[33] Liang YL, Gatzka CD, Cameron JD, et al. Effect of heart rate on arterial compliance in men [J]. Clin Exp Pharmacol Physiol, 1999, 26(4):342-346
[34] Brinton TJ,Kailasam MT, Wu RA et al. Arterial compliance by cuff sphygmomanometer. Application to hypertension and early changes in subjects at genetic risk [J]. Hypertension, 1996,28(4):599-603.
[35] 白 煜,张维忠.动脉功能指数的初步研究[J] .心脑血管病防治,2002,2(2):8-10
[36] 孙宁玲,徐成斌.今日高血压.中国医药科技出版社,1999,10,274-287
[37] McVeigh GE, Burns DE, Fiokellstein SM , et al: Reduced vascular compliance as a marker for essential hypertension.American Journal of Hypertension, 1991, 4:245- 257
[38] McVeigh GE, Bratteli CW, Morgan DJ,et al.Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance[J].Hypertension,1999,33(6):1392-1398
[39] 刘春萍,周书明,程友琴.动脉顺应性及其影响因素.中国动脉硬化杂志,2001,9(3):275-276
[40] Hypertension Diagnostics Inc. HDI CV Profilor DO-2020 动脉功能检测仪中文操作手册[M],Minneapolis, MN,USA:Hypertension Diagnostics.2001
[41] Cohn JN.Arterial compliance to stratify cardiovascular risk:more precision in therapeutic decision making.Am J Hypertens,2001,14:258-263
[42] 张维忠.动脉弹性功能检测的理论与实践(下). 2003,3(5):3-4
[43] Finkelstein SM,Cohu VR,Clhn JN.Arterial vascular compliance response to vasodilators by Fourier and pulse contour analysis. Hypertension,1988,12:380-387
[44] Cohn JN.Vascular wall function as a risk marker for cardiovascular disease [J]. Journal of Hypertension,1999,17:41-44
[45] Cohn JN, Finkelstein SM,McVeigh GE,et al.Noninvasive pulse wave analysis for the early detection of the vascular disease [J].Hypertension,1993,26(3):503-508
[46] Brinton TJ,Cotter B,Kailassm MT,et al.Developmmt and validation of a noninvasive method to determine arterial pressure and vascular compliance. Am J Cardion,1997, 80:323-330
[47] 朱燕秋,杨 浩,何 为.血管硬化指数的测量方法与临床应用研究[J] .医疗设备信息,2005,20(9):13-15
[48] 全晓莉,何 为,古良玲.动脉硬化指数的测量与临床研究[J].医疗卫生装备,2006,27(2):1-2
[2] Cohn J, Finkelstein S, McVeigh G. Noninvasive pulse wave analysis for the early detection of the vascular disease[J] .Hypertens,1993,26 (3): 503-508
[3] 王宏宇,张维思,龚兰生等.高血压合并动脉粥样硬化与大动脉缓冲功能关系的研究[J] .中华心血管病杂志,2001,4(29):206～209
[4] 柳兆荣.桡动脉压力波随生理参数的变化.力学学报,1982,(3):244～250
[5] 柳兆荣.关于脉图的分析.中国科学(B 辑),1983, 2:131～138
[6] 柳兆荣.心血管流体力学.复旦大学出版社,1986 年
[7] Masanorl M,Nobuhoko I,Tohru N,et al. Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens ,2003,16:653-657
[8] 王炳和,杨禺页.一种无创测定桡动脉脉搏波速度的方法及影响脉搏波速度的因素.生物医学工程学杂志,2000,17(2):179-182
[9] 罗志昌,张松,杨文鸣.脉搏波波形特征信息的研究.北京工业大学学报,1996,20(1):71-79
[10] 骆 璇,常昌远,魏同立.脉搏波的解析模型及初步临床应用研究.数理医药学杂志,1999,12(4):293-295
[11] J.N.Amoore.The Effects of Pulse Rate Artefact and Pulse Strength on Oscillometric Non-invasive Blood Pressure Measurements.Engineering in Medicine and Biology Society.1996,Bridging Disciplines for Biomedicine,Proceedings of the 18th Annual International Conference of the IEEE,1996, 5(11):1977-1978
[12] 柳兆荣,李惜惜.血流动力学原理与方法[M] .复旦大学出版社,1997,168-196
[13] Wu SG, Lee GC. Theoretical and Computational Investigations of Nonlinear Wave Propogations in Arteries(Ⅰ )——A Theoretical Model of Nonlinear Pulse Wave Propgations. Science in China,Series B,1989,32:711
[14] Wu SC, Lee GC. Theoretical model of nonlinear wave propogations in arteries with circumferential tissues. Journal of Beijing Polytechnic Universisty, 1986,12:1
[15] Wu SG, Lee GC, Tseng NT. Nonlinear elastic analysis of blood vessels.J Biomech Engng,1984,106:376
[16] 柳兆荣,李惜惜.弹性腔理论及其在心血管系统分析中的应用.科学出版社,1987 年
[17] 许怀湘,房兴业.采用示波法原理间接测量血压方法的进展.航天医学与医学工程,2000,13(3)
[18] 何庆华,廖维宏.振动法无创血压测量.医疗卫生装备,1997,6:17-19
[19] 孙问钦.振荡法无创血压测量原理.医疗设备信息,1994,4:61-62
[20] J.C.T.B.Moraes. A Strategy for Determination of Systolic, Mean and Diastolic Blood Pressures from Oscillometric Pulse Profiles, Computers in Cardiology,2000:211-214
[21] 赵富强,张 旭,王齐琳.对波动法血压无创自动测量技术原理及测量准确性的实验分析.中国医学物理学杂志,1997,14(3):182-184
[22] 全晓莉,何 为,张维维.利用示波法原理测量血压的一种新方法.航天医学与医学工程,2006,19(1):71-73
[23] 张维维 , 何 为 , 全晓莉 . 应用示波法计算血压方法的改进与实现 . 医疗卫生装备,2005,26(11):5-6
[24] 张维忠.动脉弹性功能检测的理论与实践(上)[J] .心脑血管病防治,2003,8(3):1-2
[25] 王宏宇.脉搏波传导速度测定的新认识[J] .国外医学·心血管疾病分册,2000,27(2):70-72
[26] Suneo Takenaka, Kenji Kobayashi, Hiromichi Suzuki. Pulse wave velocity as an indicator of arteriosclerosis in hemodialysis patients[J]. Atherosclerosis,2004,176:405-409
[27] Rabhakar Viswanathan, M.B.B.S, M.Tech, et al. Noninvasive Assessment of age-related Changes in Vascular Elasticity and Pulse Wave Velocity Spectrum[J].IEEE, 1998:104-106
[28] Harada, T. Okada, M. Sugawara, K. Niki, Development of a non-invasive real-time measurement system of wave intensity, in Proceedings of IEEE Ultrasonics Symposium,2000:1517-1520
[29] Harada, A.; Okada, T.; Niki, K.; Dehua Chang; Sugawara, M New Methods of One-point Measurement of Pulse Wave Velocity Ultrasonics Symposium, Proceedings. IEEE,2002,2:1835 - 1838
[30] 罗志昌,张 松,杨益民等.光电容积脉搏波描记法原理及其在临床上的应用[J] .世界医疗器械,2000,16(9):41-47
[31] R.S. Gupta, L. Shila Devi. Pulse wave velocities in the aorta under radial periodic motion. Proceeding RC IEEE-EMBS& 14 th BMESI,1995:289-290
[32] 林启万,罗增成,邱绪荣等. 24 小时可移动式血压测量仪的使用评估.台湾大学医院医学工程学研究所
[33] Liang YL, Gatzka CD, Cameron JD, et al. Effect of heart rate on arterial compliance in men [J]. Clin Exp Pharmacol Physiol, 1999, 26(4):342-346
[34] Brinton TJ,Kailasam MT, Wu RA et al. Arterial compliance by cuff sphygmomanometer. Application to hypertension and early changes in subjects at genetic risk [J]. Hypertension, 1996,28(4):599-603.
[35] 白 煜,张维忠.动脉功能指数的初步研究[J] .心脑血管病防治,2002,2(2):8-10
[36] 孙宁玲,徐成斌.今日高血压.中国医药科技出版社,1999,10,274-287
[37] McVeigh GE, Burns DE, Fiokellstein SM , et al: Reduced vascular compliance as a marker for essential hypertension.American Journal of Hypertension, 1991, 4:245- 257
[38] McVeigh GE, Bratteli CW, Morgan DJ,et al.Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance[J].Hypertension,1999,33(6):1392-1398
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