基于心阻抗法的无创血流动力学监测系统设计与实现

      Design and Implementation of Non-Invasive Cardiac Output Monitoring System

      • 摘要: 血流动力学监测可以反映心功能和血流灌注情况,是临床不可或缺的监测手段。热稀释法为代表的有创血流动力学监测方法,因其需要进行血管插管,故其临床应用范围受限。无创血流动力学监测由于具备安全无创、连续监测、操作简单及成本低廉等优势,近年来受到国内外医疗企业及临床医生的广泛关注。该文设计了一款基于心阻抗法的无创血流动力学监测系统,包括硬件、算法、软件设计与性能参数评估。其中,硬件部分主要包括差分高频恒流源刺激电路、心阻抗信号采集及心电信号采集电路,信号处理包括滤波、心阻抗信号校准、心电信号和心阻抗信号特征点识别。根据所采集的心阻抗与心电信号,以Nyboer胸腔圆柱模型为理论依据,计算心率(heart rate, HR)、每搏量(Stroke volume, SV)、心排量(cardiac output, CO)、每搏指数(stroke index, SI)、心排指数(cardiac index, CI)和心脏收缩指数(cardiac contractility index, ICON)等血流动力学参数。经测试,系统硬件关键技术指标优于相关医疗器械标准要求。该系统采集了40名志愿者的心阻抗及心电信号数据,所计算的HR、SV、CO三个血流动力学重要指标,与德国OSYPKA Medical的ICONCore无创心排血量监测仪对比,其Pearson相关系数分别达到0.992(P<0.001),0.948(P<0.001),0.933(P<0.001),验证了所设计的系统具有较高的准确性与可靠性。

         

        Abstract: Hemodynamic monitoring can reflect cardiac function and blood perfusion, and is an indispensable monitoring method in clinical practice. Invasive hemodynamic monitoring methods represented by thermodilution method are limited in their clinical application scope because they require vascular cannulation. Noninvasive hemodynamic monitoring has attracted extensive attention from medical companies and clinicians at home and abroad in recent years due to its advantages such as safety, noninvasiveness, continuous monitoring, simple operation and low cost. This paper designs a noninvasive hemodynamic monitoring system based on the cardiac impedance method, including hardware, algorithm, software design and performance parameter evaluation. Among them, the hardware part mainly includes differential high-frequency constant current source stimulation circuit, cardiac impedance signal acquisition and ECG signal acquisition circuit. Signal processing includes filtering, cardiac impedance signal calibration, ECG signal and cardiac impedance signal feature point recognition. According to the collected cardiac impedance and ECG signals, the hemodynamic parameters such as heart rate (HR), stroke volume (SV), cardiac output (CO), stroke index (SI), cardiac index (CI) and cardiac contraction index (ICON) are calculated based on the Nyboer thoracic cylinder model. After testing, the key technical indicators of the system hardware are better than the relevant medical device standards. The system was used to collect cardiac impedance and ECG signal data from 40 volunteers. The calculated HR, SV, and CO, three important hemodynamic indicators, were compared with the ICONCore non-invasive cardiac output monitor of OSYPKA Medical in Germany. The Pearson correlation coefficients were 0.992 (P<0.001), 0.948 (P<0.001), and 0.933 (P<0.001), respectively, verifying that the designed system has high accuracy and reliability.

         

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