【摘要】：擇期剖宮產(chǎn)麻醉后低血壓極大威脅著母嬰的安全,實(shí)現(xiàn)麻醉前的低血壓風(fēng)險(xiǎn)預(yù)測(cè)具有重要的臨床意義。與常用的心率變異性研究相比,脈搏波信號(hào)蘊(yùn)含豐富的血管特性信息,可以更為直接準(zhǔn)確地反映血壓的調(diào)節(jié)機(jī)制,因此論文圍繞脈搏波傳導(dǎo)時(shí)間變異性(Pulse Transit Time Variability, PTTV)對(duì)剖宮產(chǎn)麻醉后低血壓的風(fēng)險(xiǎn)評(píng)估進(jìn)行了深入研究。 論文的主要內(nèi)容包括： 基于脈搏波傳導(dǎo)時(shí)間與血壓的關(guān)系,提出了應(yīng)用脈搏波傳導(dǎo)時(shí)間變異性進(jìn)行低血壓預(yù)測(cè)的分析方法。研究了心電及脈搏波信號(hào)的特征點(diǎn)檢測(cè)方法、適合短時(shí)程序列分析的自回歸(Auto Regressive, AR)模型的頻域分析方法。 提出了相對(duì)心率頻率(Relative Frequency of Heart Rate, RFHR)與相對(duì)心動(dòng)周期(Relative Cardiac Cycle, RCC)兩個(gè)新概念,進(jìn)行了基于相對(duì)心率頻率的功率譜分析。將谷點(diǎn)位置作為頻段劃分依據(jù),聚集范圍分別為0.2559±0.0096、0.4213+0.01、0.6006±0.0116和0.7706+0.01817,離散程度小,具有很高的一致性,其中0.1-0.26譜段、0.26-0.42譜段及0.42-0.6譜段包含的譜峰分別對(duì)應(yīng)于五倍心動(dòng)周期調(diào)節(jié)、三倍心動(dòng)周期調(diào)節(jié)和兩倍心動(dòng)周期調(diào)節(jié),物理含義清晰,解決了頻譜峰谷位置的聚類問(wèn)題。 基于相對(duì)心率頻率的功率譜分析方法,對(duì)69例臨床數(shù)據(jù)術(shù)前一天、手術(shù)當(dāng)天擴(kuò)容前、擴(kuò)容后至麻醉前三個(gè)階段的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,結(jié)果表明,參數(shù)RCC5/RCC3(五倍心動(dòng)周期調(diào)節(jié)頻段與三倍心動(dòng)周期調(diào)節(jié)頻段的能量比值)的判別閾值設(shè)置為0.7057時(shí),預(yù)測(cè)敏感度達(dá)80%,特異性達(dá)79.7%,在擴(kuò)容后對(duì)重度低血壓具有潛在的預(yù)測(cè)能力,對(duì)擇期剖宮產(chǎn)麻醉后低血壓的風(fēng)險(xiǎn)預(yù)測(cè)具有一定臨床指導(dǎo)意義。
[Abstract]:Hypotension after elective cesarean section greatly threatens the safety of mothers and infants. It is of great clinical significance to predict the risk of hypotension before anesthesia. Compared with common heart rate variability (HRV) studies, pulse wave signals contain abundant information of blood vessel characteristics and can reflect the regulation mechanism of blood pressure more directly and accurately. Therefore, the thesis focuses on the pulse wave conduction time variability (Pulse Transit Time Variability,). PTTV) studied the risk assessment of hypotension after cesarean section anesthesia. The main contents of this paper are as follows: based on the relationship between pulse wave conduction time and blood pressure, a method for predicting hypotension using pulse wave conduction time variability is proposed. The characteristic point detection method of ECG and pulse wave signal is studied, and the frequency domain analysis method of autoregressive (Auto Regressive, AR) model is suitable for short-time program analysis. Two new concepts of relative heart rate frequency (Relative Frequency of Heart Rate, RFHR) and relative cardiac period (Relative Cardiac Cycle, RCC) are proposed, and the power spectrum analysis based on relative heart rate frequency is carried out. Taking the valley position as the basis for frequency band division, the aggregation ranges are 0.2559 鹵0.0096, 0.4213 0.01, 0.6006 鹵0.0116 and 0.7706 0.01817, respectively. 0.26 and 0.42, respectively, correspond to five-fold, three-fold, and two-fold cardiac period regulation, respectively. The physical meaning of the peak is clear. The clustering problem of peak and valley position of spectrum is solved. Based on the power spectrum analysis method of relative heart rate frequency, the data of 69 cases of clinical data were analyzed statistically one day before operation, and after volume expansion to three stages before anaesthesia. When the discriminant threshold of the parameter RCC5/RCC3 (the energy ratio between the five-fold and triple-cycle regulation bands) is set to 0.7057, the sensitivity and specificity of the prediction are 80% and 79.7%, respectively, when the threshold value is set to 0.7057. It has the potential to predict severe hypotension after expansion, and has some clinical significance in predicting the risk of hypotension after elective cesarean section anesthesia.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：TN911.7

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