本文選題：光電容積脈搏波　切入點(diǎn)：低血壓　出處：《浙江大學(xué)》2012年博士論文

【摘要】：麻醉手術(shù)中的低血壓及傷害感受的監(jiān)測(cè)及預(yù)測(cè)是非常重要的,它可以幫助麻醉醫(yī)生及時(shí)了解病人生理狀態(tài)的變化。目前市場(chǎng)上已有的麻醉監(jiān)測(cè)設(shè)備大多只能提供簡(jiǎn)單的測(cè)量參數(shù)顯示和報(bào)警功能,這些設(shè)備中的參數(shù)雖多,但卻沒(méi)有建立起這些參數(shù)與生理狀態(tài)之間的聯(lián)系,也就難以發(fā)揮麻醉醫(yī)生們的主觀能動(dòng)性。隨著近幾十年來(lái)對(duì)光電容積脈搏波(PPG)所做的大量臨床研究,PPG已被廣泛的用于麻醉生理參數(shù)監(jiān)測(cè),該方法安全無(wú)創(chuàng)、可靠性高,所以本論文根據(jù)PPG研究的生理學(xué)基礎(chǔ),設(shè)計(jì)了基于PPG的麻醉手術(shù)中無(wú)創(chuàng)生理參數(shù)監(jiān)測(cè)系統(tǒng)。 本論文的主要研究工作如下： 1.設(shè)計(jì)了基于光電容積脈搏波的麻醉手術(shù)中無(wú)創(chuàng)生理參數(shù)監(jiān)測(cè)系統(tǒng),可以完成麻醉過(guò)程相關(guān)的心率(HR)、血氧飽和度(SpO2)、收縮壓、舒張壓、平均壓、脈搏波傳導(dǎo)時(shí)間(PTT)、衰減時(shí)間常數(shù)(RC)、光電容積脈搏波幅度(PPGA)、下降支面積比(ARD)等參數(shù)的同步實(shí)時(shí)監(jiān)測(cè)。其中,RC和ARD均為本系統(tǒng)所獨(dú)有的生理參數(shù)。 2.設(shè)計(jì)實(shí)現(xiàn)了以nRF24L01模塊為核心的低功耗無(wú)線傳輸方案。該方案以nRF系列芯片內(nèi)嵌的Enhanced ShockBurst協(xié)議為基礎(chǔ),設(shè)計(jì)開(kāi)發(fā)了短距離無(wú)線傳輸網(wǎng)絡(luò)協(xié)議(NWSN),實(shí)現(xiàn)了數(shù)據(jù)傳輸?shù)牡凸�。該方案與載波監(jiān)聽(tīng)多路訪問(wèn)協(xié)議(CSMA)相比,極大地降低了數(shù)據(jù)收發(fā)的電流,總功耗約為后者的1/3。同時(shí)該方案利用了無(wú)線天然無(wú)漏電流、無(wú)需隔離的特點(diǎn),節(jié)省了硬件成本,降低了設(shè)計(jì)復(fù)雜度。 3.提出了麻醉監(jiān)測(cè)過(guò)程中脈搏波傳導(dǎo)時(shí)間變異性(PTTV)的分析算法,并首次將其應(yīng)用于麻醉手術(shù)中無(wú)創(chuàng)生理參數(shù)監(jiān)測(cè)系統(tǒng)。本論文提出了一個(gè)新的光電容積脈搏波(PPG)信號(hào)特征點(diǎn)檢測(cè)算法。此算法主要采用窗口化的局部查找方法,再與一階導(dǎo)數(shù)和邏輯判斷相結(jié)合來(lái)檢測(cè)特征點(diǎn)。當(dāng)接受區(qū)間為24.0ms時(shí),該算法的檢出率高于95%。由心電圖(ECG)信號(hào)的R波和PPG信號(hào)的P波位置可以計(jì)算得到PTT,進(jìn)而將其作為PTTV的原始輸入,采用自回歸(AR)模型建立PTTV分析算法。 4.首次將PTTV分析方法應(yīng)用于麻醉低血壓研究。在浙江大學(xué)醫(yī)學(xué)院附屬婦產(chǎn)科醫(yī)院，，經(jīng)過(guò)24例臨床實(shí)驗(yàn),結(jié)果表明,甚低頻與低頻功率的比值(VLF/LF)以及低頻功率與總功率的比值(LF/ALL)這兩個(gè)參數(shù)的P值分別為：PVLf/LF=0.028、PLF/ALL=0.031,說(shuō)明這兩個(gè)參數(shù)在低血壓組與正常組中有明顯差異，具有預(yù)測(cè)麻醉低血壓發(fā)生的可行性。 該系統(tǒng)被應(yīng)用于麻醉低血壓及傷害感受的臨床研究,初步實(shí)現(xiàn)了對(duì)低血壓及傷害感受的有效評(píng)估。本論文所設(shè)計(jì)之系統(tǒng)嚴(yán)格按照國(guó)家相關(guān)標(biāo)準(zhǔn)要求開(kāi)發(fā),具有很好的臨床應(yīng)用前景。
[Abstract]:Monitoring and prediction of hypotension and injury perception in anaesthesia surgery is very important, which can help anesthesiologist to keep abreast of the changes of patient's physiological state.At present, most of the existing anesthetic monitoring equipment in the market can only provide simple display and alarm functions of measuring parameters. Although there are many parameters in these equipment, there is no relationship between these parameters and physiological state.It is difficult to give full play to the subjective initiative of the anesthesiologist.As a large number of clinical studies have been carried out in recent decades, PPG has been widely used in the monitoring of physiological parameters of anesthesia. This method is safe and non-invasive, and has high reliability. Therefore, this paper based on the physiological basis of PPG research.A non-invasive physiological parameter monitoring system based on PPG was designed.The main research work of this thesis is as follows:1.A non-invasive physiological parameter monitoring system based on photovolumic pulse wave was designed. The system can complete the following functions: HRT, SPO _ 2, systolic blood pressure, diastolic blood pressure, mean pressure, etc.The parameters of pulse wave conduction time (PTT), attenuation time constant (RC), photovolumic pulse wave amplitude (PPGAA) and descending branch area ratio (ARD) are monitored simultaneously and in real time.Among them, RC and ARD are the unique physiological parameters of the system.2.A low power wireless transmission scheme based on nRF24L01 module is designed and implemented.Based on the Enhanced ShockBurst protocol embedded in nRF chips, the short range wireless transmission network protocol (NWSNN) is designed and developed, and the low power consumption of data transmission is realized.Compared with CSMA, the proposed scheme greatly reduces the current of data receiving and receiving, and the total power consumption is about one third of that of the latter.At the same time, the scheme makes use of the characteristics of wireless natural leakage current, no isolation, saves hardware cost and reduces design complexity.3.The analysis algorithm of pulse wave conduction time variability (PTTVV) during anesthesia monitoring was proposed and applied to the monitoring system of noninvasive physiological parameters in anesthesia surgery for the first time.In this paper, a new feature point detection algorithm for optoelectronic volumetric pulse wave (PPG) signal is proposed.This algorithm mainly uses the windowed local search method, and then combines with the first order derivative and logical judgment to detect the feature points.The detection rate of the algorithm is higher than that of 95 when the interval is accepted as 24.0ms.The position of R wave and P wave of PPG signal can be calculated from the position of R wave and P wave of electrocardiogram (ECG) signal, which can be taken as the original input of PTTV, and the PTTV analysis algorithm is established by using autoregressive PTTV model.4.For the first time, PTTV analysis was applied to the study of anaesthesia hypotension.In the Department of Obstetrics and Gynecology, affiliated to Zhejiang University Medical College, 24 cases of clinical trials have been conducted. The results show thatThe ratio of very low frequency to low frequency (VLF / LFL) and the ratio of low frequency power to total power (LFR / ALL) were 0. 028% PLF / ALL 0.031, respectively, which indicated that these two parameters had obvious difference between hypotension group and normal group, and it was feasible to predict the occurrence of anaesthesia hypotension.The system has been applied to the clinical study of anaesthesia hypotension and injury perception.The system designed in this paper is developed in strict accordance with relevant national standards and has a good prospect of clinical application.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R318.6

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