基于脈搏波速度和中心動(dòng)脈壓的大動(dòng)脈功能無創(chuàng)評(píng)估方法研究
發(fā)布時(shí)間：2018-07-22 16:57
【摘要】：動(dòng)脈硬化是多種心血管病的共同病理生理學(xué)基礎(chǔ)。動(dòng)脈功能異常是動(dòng)脈硬化病變早期征兆,早期篩查并積極干預(yù)大動(dòng)脈功能異常是防治心血管病的重要措施。頸股脈搏波速度(carotid femoral pulse wave velocity, CFPWV)和中心動(dòng)脈壓(central arterial pressure, CAP)是無創(chuàng)評(píng)估大動(dòng)脈功能主要指標(biāo)。CFPWV測量依賴于脈搏波傳遞時(shí)間(pulse transit time, PTT)的準(zhǔn)確估計(jì)。然而,現(xiàn)有的"foot-to-foot"方法估計(jì)PTT可能存在精度不足的問題且不同方法產(chǎn)生的CFPWV存在本質(zhì)差異。因此,需要建立新的PTT估計(jì)方法提高CFPWV評(píng)估主動(dòng)脈硬度的準(zhǔn)確性。頸動(dòng)脈張力法是無創(chuàng)估計(jì)CAP常用方法,但頸動(dòng)脈埋藏較深且相對移動(dòng),導(dǎo)致信號(hào)采集困難,且壓迫頸動(dòng)脈會(huì)給患者帶來不適。頸動(dòng)脈波形可以通過廣義傳遞函數(shù)(generalized transfer function, GTF)從易于測量的橈動(dòng)脈位置獲取,但GTF主要在外國人群中構(gòu)建并驗(yàn)證。在中國人群構(gòu)建中GTF并研制相應(yīng)的檢測設(shè)備對于無創(chuàng)評(píng)估CAP具有重要意義�；谏鲜鲂枨�,本文圍繞PTT估計(jì)方法和基于GTF的無創(chuàng)CAP獲取方法開展研究,主要內(nèi)容包括：1.基于區(qū)域匹配的PTT估計(jì)方法研究通過對脈搏波形上升階段形態(tài)的分析,提出了一種波形匹配法(waveform matching, WFMA)估計(jì)PTT。WFMA法選擇頸動(dòng)脈和股動(dòng)脈壓力波形舒張期極小值點(diǎn)至斜率最大值點(diǎn)之間的波形作為待匹配區(qū)域,通過時(shí)移匹配技術(shù)確定PTT。采集頸股動(dòng)脈脈搏數(shù)據(jù),使用參考方法、"foot-to-foot"法和WFMA法分別估計(jì)PTT計(jì)算CFPWV。結(jié)果表明WFMA法比"foot-to-foot"法測量的CFPWV具有更好的準(zhǔn)確性和重復(fù)性。WFMA法提高了CFPWV測量的可靠性,具有潛在的臨床應(yīng)用價(jià)值。2. WFMA法測量CFPWV影響因素研究進(jìn)一步研究脈搏波形的標(biāo)定、匹配區(qū)域的選擇和年齡對WFMA法的影響。通過比較WFMA法在標(biāo)定前后的頸股動(dòng)脈脈搏波形中測量的CFPWV結(jié)果,我們發(fā)現(xiàn)WFMA法在標(biāo)定后的壓力波形中產(chǎn)生的CFPWV具有更小的偏差,測量的CFPWV更加準(zhǔn)確。分別選擇壓力波形上升段的部分和全部區(qū)域估計(jì)PTT,結(jié)果表明當(dāng)選擇脈搏波形整個(gè)上升階段估計(jì)PTT時(shí),WFMA法測量CFPWV的準(zhǔn)確性顯著降低。根據(jù)年齡將研究對象分為青年、中年和老年三組,結(jié)果表明WFMA法在這三個(gè)組群中測量CFPWV的準(zhǔn)確性依次降低,但都產(chǎn)生了準(zhǔn)確的CFPWV估計(jì)結(jié)果。這一發(fā)現(xiàn)說明WFMA法具有很好的年齡適用性,為其在臨床實(shí)踐中的應(yīng)用奠定了基礎(chǔ)。3.基于自回歸外生模型的GTF構(gòu)建方法研究利用系統(tǒng)辨識(shí)中的自回歸外生(autoregressive exogenous, ARX)模型在中國人群中構(gòu)建(individual transfer function, ITF)和GTF。65位研究對象被分為構(gòu)建組和驗(yàn)證組。在構(gòu)建組中采用交叉驗(yàn)證技術(shù)和Akaike's信息準(zhǔn)則確定模型的最佳階次(10階),并構(gòu)建橈動(dòng)脈至頸動(dòng)脈GTF；在驗(yàn)證組中對GTF的準(zhǔn)確性進(jìn)行驗(yàn)證,同時(shí)將其與ITF對比。GTF能夠從橈動(dòng)脈壓力波形中準(zhǔn)確估計(jì)中心動(dòng)脈收縮壓(systolic blood pressure, SBP),但不能精確地重構(gòu)中心動(dòng)脈壓力波形,在對某些依賴于脈搏波形高頻分量的參數(shù)的估計(jì)上表現(xiàn)不佳。與GTF相比,ITF提高了中心動(dòng)脈壓力和波形估計(jì)的準(zhǔn)確性。研究結(jié)果為無創(chuàng)中心動(dòng)脈壓分析儀的研制提供了理論和技術(shù)支持。4.中心動(dòng)脈壓力波形形態(tài)對GTF重構(gòu)中心動(dòng)脈血流動(dòng)力學(xué)特征影響研究根據(jù)頸動(dòng)脈壓力波形形態(tài)(A類和C類)將研究對象分為A組和C組,構(gòu)建組平均傳遞函數(shù)(MTFA和MTFC)和GTF。研究結(jié)果表明形態(tài)特定的TF稍微但沒有顯著提高某些波形參數(shù)的估計(jì),包括中心動(dòng)脈SBP,收縮期和舒張期壓力時(shí)間積分,但改善了某些依賴于波形輪廓的參數(shù)(如增強(qiáng)指數(shù))的估計(jì)。這一發(fā)現(xiàn)表明在利用傳遞函數(shù)從外周動(dòng)脈估計(jì)中心血流動(dòng)力學(xué)指標(biāo)時(shí),使用形態(tài)特定的TF可能更合適。5.動(dòng)脈功能評(píng)估儀器的研制和示范應(yīng)用根據(jù)上述研究建立的方法和技術(shù),研制了動(dòng)脈硬化檢測儀(BX-CFTI-200)和無創(chuàng)中心動(dòng)脈壓分析儀(BX-CAP-100),并在中國人民解放軍總醫(yī)院運(yùn)動(dòng)干預(yù)門診中進(jìn)行示范應(yīng)用。BX-CFTI-200運(yùn)用WFMA法測量CFPWV評(píng)估大動(dòng)脈彈性。BX-CAP-100利用平面張力法記錄橈動(dòng)脈壓力波形,經(jīng)GTF轉(zhuǎn)換獲取中心動(dòng)脈壓力和波形,隨后,利用波形分析技術(shù)提取包括中心動(dòng)脈SBP、AIx和SEVR在內(nèi)的多項(xiàng)血流動(dòng)力學(xué)指標(biāo)。這兩臺(tái)設(shè)備成本低廉、操作簡單,滿足動(dòng)脈硬化的早期篩查需求。
[Abstract]:Arteriosclerosis is the common pathophysiological basis of various cardiovascular diseases. Abnormal arterial function is an early sign of arteriosclerosis. Early screening and active intervention of abnormal arterial function are important measures for the prevention and treatment of cardiovascular disease. Carotid femoral pulse wave velocity (CFPWV) and central arterial pressure (central arteri) Al pressure, CAP) is a noninvasive assessment of the major arterial function,.CFPWV measurement depends on the accurate estimation of the pulse transit time (PTT). However, the existing "foot-to-foot" method estimates that PTT may have a lack of precision and there are essential differences in the production CFPWV of different methods. Therefore, a new PTT estimate is needed. This method improves the accuracy of CFPWV to evaluate the hardness of the aorta. The carotid tension method is a noninvasive method to estimate CAP, but the carotid artery is buried deeper and relatively moving, which leads to the difficulty of signal acquisition, and the compression of the carotid artery will bring discomfort to the patient. The carotid waveform can be from the generalized transfer function (GTF). The location of the measured radial artery is obtained, but GTF is mainly constructed and verified in the foreign population. In the construction of the Chinese population, GTF and the development of the corresponding detection equipment are of great significance for non-invasive evaluation of CAP. Based on the above requirements, this paper focuses on the PTT estimation method and the GTF based CAP acquisition method based on GTF. The main contents include: 1. base In the study of PTT estimation method of regional matching, a waveform matching method (waveform matching, WFMA) is proposed to estimate the waveform between the diastolic minimum point of the carotid and femoral artery pressure waveform and the maximum point of the slope by the PTT.WFMA method. The time shift matching technique is used. PTT. acquisition of carotid femoral artery pulse data, using reference methods, "foot-to-foot" and WFMA methods to estimate PTT CFPWV. results, respectively, indicating that WFMA method has better accuracy and repeatability.WFMA method than "foot-to-foot" method to improve the reliability of CFPWV measurement, and it has potential clinical application value.2. WFMA method measurement. PWV influence factor research further study the pulse waveform calibration, the selection of matching area and the influence of age on the WFMA method. By comparing the CFPWV results measured in the pulse waveform of the carotid femoral artery before and after the WFMA method, we find that the CFPWV produced in the calibrated pressure waveform has smaller deviation, and the measured CFPWV is more than the WFMA method. Accurate. Select the partial and all regions of the rise section of the pressure waveform to estimate PTT. The results show that the accuracy of the WFMA method for measuring CFPWV is significantly reduced when the pulse waveform is estimated to be PTT in the whole rising stage. According to age, the research objects are divided into three groups of youth, middle age and old age. The results show that the WFMA method is used to measure CFPWV in these three groups. The accuracy is reduced in turn, but all of the accurate CFPWV estimation results are produced. This discovery shows that the WFMA method has a good age applicability, laying a foundation for its application in clinical practice, based on the GTF construction method based on the autoregressive exogenous model of.3., and using the autoregressive exogenous (ARX) model in system identification. In the Chinese population, the individual transfer function (ITF) and GTF.65 sites were divided into the construction group and the verification group. In the construction group, the best order (10 order) of the model was determined by cross validation and Akaike's information criteria, and the radial artery to the carotid artery GTF was constructed, and the accuracy of GTF was verified in the validation group. Compared with ITF,.GTF can accurately estimate the systolic pressure of central artery (systolic blood pressure, SBP) from the radial artery pressure waveform, but it can not accurately reconstruct the central arterial pressure waveform, which is not good in the estimation of some parameters which depend on the high frequency component of the pulse wave. Compared with GTF, ITF improves the central arterial pressure and waveform. The results of the study provide theoretical and technical support for the development of the noninvasive central arterial pressure analyzer for the study of the influence of the.4. central arterial pressure waveform on the hemodynamic characteristics of the central artery of the GTF reconstruction. According to the shape of the carotid pressure waveform (Class A and the C class), the image is divided into the A group and the C group, and the average transfer function of the construction group is constructed. The results of the (MTFA and MTFC) and GTF. studies showed that the form specific TF slightly but did not significantly increase the estimation of certain waveform parameters, including the central artery SBP, the systolic and diastolic pressure time integral, but improved the estimation of some parameters (such as the enhancement index) that depended on the contour of the waveform. This discovery shows that the transfer function is used to move from the peripheral movement. The use of morphologic specific TF may be more appropriate for the development and demonstration of.5. arterial function assessment instruments when the pulse estimation center hemodynamic indicators are developed and applied in accordance with the methods and techniques established above, and developed an arteriosclerosis detector (BX-CFTI-200) and a noninvasive central arterial pressure analyzer (BX-CAP-100), and in General Hospital of PLA The demonstration application of.BX-CFTI-200 in the exercise intervention clinic uses the WFMA method to measure CFPWV and evaluate the elastic.BX-CAP-100 of the large artery by using the plane tension method to record the radial pressure wave. After GTF conversion, the central artery pressure and waveform are obtained. Then, a number of hemodynamic forces, including the middle heart artery SBP, AIx and SEVR, are extracted by the waveform analysis technique. These two devices are cheap and simple to operate, and meet the early screening needs of arteriosclerosis.
【學(xué)位授予單位】：中國科學(xué)技術(shù)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R543.5
本文編號(hào)：2138137
[Abstract]:Arteriosclerosis is the common pathophysiological basis of various cardiovascular diseases. Abnormal arterial function is an early sign of arteriosclerosis. Early screening and active intervention of abnormal arterial function are important measures for the prevention and treatment of cardiovascular disease. Carotid femoral pulse wave velocity (CFPWV) and central arterial pressure (central arteri) Al pressure, CAP) is a noninvasive assessment of the major arterial function,.CFPWV measurement depends on the accurate estimation of the pulse transit time (PTT). However, the existing "foot-to-foot" method estimates that PTT may have a lack of precision and there are essential differences in the production CFPWV of different methods. Therefore, a new PTT estimate is needed. This method improves the accuracy of CFPWV to evaluate the hardness of the aorta. The carotid tension method is a noninvasive method to estimate CAP, but the carotid artery is buried deeper and relatively moving, which leads to the difficulty of signal acquisition, and the compression of the carotid artery will bring discomfort to the patient. The carotid waveform can be from the generalized transfer function (GTF). The location of the measured radial artery is obtained, but GTF is mainly constructed and verified in the foreign population. In the construction of the Chinese population, GTF and the development of the corresponding detection equipment are of great significance for non-invasive evaluation of CAP. Based on the above requirements, this paper focuses on the PTT estimation method and the GTF based CAP acquisition method based on GTF. The main contents include: 1. base In the study of PTT estimation method of regional matching, a waveform matching method (waveform matching, WFMA) is proposed to estimate the waveform between the diastolic minimum point of the carotid and femoral artery pressure waveform and the maximum point of the slope by the PTT.WFMA method. The time shift matching technique is used. PTT. acquisition of carotid femoral artery pulse data, using reference methods, "foot-to-foot" and WFMA methods to estimate PTT CFPWV. results, respectively, indicating that WFMA method has better accuracy and repeatability.WFMA method than "foot-to-foot" method to improve the reliability of CFPWV measurement, and it has potential clinical application value.2. WFMA method measurement. PWV influence factor research further study the pulse waveform calibration, the selection of matching area and the influence of age on the WFMA method. By comparing the CFPWV results measured in the pulse waveform of the carotid femoral artery before and after the WFMA method, we find that the CFPWV produced in the calibrated pressure waveform has smaller deviation, and the measured CFPWV is more than the WFMA method. Accurate. Select the partial and all regions of the rise section of the pressure waveform to estimate PTT. The results show that the accuracy of the WFMA method for measuring CFPWV is significantly reduced when the pulse waveform is estimated to be PTT in the whole rising stage. According to age, the research objects are divided into three groups of youth, middle age and old age. The results show that the WFMA method is used to measure CFPWV in these three groups. The accuracy is reduced in turn, but all of the accurate CFPWV estimation results are produced. This discovery shows that the WFMA method has a good age applicability, laying a foundation for its application in clinical practice, based on the GTF construction method based on the autoregressive exogenous model of.3., and using the autoregressive exogenous (ARX) model in system identification. In the Chinese population, the individual transfer function (ITF) and GTF.65 sites were divided into the construction group and the verification group. In the construction group, the best order (10 order) of the model was determined by cross validation and Akaike's information criteria, and the radial artery to the carotid artery GTF was constructed, and the accuracy of GTF was verified in the validation group. Compared with ITF,.GTF can accurately estimate the systolic pressure of central artery (systolic blood pressure, SBP) from the radial artery pressure waveform, but it can not accurately reconstruct the central arterial pressure waveform, which is not good in the estimation of some parameters which depend on the high frequency component of the pulse wave. Compared with GTF, ITF improves the central arterial pressure and waveform. The results of the study provide theoretical and technical support for the development of the noninvasive central arterial pressure analyzer for the study of the influence of the.4. central arterial pressure waveform on the hemodynamic characteristics of the central artery of the GTF reconstruction. According to the shape of the carotid pressure waveform (Class A and the C class), the image is divided into the A group and the C group, and the average transfer function of the construction group is constructed. The results of the (MTFA and MTFC) and GTF. studies showed that the form specific TF slightly but did not significantly increase the estimation of certain waveform parameters, including the central artery SBP, the systolic and diastolic pressure time integral, but improved the estimation of some parameters (such as the enhancement index) that depended on the contour of the waveform. This discovery shows that the transfer function is used to move from the peripheral movement. The use of morphologic specific TF may be more appropriate for the development and demonstration of.5. arterial function assessment instruments when the pulse estimation center hemodynamic indicators are developed and applied in accordance with the methods and techniques established above, and developed an arteriosclerosis detector (BX-CFTI-200) and a noninvasive central arterial pressure analyzer (BX-CAP-100), and in General Hospital of PLA The demonstration application of.BX-CFTI-200 in the exercise intervention clinic uses the WFMA method to measure CFPWV and evaluate the elastic.BX-CAP-100 of the large artery by using the plane tension method to record the radial pressure wave. After GTF conversion, the central artery pressure and waveform are obtained. Then, a number of hemodynamic forces, including the middle heart artery SBP, AIx and SEVR, are extracted by the waveform analysis technique. These two devices are cheap and simple to operate, and meet the early screening needs of arteriosclerosis.
【學(xué)位授予單位】：中國科學(xué)技術(shù)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R543.5
【相似文獻(xiàn)】
相關(guān)期刊論文 前10條
1 金慰鄂;;檢查動(dòng)脈功能不全的新方法:血小板聚集的定量測定[J];國外醫(yī)學(xué)參考資料(內(nèi)科學(xué)分冊);1975年09期
2 胡德良;;偶爾吸煙也會(huì)削弱動(dòng)脈功能[J];科學(xué)養(yǎng)生;2009年01期
3 胡德良;;偶爾吸煙也會(huì)削弱動(dòng)脈功能[J];保健醫(yī)苑;2010年04期
4 姜一農(nóng);;動(dòng)脈功能評(píng)價(jià)與降壓質(zhì)量[J];醫(yī)學(xué)與哲學(xué)(臨床決策論壇版);2007年07期
5 李新立;徐瓊;;檢測你的動(dòng)脈功能用哪些方法[J];求醫(yī)問藥;2009年12期
6 李萍;馮平;何臣;鄒盛智;秦大德;;大動(dòng)脈功能的臨床研究近況[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2008年12期
7 馬志敏;;第三屆中國血管病變和動(dòng)脈功能學(xué)術(shù)會(huì)議暨第一屆國際血管健康學(xué)會(huì)亞太地區(qū)會(huì)議紀(jì)要[J];中華老年醫(yī)學(xué)雜志;2006年09期
8 馬志敏;;第五屆中國血管病變和動(dòng)脈功能學(xué)術(shù)會(huì)議暨第三屆國際血管健康學(xué)會(huì)亞太地區(qū)會(huì)議紀(jì)要[J];中國民康醫(yī)學(xué);2008年15期
9 王宏宇,龔蘭生,張維忠,胡大一;動(dòng)脈功能檢測方法學(xué)研究[J];中國民康醫(yī)學(xué);2005年08期
10 馬志敏;;第三屆中國血管病變和動(dòng)脈功能學(xué)術(shù)會(huì)議暨第一屆國際血管健康學(xué)會(huì)亞太地區(qū)會(huì)議紀(jì)要[J];中國民康醫(yī)學(xué);2006年15期
相關(guān)博士學(xué)位論文 前1條
1 胡福松;基于脈搏波速度和中心動(dòng)脈壓的大動(dòng)脈功能無創(chuàng)評(píng)估方法研究[D];中國科學(xué)技術(shù)大學(xué);2016年
相關(guān)碩士學(xué)位論文 前1條
1 王曉靜;瞬時(shí)波強(qiáng)（WI）評(píng)價(jià)糖尿病患者頸動(dòng)脈內(nèi)皮功能[D];中南大學(xué);2009年
，本文編號(hào)：2138137
本文鏈接：http://sikaile.net/yixuelunwen/xxg/2138137.html
最近更新
教材專著
