Pathophysiologically oriented monitoring for carrying out monitoring control of human vegetative process in human being

FIELD: medicine.

SUBSTANCE: method involves measuring cardio- and hemodynamic values, calculating estimates of the values and displaying the estimates on monitor. Measuring and calculating each cardio- and hemodynamic value is carried out during basic periods of their oscillations corresponding to heart contraction cycle and respiratory cycle related to absolute time.

EFFECT: high accuracy of estimation.

4 dwg, 1 tbl

 

The invention relates to medicine, namely to surgery, intensive care, intensive care, cardiology.

The known method of the monitor control using monitor Agilent M4 MA (user Manual. Monitor Agilent M2, M3 and M4 MA, the measuring Module server Agilent M3000A and expansion of the measuring server Agilent M3016A. Ed 6. - Germany, 2001 - 405 C.), at which carry out the control and measuring electrical activity of the heart, arterial, venous, pulmonary arterial and pulmonary venous pressure, skin and rectal temperature, pulse oximeter, EEG and some other indicators, display monitor their instantaneous values, conduct primary processing and display on the monitor screen in numerical form the heart rate, systolic, diastolic and mean pressure, respiratory rate and some other indicators, conduct statistical processing and clinical interpretation of the ECG is stored in memory and are on display trends of indices for every half a minute, a minute, 15 minutes, etc.

The disadvantage of this method is the lack of a pathophysiological explanation for the described processing of data, information, for what period are averaging what the principle of selection of the maximum values and other Digital data correlated with the real Smarties the nearest minute. Accordingly, we have the loss of information and direct errors due to averaging performance over time, not specific and not due to pathophysiologically.

The technical result of the proposed method is to improve the accuracy of estimates characterizing the performance of cardio - and hemodynamics.

The method is as follows.

Hold the measuring cardio - and hemodynamics, which for each indicator allocate the main periods of the oscillations and the smallest period taken for the period of measurement, for example, the cycle of contraction of the heart and the respiratory cycle. The obtained measuring period is strictly tied to absolute time.

Carry out calculations estimates cardio - and hemodynamics in accordance with the specific pathophysiological need for defined earlier period of measurement, such as the mean, the beginning and the end of which is also bound to absolute time, and the formula for calculation is as follows:

where f(n) is the average value of the controlled parameter for the n-th measurement period, ton- the start time of the nth measurement period, Tn- the duration of the n-th measurement period, τ - current time, f(τ) - instantaneous value of the controlled parameter.

Present on the screen of the monitor system is obtained indicators of cardio - and hemodynamics.

The technical result is achieved by measurement and calculation of estimates cardio - and hemodynamics during each main period of their oscillations with reference to absolute time.

Example 1:

Conduct monitoring control of heart rate (HR). Given the variation period of the fundamental oscillation - cycle contractions of the heart, which is the period of measurement. Carry out the measurement of the electrocardiogram (ECG), a five second interval which is presented in figure 1. The start time of the measurement is the same for all monitored indicators linked to absolute time. Carry out the calculation of estimates: RR-intervals of the ECG and heart rate in real lengths of ECG intervals of each cycle of the heartbeat, given the start time of the cycle and the time of measurement. Heart rate count per minute is required for pathophysiological analysis time. Figure 2 presents: HR, calculated at the real lengths of the intervals (1); HR, calculated per minute (2); HR, calculated monitor system Agilent M4 MA (3).

Figure 3 shows the error determined by the heart rate monitor for the actual instantaneous values of HR (1) and relative heart rate, calculated per minute (2).

The greatest distortion of the lengths of the RR-intervals was observed in the field extrema changing curves, where the difference in average amounted to 8 beats per minute (BPM), mA is the maximum - 18 beats/min

The distribution of the error relative to the heart rate per minute was close to normal with a maximum value of 14 beats/min, the average quadratic deviation of 5.6 beats/min, and 95%confidence interval of 11.5 beats/min. the Distribution of the error relative to the actual instantaneous heart rate was close to normal with a maximum value of 25 beats/min, the average quadratic deviation of 7.2 BPM and 95%confidence interval 14,1 beats/min

The way pathophysiologically oriented monitor control of autonomic processes of the person at which the measurement and calculation of the estimated heart rate exercise for each cycle of the heartbeat is a basic oscillation period with reference to absolute time, allows to increase the precision of these estimates.

Example 2:

Conduct monitoring control pulmonary blood pressure. Allocate the main periods of the oscillation - cycle contractions of the heart and the respiratory cycle. The measuring period is the cycle of contraction of the heart. Carry out the measurement of pulmonary arterial pressure, debatecountry interval (two respiratory cycles) is shown in figure 4. The start time of the measurement is the same for all monitored indicators linked to absolute time. Carry out the calculation of estimated parameters: systolic, diastolic and average lung art is financial pressure for each cycle of the heartbeat, given the start time of the cycle and the start time of the measurement. Assessment of pulmonary arterial pressure, systolic, diastolic and average for each cycle of cardiac contractions are shown in table 1.

The calculation of the average of the estimated pulmonary arterial systolic pressure, diastolic and average spend per respiratory cycle is required for pathophysiological analysis period of time.

Table 1
Time (h:m:s:MS)Pulmonary arterial systolic pressure (mm RT. Art.)Pulmonary arterial diastolic pressure (mm RT. Art.)Pulmonary arterial pressure mean (mm RT. Art.)
8:48.06.55251721
8:48.07.44211317
8:48.08.39211115
8:48.09.23211116
8:48.10.12261519
8:48.11.01251721
8:48.12.79211317
8:48.13.66221116
8:48.14.54261419
8:48.15.34251721

Performance assessment of pulmonary arterial pressure, calculated and presented on the monitor screen Agilent M4 MA on time 8:48: systolic pressure is 25 mm Hg, diastolic - 17 mm Hg, mean 20 mm Hg

Averaged over the first respiratory cycle (8:48.06.55-8:48.10.12) pulmonary systolic arterial pressure was 22,8±0.9 mm Hg and differed from the electrode by 9.6%, for the second respiratory cycle (8:48.11.01-8:48.15.34) it amounted to 23.8±0.8 mm Hg, and differed from the testimony of the monitor by 5%.

Averaged over the first respiratory cycle (8:48.06.55-8:48.10.12) diastolic pulmonary arterial pressure was 13,4±0,95 mm Hg and differed from the electrode 27%, for the second respiratory cycle (8:48.11.01-8:48.15.34) it was $ 14.4±0,95 mm RT. Art. and differed from the electrode 18%.

The average pulmonary arterial pressure average for the first respiratory cycle (8:48.06.55-8:48.10.12) was 17,6±0,88 mm Hg and differed from the electrode 14%, for the second respiratory cycle (8:48.11.01-8:48.15.34) it was 18,8±0,83 mm Hg and differed from the testimony of the monitor by 6%.

Error estimates calculated and submitted by the monitor, ranged from 5 to 28%.

The way pathophysiologically Orien the new monitor control of autonomic processes of the person, when the measurement and calculation of estimated pulmonary arterial pressure is carried out for each cycle of the heartbeat and the breathing cycle - main periods of the oscillations, with reference to absolute time, allows to increase the precision of these estimates.

The way pathophysiologically oriented monitor control of autonomic processes of man, which consists in measuring cardio - and hemodynamics, calculating estimates of these indicators and performance assessments indicators on the monitor, characterized in that the measurement and calculation of estimates for each indicator of cardio - and hemodynamics carried out for the main oscillation period corresponding to the cycle of the heartbeat and the breathing cycle with reference to absolute time according to the formula,

where f(n) is the average value of the controlled parameter for the n-th measurement period, ton - the start time of the nth measurement period, TP is the duration of the n-th measurement period, τ - current time, f(τ) - instantaneous value of the controlled parameter.



 

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FIELD: medicine.

SUBSTANCE: method involves measuring cardio- and hemodynamic values, calculating estimates of the values and displaying the estimates on monitor. Measuring and calculating each cardio- and hemodynamic value is carried out during basic periods of their oscillations corresponding to heart contraction cycle and respiratory cycle related to absolute time.

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4 dwg, 1 tbl

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SUBSTANCE: selected reference point in every cardiac cycle on TP-segment. Values of neighboring N=2n+1 reference points also belonging to TP-segment are recorded, n=1,2,…, beginning from the first reference point. Other reference points are set to zero. The central reference point value is left without changes in a group of 2n+1 member. Reference point values of each of n pairs of reference points symmetrically arranged relative to the central reference point are scaled relative to condition Uj=U0Kj, where U0 is the central reference point amplitude, Uj is amplitude of j-th reference point pair, j=1,2,…,n is the number of each reference point pair relative to the central reference point, Kj is the scaling coefficients determined from received signal suppression condition of the first n spectral zones in spectrum. The so formed electrocardiogram signal reference point groups sequence is let pass through lower frequency filter with isoline drift signal being obtained being produced on output. The signal is amplified and subtracted from the initial electrocardiogram signal that is preliminarily delayed for lower frequency filter delay time. Device has the first lower frequency filter, discretization unit and unit for selecting anchor reference points connected in series, as well as subtraction unit, unit for saving N reference points, scaling unit, the second lower frequency filter, amplifier and delay unit. Output of the unit for selecting anchor reference points is connected to the first input of memory unit the second input of which is connected to discretization unit output. Each of N memory unit outputs is connected to one of N inputs of scaling units. Scaling unit output is connected to the second lower frequency filter input which output is connected to amplifier input. Amplifier output is connected to the first input of subtraction unit, the second output of subtraction unit is connected to delay unit output. Its input is connected to output of the first lower frequency filter. Subtraction unit output is the device output.

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2 cl, 8 dwg

FIELD: medicine, anesthesiology-resuscitation, traumatology, surgery.

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EFFECT: higher efficiency and accuracy of diagnostics.

4 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.

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18 dwg, 3 tbl

FIELD: medicine; medical engineering.

SUBSTANCE: method involves recording patient electrocardiogram in maximum comfort state in one lead and photopletysmogram. Vascular tone index (VTI) is measured as time interval from next in turn R-tooth peak to the next following pulse oscillation. Set of values is built and statistically processed. Mode value MoVTIR is calculated as patient rest state characteristic to estimate current functional state of patient regulation and control systems. Electrocardiogram in maximum comfort state is recorded in one lead and photopletysmogram at the same time. A set of RR-intervals and time intervals from next in turn R-tooth peak to the next following pulse oscillation is built and statistically processed. Amo, Mo and MoVTI values are calculated to estimate current functional state of patient. Neighboring cardio-interval values are additionally measured and mean square deviation MSDP is calculated and then variational pulse ametria SAT index is calculated from formula SAT=0.1 x Mo/MSDP and integral regulation and control system stress index of patient (IRCSS)is calculated from formula IRCSS=(SAT) x [1+(Movtir-MoVTI)MoVTI. Patient organism regulation and control system state is estimated as one corresponding to normative neuropsychic stress characteristic for rest state or when working without significant psychic tension with IRCSS value being within interval from 40 to 300, working neuropsychic stress characteristic for significant tension belonging interval from 300 to 900. Neuropsychic overstress showing necessity of rest belongs to an interval from 900 to 3000. Neuropsychic overstress threatening health belongs to an interval from 3000 to 10000. Attrition showing emergency of escaping from the current state with obligatory cardiologist advice takes place when the value is greater than 10000. The device has unit for recording electrocardiogram, data processing unit and calculation unit connected to estimation unit with its output and unit for recording pulse oscillations, analog-to-digital converter unit having inputs connected to electrocardiogram-recording unit and pulse oscillations-recording unit outputs and its output are connected to calculating unit inputs via the data processing unit, and display unit for showing patient regulation and control systems state. Units for processing and calculating are manufactured on microprocessor base. Signals are form on exit from the microprocessor, their values being corresponding to integral regulation and control system stress index value of a patient(IRCSS). The unit for recording pulse oscillations is designed as electronic transducer set on patient finger. The unit for recording electrocardiogram, records cardiac pulses in single lead.

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3 cl, 2 dwg

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4 ex, 5 tbl

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