Method of pulse-measuring evaluation of functional condition and character of vegetative regulation of human cardio-vascular system

FIELD: medicine; cardiology.

SUBSTANCE: method allows registering differential sphygmograms by means of computer and piezoelectric transducer providing high precision. Registration is carried out continuously and doesn't take much labor input. On the base of sphygmograms by using method of finding of "coding" points, two main characteristics of heart beat rate can be found by express analysis. Two main characteristics have to be rhythm and pulse oscillations of arterial pressure induced by periodical throwing of shock volume of blood into aorta. Algorithm of data processing which is developed on purpose, provides automatic placing of "coding" (received on the base of calculation) points onto averaged graph of cardiologic cycle that provides higher precision of determination of amplitude-time parameters at any recognized normal pulsation of selected fragment of pulsogram together with additional visual correction of localization of those points. Fragment of pulsogram with duration of no less than 2 minutes (standard duration equals to 5 minutes) is used for measuring and analyzing time factors which characterize rhythm of heart beating and its variability. After that the calibration factor is calculated to transfer conditional units of computer "digitization" into common units of measurement of blood arterial pressure (in mm of mercury column) and values of pulsation increase in blood arterial pressure in mm of mercury column are determined by integrating cardiologic cycles at selected fragment of pulsogram for corresponding areas. The meanings achieved are used for calculating all the amplitude-time cardiologic hemo-dynamic factors which depend on blood arterial pressure and which characterize systole of myocardium of left ventricle and elastic-resilient properties of walls of arterial channel. Continuous monitoring of changes in amplitude-time factors of pulsogram is provided as well as practically real time scale of getting of all the computational data and quick performance of all the mathematical transformations for making spectral analysis of variability of heart beat rate and selected amplitude-time cardiologic hemo-dynamic factors to determine their total and differential spectral power of oscillations. Results of static and spectral analysis of variability of measured parameters the functional condition and character of vegetative regulation of cardio-vascular system are estimated due to comparison of measured values with average statistical numerical values of the same factors which were specified for cardio-vascular system in relation to age, sex, state of health and signs for groups of people chosen as a test group.

EFFECT: improved precision; widened number of informative factors for estimation of cardio-vascular system.

8 dwg, 2 tbl

 

The invention relates to medicine, namely cardiology, and can be used for non-invasive rapid analysis of the functional state of the cardiovascular system (CVS) of the person and the nature of its regulation of the autonomic nervous system and other regulatory systems of homeostasis. On the basis of the invention have developed a new diagnostic device for comprehensive and, at the same time simple to perform examination CCC person using a computer-based recording and analysis of heart rate and fluctuations of the arterial wall during the passage of the pulse wave. The invention can be used for the diagnosis of cardiovascular diseases in the clinic during routine medical monitoring of the health status of different population groups, as well as in medical prognostic studies to assess trends in the development of functional preclinical changes in CCC and the probability of their output within the permissible limits.

Development and improvement of methodologies and technical tools for early diagnosis of the state of SSA person is an extremely important task in modern conditions, because this system is the most vulnerable to physical and emotional (stress) stress the part of the body and that of cardiovascular patologia morbidity, of morbidity and mortality is sustainable in the first place in developed countries. The most important role in the regulation of CAS and to adapt its functions to the changing conditions of the external and internal environment plays an autonomic nervous system (ANS). Therefore, the current system is a comprehensive survey of the CAS should include the assessment of vegetative regulation of this system.

Until recently, the system of this survey CCC constructed primarily on the basis of variation-statistical and spectral analysis of kardiointervalogrammy obtained using the method of electrocardiography (ECG) (for example, such known systems as "Ankara", "Incart", "Holter for Windows", "SphygmoCor Px" and others).

Famous patented method of diagnosis for heart rate using ECG for reception and accumulation of the R-interval for a certain period of time, and then analyzed [1].

However, used in such systems and methods ECG method, despite its high relevance in the study of the dynamics of the electrical excitation of the heart and broad applicability when conducting spectral analysis of heart rate variability, may not sufficiently appreciate cardiohemodynamic, the contractile properties of the myocardium and the state of the vascular tone. At the same time, patients often functional on is osenia, what is happening in the myocardium and blood vessels, precede the changes detected using ECG. Therefore, in recent years actively developing systems that use other ways of non-invasive study of the state of CVS.

Widespread method of ultrasonic echocardiography, allowing non-invasive assessment of a number of important cardiovascular and hemodynamic characteristics of CAS. However, this method requires complex and expensive equipment, highly qualified operator and considerable time of the survey, which reduces its value as a method for rapid information.

Further progress in this direction has been associated with the creation of specialized systems analysis CCC, based on the registration of amplitude and time parameters of pulse waves in the form of electrical signals resulting from conversion of special sensors mechanical signals from moving under the influence of the wave pulse pressure of the walls of arteries - sphygmography (SFG) or from changing under the influence of the pulsating blood flow amounts of tissue - plethysmography. Based on the photo and impedance plethysmographically and other sensors (for example, using a compression cuff) were created, such as "DynaPuls", "inapres", "Portapres and others [2], largely comprising plethysmography with sphygmography, and the method is called volume sphygmography (OSFG). At the same time saves the high cost of these devices and the complexity of the decoding results. For example, when using relatively inexpensive ($499) system DynaPuls" you want to send initial information on the Internet" in a special commercial analytical center in California for its interpretation, which creates additional difficulties and significantly increases the cost of the survey.

Closest to the claimed is a Method of assessing the functional state of the cardiovascular system", which is carried out by measuring arterial blood pressure (BP) and registration of SFG for one respiratory cycle in order to determine the average duration of one cardiac cycle and rise time pulse pressure (t, MS) [3]. This method allows using the proposed empirical formulas for the value of "t", diastolic and pulse pressures to give a rough estimate in units of the severity of functional stress under the influence of physical activity. However, it cannot be used as a method of complex examination of CCC because of the limited number of studied parameters and the inability you the effect of the dynamics of changes over time are important for diagnosis indicators, limitation in the analysis of only a few of pulse waves of a single respiratory cycle. For this reason, a patented method may not be applied for the spectral analysis of variability of amplitude and time parameters when determining the nature of the vegetative regulation of CVS.

The closest in essence to the claimed method is a method that uses sensors to register OFG with subsequent mathematical differentiation pulse curves [4]. The disadvantage of this method is that the recorded signal is reflected pulse changes and arterial, capillary, and venous blood supply to tissues, at different changing their volume. This leads to a damping of the signal, smoothing or, on the contrary, the complexity of the contour graph of the cardiac cycle and the loss of significant parts of the recorded curve. Differentiation such pulsogram facilitate temporal analysis graph "encoding" points, but does not increase the accuracy and usefulness of the survey, which further leads to uncertainty in the assessment of the status of CCC, and the limited number of registered cardiocycle does not allow to analyze the impact of the regulatory systems of the organism in the state of CVS.

Analysis of the current state of the problem of pulse diagnosis CCC has led to the yodu on preferences and the availability of using the generator (induction and piezoelectric sensors for direct reception of differential sphygmogram (DSFG) with the pulsating area of the body over the artery [5]. This possibility has emerged in recent years in connection with industrial creating compact and highly sensitive piezoelectric transducers with a wide band of operating frequencies and high resonance frequency (>2000 Hz) [6]. Such sensors are among the most accurate and allow you to convert mechanical stress on the sensor directly into an analog electrical signal that can be recorded graphically as a curve of the rate of change of the force of impact. The development of computer technology has opened up the possibility of overcoming difficulties that arise when quantitative processing and analysis of large volumes of produced polysomatism information [7]. It became possible to conduct continuous monitoring of changes of amplitude and time parameters pulsogram, obtaining design data almost in real time, as well as fast execution of complex mathematical transformations to identify periodic components in the oscillation amplitude and time parameters of pulse curves to assess the significance of their contribution in providing the necessary kardeogemodyinamiki.

The invention was a method for noninvasive examination of the functional state of SSA person, allowing a high fine is stew, continuously, within a reasonable time and not difficult to perform recording pulse curves and for him to make a rapid analysis of the two main characteristics of the pulse and rhythm and b) pulse fluctuations in blood pressure caused by periodic ejection of stroke volume into the aorta. To this end, we developed a computer version of the method DSFG, in which the sensor was used not used previously for this purpose simple and convenient to mount on pulsating body technical device for other purposes, commercially available (sound Converter type "PO" with a metal membrane on the inner side of which is affixed a piezoceramic element in providing such a sensor sensitivity of about 0.5 mm Hg/s at its own resonant frequency over 2600 Hz). Specially developed software (SOFTWARE) and data processing made simple for the operator (and any persons who do not have medical training, but carefully observe the instructions for the user) conduct automated registration curve DSFG, the measurement for the selected fragment pulsogram its amplitude-temporal parameters and receiving results of the analysis of a wide range of indicators, taken together, is about characterizing the functional state of the CCC and its regulation by ANS and other regulatory systems.

The invention is illustrated the accompanying drawings, and charts, which depict: figure 1 - structural diagram of the device for polysomatism survey; figure 2 - functional diagram of the device interface signal with the computer; figure 3 - block diagram of the data processing algorithm; figure 4 - example of a complete pulsogram and selected from it fragments; figure 5 is a fragment of DSFG with the selected set of individual pulses and the graph of the averaged cardiac cycle; figure 6 - examples of the three main types of graphs cardiac cycle.

The device for implementing the method polysomatism examination of the cardiovascular system contains (1) the piezosensor 1, the output of which is connected with input devices 2 connected to the computer 3. Information is displayed on the monitor 4. Second input of the computer 3 is connected to the output of the sphygmomanometer 5.

The device 2 consists of an amplifier 6 (figure 2), the output of which is connected to the input of analog-to-digital Converter 7 (ADC)associated with the conversion unit 8, the output of which through the block matching 9 is connected to the computer. The clock pulses from the output of clock 10 (GTI) are fed to the conversion unit 8. The power of the whole circuit is supplied from the power source 11. The analog signal from the sensor, amplified to the required amplitude, is fed to the input of the ADC, where it is quantized with the certain sampling frequency (in our device uses a frequency, equal to 200 Hz, and accordingly, the time interval between the timing or duration of discrete quantization - Δt=5 MS) and digitized. Further information is transmitted to the conversion unit 8, which clock pulses from the GTI produces control signals for the ADC and prepares the data for transmission through the block matching 9 serial channel on the transmitter computer with appropriate software.

The way polysomatism survey CCC is as follows (figure 3). The examined non-invasive by using the piezosensor installed above the pulsating, superficially located Central (e.g., carotid or peripheral (e.g., finger or temporal) artery, remove the signal and continuously registering it in the RAM of the computer. On figa as an example, presents stretched in full screen graph DSFG duration 25 min, registered with the finger artery of the thumb of the left hand of a young (23 year) men in the study of the effect of orthostatic stress on his CAS. In this form pulsogram stored on the hard drive of the computer in a file for later analysis. Then in this file write information about the patient (name, age, sex, blood pressure, medical history, tentative diagnosis, and others) and the measurement parameters (date, time, duration register is tion, and others). In the next step, in accordance with the purpose of the research (in the present case the effect of orthostatic stress on CCC) choose slices DSFG. On figb presents selected five-minute fragment pulsogram registered in the supine position (fragment 1, conditional control, 5 min prior to lifting), figv is also a five-minute segment in the standing position (fragment 2, with 15 to 20 minute orthostatic stress). These fragments duration is usually not less than 2 minutes (the standard duration - 5 minutes) can be stored in separate files for further analysis. To improve the accuracy of comparative analysis of the characteristics of the selected fragments DSFG with define the temporal boundaries of these fragments, which allows to calculate the strictly corresponding indices.

Schedule DSFG reflects the rate of change of HELL at different stages of the cardiac cycle during the entire period of the survey and represents each of cardiocel in the form of a complex circuit with a characteristic kinks. This allows, in accordance with theory of information using special computer algorithm on the graph DSFG to emphasize certain points: zero (the intersection with the contour), the extreme and the inflection point as "coding" (settlement, reference points and to measure and then calculate all amplitude-time parameters and indicators. Proper placement of these points is essential to the accuracy and reliability of measurement results and the procedure requires additional clarification. With this purpose, selected as an example of a fragment DSFG (figure 5-I) using the computer distinguish all individual ripple and put them on the schedule for a single cardiac cycle, combining the coordinate of the maximum positive extremum (figure 5-II). Then this set automatically build a graph of the averaged ripple (figure 5-III) and select "encoding" point, the user visually checks and, in case of an error, corrects. Identify normal the teeth on the chart DSFG and drop the false teeth from a set of pulsations. To do this, calculate the threshold amplitude (horizontal line in figure 5-II), with respect to which searches for the absolute systolic maximum (most positive extremum) graphics DSFG above this threshold. Criterion drop is a sharp deviation of the amplitude-time parameters of the analyzed teeth from the average (more than 3 standard deviations). Remaining after the procedure drop set of teeth is a set of ripples, reflecting the rate of change of HELL blood. Then the principle of the adjusted arrangement of reference points on the graph Sredne the Noah ripple is automatically transferred to each of the recognized normal pulsation (figure 5-IV).

The position of the "coding" of the data points DSFG determine all the timing settings and indicators. The calculation of the amplitude characteristics of the signal containing information about the size of HELL blood, requires additional calibration data for translation to a common unit of measurement of blood pressure (mm Hg). For this computer check signal from the sensor in the form of a curve DSFG accompanied by periodic measurement of systolic (SBP) and diastolic (DBP) blood pressure using a sphygmomanometer. These values are entered into the computer to calculate the average PAD (=GARDEN-dad) for the selected period of the survey. The correlation of this directly measured in mm Hg size PAD with an average PAD, computed in the same period in units of a computer "digitizing" by integrating relevant areas of the selected fragment of the curve DSFG, allows to determine the calibration factor of proportionality HELL. Taking into account this factor is calculated in mm Hg, the pulse magnitude increase in HELL the blood at various stages of the cardiac cycle and calculate all indicators that depend on HELL of blood and characterizing cardiohemodynamic and the elastic properties of the vascular wall of an arterial channel. This allows long and nepr is sustained over time monitoring of the dynamics of pulse fluctuations HELL of blood during the entire period of the survey in conventional units - mm Hg can provide the required level of confidence in the statistical processing of the measured amplitude-temporal parameters, it becomes possible to carry out the spectral analysis of their variability, including, with different effects on the body (load tests, and medications and other), as well as the comparison of the results of surveys made at different times.

Figure 6 shows examples of the three main types occurring graphs of individual cardiac cycle and options for the location of these charts "coding" points.

Types (1) and (3) graphs correspond to CCC young and the elderly, type (2) are typical for most adults (25 to 55 years) people.

Graphics DSFG represent the first derivative graphs according to changes in blood pressure from time to time (SFG) with the passage of the pulse wave that determines mathematically unambiguous location of point a as the start point necroticism phase of the expulsion of blood, corresponding to the moment of opening of the aortic valve. At this point HELL=DBP and the first derivative of SFG is equal to zero, which allows to draw through this point a horizontal contour that defines the area under and/or above the curve of the graph, reflecting the increase or decrease in blood pressure in the arteries during the passage of the pulse wave caused by the ejection of stroke volume of crowies of the left ventricle. Point b corresponds to the moment of reaching the maximum speed of the systolic increase in blood pressure (absolute positive extremum DSFG); point C - point, the maximum value of blood pressure in the result of the expulsion of blood from the left ventricle during systole (point of intersection of the contour of the descending part of the systolic pressure wave, the first derivative of SFG at this point is equal to zero); the point D is the end of the expulsion of blood (closure of the aortic valve, the negative extremum DSFG prior to the increase dicrotism AD) [4]; point F - point maximum rate of increase in HELL, due in early diastole dicrotism wave blood pressure, reflected from the closed aortic valve; point G - point maximum values of secondary systolic increase in HELL due to early (before the closure of the aortic valve) reflected from the periphery of the primary wave pulse blood pressure.

Given the "International standards" [8], as well as the official methodological recommendations of the group of Russian cardiologists [9], in the time domain according to the "encoding" points to measure and analyze all key indicators of heart rate and its variability: the average duration of the detected R-interval (between adjacent dots "In figure 6), the average duration of normalizewhitespace - TNN and also the duration of the individual phases of the cardiac cycle; assess the variability selected for measurement of time parameters (calculate SD, DX, CV, RMSSD, pNN50, and others).

"Encoding" point is used to determine (see Fig.6) in conventional units computer "digitizing" the average for the selected fragment DSFG size PAD - integration over the area covered by the ordinates between points a and C, if the area between points C and G is less than or equal to zero, or between points a and G, if the area between points C and G is greater than zero. As already mentioned, the comparison of this quantity PAD with an average PAD, measured by using a sphygmomanometer, allows to convert conventional units "digitization" in the conventional units of mm Hg and calculate in these units, all the indicators of the pulse changes the HELL blood at certain periods of the cardiac cycle during the whole time of the survey:

value of accelerated necroticism increase in HELL during the systolic ejection of blood into the aorta from the left ventricle - ΔDousk [mm Hg] (integration over the area covered by the ordinates between the points a and b, figure 6 selected hatching tilted to the left);

- the value of delayed necroticism increase in HELL during systole - ΔAdesam [mm Hg] (integration over the area covered by the ordinates between points b and C or b and , see below);

value dicrotism increase in HELL blood in the phase of accelerated growth in the initial period of diastole - ΔHaddock [mm Hg] (integration over the area covered by the ordinates between the points D and F, figure 6 highlighted by shading with a slope to the right). This value is clearly identified on all curves DSFG reflects the tone of blood vessels arterial determining peripheral resistance at the level of the arterioles, which are the cause of the reflected pulse waves;

- the value of the secondary wave of growth in HELL due to early reflected from the peripheral resistance wave pulse pressure during systole - ΔADOS [mm Hg], manifested or during katikati, or phase delayed necroticism ejection of blood (determined by integrating over the area covered by the ordinates between the points C and G). Negative or zero value of the integral of the square corresponding to the undulating catachrestically change the AD on the chart DSFG individual cardiac cycle (figure 6-2 this area of the selected horizontal hatching), characteristic of healthy adults with elastic and at the same time elastic aortic walls. Young and especially in physically trained people with very elastic walls of the aorta this wave is extinguished and may be almost zametnoi (Fig.6-1). Positive values of the integral of the square CG (ΔADOS greater than zero), increasing the GARDEN and PAD and AdminStudio delayed necroticism phase of systole (figure 6-3 this area of the selected horizontal hatching), indicate an excess of normal elasticity (stiffness) of the wall of the aorta that appear with age and under the influence of risk factors for cardiovascular diseases (such as diabetes, Smoking). This increase in HELL due to the fact that the decrease in elasticity of the walls prevents the expansion of the aorta under the influence of the incoming reflected from the peripheral resistance of the pressure wave of blood, and increased the speed of wave propagation on the vascular wall [10] provides a faster return and earlier overlay on the primary systolic wave. Considering the above, if ΔADOS greater than zero, in order to conduct comparative assessments of the contractility of the left ventricle different surveyed to determine the magnitude of the normalized pulse blood pressure - Padn=PAD-ΔADOS [mm Hg].

These values calculate derivatives kardiogemodinamicheskuyu indicators:

- the average speed of the systolic increase in blood pressure in a period of rapid necroticism ejection of blood into the aorta[mm Hg/sec]

where tsub> AB- the duration of the period AB;

- maximum speed of this growth - Vmax [mmHg/s], defined by the ordinate of the point C. these values are not significant impact (not imposed) reflected from the peripheral resistance of the pulse wave of the blood pressure and, therefore, they, together with the normalized value of Padn display it contractility of the myocardium of the left ventricle and the condition of the aortic valve, i.e. characterize the efficiency of the pump (discharge) function of the heart;

- kardiogemodinamicheskuyu index -that also characterizes the contractile efficiency (pump) functions of the left ventricular myocardium and may serve as an indicator of the development of stenosis of the aortic valve and tightening the walls of the aorta. Determine the parameters characterizing the elastic properties of blood vessels arterial:

- the index of the stiffness of the walls of the aortaif ΔADOS greater than zero.

- the index of the tone of the arterial wall,

where ΔHaddock - accelerated microtechnique increase in HELL blood in the initial period of diastole.

As an example, Table 1 shows the results obtained using the proposed method and characterize the effect of orthostatic stress on serdechnyi, cardiohemodynamic and the elastic properties of the vascular arterial healthy young (the subject - I, 23,) and elderly (the subject - II, 69 L.) men. The results show that orthostatic load affects the functional state of the CCC and the young and elderly men and nature of this influence varies with age. Load leads to an increase in heart rate in both subjects, but the young man this increase is more pronounced and is accompanied by increased variability (significantly reduced the amplitude of fashion duration of NN intervals in the histogram). Both the subject while maintaining the average speed necroticism increase in blood pressure in the phase of rapid expulsion of blood from the left ventricle increases the maximum rate of growth in HELL. This revealed a different orientation changes kardiogemodinamicheskuyu index (CGDI) in subjects: the I-th (CGDI decreased from a rate of 1.51 to 1.08) while maintaining the magnitude of the normalized PAD orthostatic stress has resulted in the redistribution of the relative contribution of fast and slow anachronistic increments HELL due to a decline in the share of ΔAduck (from 28 to 24 mm Hg); the second examined (CGDI increased from 0.47 to 0.69) in terms of the load required level of ADN was saved put the m increases relative contribution Δ Aduck (from 15 to 19 mm Hg). On the basis of these unit provided in the example data, it is possible to Express the assumption that the observed age-related peculiarities of changes of indicators kardeogemodyinamiki functionally associated with changes in the elastic properties of the vascular wall of an arterial channel at the subject. The young man wall and the aorta and elastic arteries (the value of IGO less than zero) and adequate circulation when the load is provided by the increased tone of the walls of arteries (value ITAR increases with 0,308 to 0.743). An old man with a rigid vessel walls adequate circulation in orthostatic load is provided by the reduction of vascular tone (value ITAR decreases with 0,632 to 0,497). The example illustrates the advantages of the proposed method, compared to, for example, is widely used in cardiology practice the method of the ECG, which is limited to receiving information only about the temporal characteristics of the cardiac rhythm.

Using the algorithm of Fourier transforms, conduct spectral analysis curve DSFG as heart rate variability (variability of the duration of NN intervals - TNN)and the variability of the parameters characterizing cardiohemodynamic and arterial vascular tone: Padn, Vmax, Δ Haddock and others, depending on research objectives. As an example, figure 7 and 8 shows the graphs of the power spectra of fluctuations of the number of indicators examined - I (see above and Table 2), obtained by studying the effect of orthostatic stress on the body in the supine position (background, Fig.7) and standing (load, Fig). Determined total (TR, 0.003÷0.4 Hz) and differentiated on a standard frequency bands (HF, 0.15÷0.4 Hz; LF, 0.04+0.15 Hz; VLF, 0.015÷0.04 Hz; ULF, 0.003÷0.015 Hz) spectral power fluctuations of the selected indicators. Table 2 shows the results of spectral analysis of heart rate variability (largest TNN) and normalized pulse arterial pressure (Padn) the young (I) and the elderly (II) the subject. It is seen that under orthostatic stress on the body increases the contribution of sympathetic ANS in regulation of heart rate relative to parasympathetic dominance, and the young man this redistribution is expressed to a much greater extent, as compared to older men (index sympathovagal balance - SVI at first increases from 1.5 to 8.8, and the second from 2.6 only to 3.9). Less significant in magnitude and opposite in sign to the identified changes sympathovagal balance of vegetative regulation of Padn the same subject. Orthostatic load is not casalbordino impact on the total spectral power (TP) variability of Padn young man, but more than 2-fold increased TR an old man (from 10.3 to 24,0 [mm Hg]2). You can see that both surveyed in orthostatic load is a significant redistribution of the relative participation of the regulatory systems in maintaining the required level of hemodynamics. Relatively slow humoral-metabolic regulation, identified lying mainly in the ULF range (70% and 65% of the quantities TR I and II patients, respectively) giving way to a more rapid neurogenic regulation (in the LF range, for example, the spectral power variation of Padn the examined - I increases from 11% to 41%).

Thus, the inventive method extends the range of the study of the nature of autonomic and humoral-metabolic regulation CCC man, opening the possibility of studying the physiological mechanisms of regulation of blood flow, which are based not only monitor cardiac rhythm and hemodynamic parameters associated with pulse changes the HELL blood. The comparison of the results of the spectral analysis of variability of different parameters allows to obtain qualitatively new information about the role and relative contribution of the sympathetic and parasympathetic divisions of autonomic nervous system, as well as other regulatory systems homeos the Aza in the control of cardiac rhythm, and functional characteristics of the myocardium and smooth muscle structures of the walls of arterial vessels, jointly determine the dynamics of the pulse changes the HELL to ensure physiologically adequate circulation.

According to the results of the statistical and spectral analyses of the variability of the measured parameters (selected depending on the objectives of the study) to assess the functional status and the nature of the vegetative regulation of the CAS examined by comparing the measured values with the average numerical values of these indicators established for CCC defined by age, sex, state of health (history) and environmental conditions of groups of people, selected as a control. Based on the application of special methods of statistical analysis (discriminant, dispersion or factor) these results can be used to address issues of differential diagnostics of CCC patients.

Thus, the use of piezoceramic sensor in combination with computer Desk and analysis DSFG allowed us to develop a simple on the implementation of the automated method is accurate quantitative rapid analysis of a wide range of already known and some new indicators that collectively characterize the function the national state of the CCC and its regulation by the ANS.

On the basis of the developed method can be created in a sample of arterial piezopolymers in the form of a compact and inexpensive attachment to a computer or component of a universal multifunctional system cardiocrinum can provide need to equip these appliances domestic clinics, diagnostic and recreational sports centers, specialized sanitation facilities and similar profile medical institutions. Easy maintenance Autonomous version polysomatism console to a personal computer allows you to use this device for regular individual patient surveys and large-scale observation of CAS in different populations (e.g., students, military personnel, employees of enterprises increased risk, contingent working in remote locations, and so on). The proposed method makes it possible operational control state CCC man in the stress effects of unfavorable environmental conditions, as well as monitoring the status of CCC representatives of the professions associated with continuous and hard work, as air traffic controllers, pilots, astronauts and others

Table 1
The effect of orthostatic stress on the indicators of the functional state of the cardiovascular system of young and elderly people.
IndicatorsThe subject - I (23 g)The subject - II (69 HP)
LyingStandingLyingStanding
Heart rate:
The frequency of the Intel atom & trade;. abbreviations heart rate, beats/min56805761
AVG. duration-here NN intervals (TNN), MS10707501060980
STD. reject-e NN intervals (SDNN), MS51592621
Fashion NN intervals (MoNN), MS10807651045970
The amplitude of fashion NN-intervals s (AMoNN), %44,128,067,551,5
The share is great, for example by transferring them nearby. the interval for s (pNNSO), %30,88,900
Cardiohemodynamic:
Normalized PAD (Pads), mm Hg47474546
STD. reject-e Padn (SD), mm Hg5,54,65,27,5
Hasten. anukret. the increase in HELL (ΔAausc), mm Hg28241519
AVG. ADJ. growth of HELL (V), mm Hg/s335352210214
Maxscore. increase PAD (Vmax), mm Hg/s703801437519
Kardiogemodinamicheskuyu index (CGDI)1,511,080,470,69
The elastic properties of blood vessels:
The stiffness index of the aorta (IGO), %--a 38.523,2
The index of the tone of the arterial wall (ITAR)0,3080,7430,6320,497

Table 2
The effect of orthostatic stress on the performance of spectral analysis, the characteristic is karisawa features of autonomic regulation of the cardiovascular system of young and elderly people.
Performance variability spectral analysisThe subject - I (23 g)The subject - II (69 HP)
lyingstandinglyingstanding
a) heart rhythm:
The total spectral power (TP), MS2400066811297885
Range. the power of high frequency (HF), MS2125540710077
Range. the power of high frequency (HF), %31689
Range. the power of low frequency (LF), MS218453576258296
Range. the power of low frequency (LF), %46542033
Range. powerful-th low frequency (VLF), MS23911738456203
Range. powerful-th low frequency (VLF), %10263523
Range. powerful-te ultralow frequency (ULF), MS2510 960483309
Spectron-TB ultra-low frequency (ULF), %13143735
Sympathovagal index (SVI)1,58,82,6a 3.9
b) size Pads:
Summary. range, power (TP), [mm Hg]229,631,910,324,0
Range. powerful-here are high frequency (HF), [mm Hg]22,98,51,18,0
Range. the power of high frequency (HF), %9,9271133
Range. power-efficiency low frequency (LF), [mm Hg]23,213,11,89,9
Range. the power of low frequency (LF), %11411741
Spectroscopist h from (VLF) [mm Hg]22,77,20,71,9
Range. the powerful. ultra-low frequency (VLF), %9,22378
Range. the powerful. ultralisk. frequency (ULF) [mm Hg]2 20,83,16,74,2
Range. the powerful. ultra-low frequency (ULF), %70106518
Sympathovagal index (SVI)1,11,51,61,2

Sources of information

1. The description of the patent RU №2200461 "Method of diagnosis heart rate and device for its implementation", published 20.03.2003, Authors: Gmolden and Ausatralia.

2. Langewouters G.J., Settels J.J., R. Roelandt, K.H. Wesseling Why use Finapres or Portapres rather than infra-arterial or intermittent non-invasive techniques of blood pressure measurement? // J Med Eng Technol. 1998. vol.22. p.37-43.

3. The description of the patent RU №2013990 "Method of assessing the functional state of the cardiovascular system", published 15.06.94. Authors: Jurrah-Zadeh and Specifici.

4. Nuraliev and Ismaelites. Atlas hemodynamic studies in the clinic of internal diseases. - M.: Medicine, 1975. 238 C.

5. Uselogin. A diagnostic method for the parameters of oscillatory and wave processes in the cardiovascular system // in the book: Pulse diagnosis in Tibetan medicine. - Novosibirsk: "Nauka", 1988. S-98.

6. Bee, Wedgelike, Aaaaaw. Pulse sensors for practical diagnosis in Tibetan medicine // in the book: Pulse diagnosis in Tibetan medicine.- Novosibirsk: "Nauka", 1988. P.64-77.

7. Avimelech, Valery A. Orlov. The use of computational methods and modeling in the study of the cardiovascular system // Proc.: research Methods blood circulation. - Leningrad: "Nauka", 1976. - s-270.

8. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use // European Heart Journal. 1996. Vol.17, p.354-381.

9. Rembowski, Guy, Lvjian and other Analysis of heart rate variability using different electrocardiographic systems - Moscow. 2002. 50 pages

10. ACI. Biophysical bases of circulatory and clinical methods of studying hemodynamics - Leningrad: "Medicine", 1974. 311 pages

The way polysomatism assessment of functional status and the nature of autonomic regulation of the cardiovascular system of man, in which we surveyed in a state of relative rest and under load test a non-invasive method of differential sphygmography using the appropriate sensor register pulsogram, which examined using the method of "coding" of points, wherein the removable sensor analog pulsogram signal is converted into a digital signal, which is continuously recorded and analyzed by computer, and in parallel to periodically measure blood pressure (BP) blood sphygmomanometer, then choose the fragment pulsogram duration not less than two minutes, which is used to plot the averaged cardiac cycle and the definition of "coding" points, the principle of arrangement which is transferred to each of the recognized normal pulsation of the selected fragment and then it temporary measure indicators of heart rate and its variability, on the same fragment pulsogram determine the average pulse blood pressure (ADP) in conventional digital units by integrating the corresponding portion of the curve differential be noticed and then comparing this value with the average value of the PAD measured in the same period a sphygmomanometer, determine the calibration factor of proportionality HELL and recalculate given conventional digital units in mm Hg and them expect the magnitude of the increase in arterial blood pressure at different stages of the cardiac cycle, which then determine the amplitude and time kardiogemodinamicheskuyu indicators of myocardial contractility of the left ventricle, namely:

normalized pulse blood pressure - Padn;

kardiogemodinamicheskuyu index -,

where ΔAduck and ΔAdesam respectively faster and slower necroticism increase in blood pressure is;

medium - V and maximum Vm speed necroticism increase in blood pressure in the phase of rapid expulsion of blood from the left ventricle;

and upregulations properties of the walls of arterial vessels, such as

the stiffness index of the walls of the aorta,

where ΔADOS - increase in blood pressure due to reflected from the periphery of the wave pulse pressure during systole, and

the index of the tone of the arterial wall,

where ΔHaddock - accelerated microtechnique increase in arterial blood pressure during the initial period of diastole,

followed by statistical processing of all indicators and perform spectral analysis of heart rate variability and selected amplitude and time kardiogemodinamicheskuyu indicators, which assess functional status and autonomic regulation of the cardiovascular system of the subject by comparing the indicators with the average control values for the same indicators established for specific age, gender, health status and other characteristics of the control groups of people.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves evaluating the following rhythmogram values: CV% - R-R interval variability coefficient; RMSSD ms - interinterval values; pNN50% - rapid rhythm frequency and spectrogram changes: TP ms2- total spectral power; LF ms2 - spectral power in low frequency bandwidth from 0.04 to 0.15 Hz; HF ms2 - spectral power in high frequency bandwidth from 0.15 to 0.4 Hz; VLF ms2 - spectral power in very low frequency bandwidth from 0.003 to 0.004 Hz. Rhythmogram and spectrogram values being equal to: CV -4.5±0.2; RMSSD ms - 25.6±1.6; pNN50 - 7.3±1.1; TP - 998.3±74.2; LF - 300.3±33.1; HF - 291.1±39.0; VLF - 407±43.9, high activity of sympathetic division of vegetative nervous system (sympathicotonia). Rhythmogram and spectrogram values being equal to: CV -11.4±0.5; RMSSD ms - 114.7±7.9; pNN50 - 63.3±2.1; TP - 9360±952.1; LF - 2206±249.0; HF - 5323±668.8; VLF - 1832±445.3, high activity of parasympathetic division of vegetative nervous system (vagotonia).

EFFECT: high objectivity of criteria.

2 tbl

FIELD: medicine.

SUBSTANCE: method involves carrying out electrocardiogram examination and recording late ventricular potentials by applying signal-averaged electrocardiography approach. RR-interval deviations within a day, QT-interval variances, left ventricle output fraction value are calculated. Personality anxiousness is analyzed. Signs of late ventricular potentials and combinations of other parameters under study being observed within subacute myocardial infarction stage, malignant ventricular rhythm disorders are to be predicted to occur within post-infarction cardiosclerosis period.

EFFECT: high accuracy of prognosis.

FIELD: medicine; radio electronics.

SUBSTANCE: device can be used for monitoring of heart activity as well as for self-diagnosing of exacerbation of disease. Electrocardiograph monitoring portable unit has multi-channel unit for reading electrocardiograph, multiplexer, keyboard with register, microprocessor with common bus, analog-to-digital converter, indication and signaling unit provide with register, and removable memory card with register. Device provides current monitoring of heart activity and helps to detect exacerbation of disease as well as slowed testing of development of exacerbation in hospitals due to inspecting data stored at removable memory card.

EFFECT: simplified design; improved reliability.

1 dwg

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.

EFFECT: high accuracy in estimating functional state of human organism regulation and control system.

3 cl, 2 dwg

FIELD: medicine, cardiology.

SUBSTANCE: in children and teenagers one should carry out variation pulsometry to register the values obtained in the mode of patient's free activity during the day. One should evaluate variability values of cardiac rhythm - rMSSD pNN50 and variability of arterial pressure. In case of decreased rMSSD, pNN50 and daily index of arterial pressure and increased coefficient of arterial pressure variation one should diagnose pre-clinical stage of diabetic autonomic cardiovascular neuropathy despite disease duration.

EFFECT: higher efficiency of pre-clinical diagnostics.

2 ex, 2 tbl

FIELD: medicine, electrocardiography.

SUBSTANCE: the present innovation deals with measuring parameters of electrocardiosignal (ECS) ST-segment and their analysis to detect deviations against the norm. At every step of quantization one should form the readings of first-order differences and modules of first-order differences. One should memorize N of readings for the modules of first-order differences coming after ECS readings that correspond to the onset of cardiocycle. Then it is necessary to sum up memorized values of modules and at every step of quantization one should compare the obtained current sum value with previous one. It is necessary to memorize the greater of them and according to maximal value one should form threshold level to compare current value of modules sum. Time moments when sum value is at first greater and then lower against threshold level one should consider to be, correspondingly the onset and the end of ST-segment. Time segment between the onset and the end of ST-segment should be considered as duration of ECS ST-signal. Device to isolate ECS ST-signal on-line contains a block for forming ECS, a block for primary ECS processing, a quantization block, a block for isolating the point of cardiocycle onset and measurement of its duration, a block to form first-order differences, a block to form modules of first-order differences, a block to memorize readings for the modules of first-order differences, a block to detect the number of summarized readings for the modules of first-order differences, a summarizing block, a block to form a threshold level, a block for comparison and a key device. The innovation enables to isolate ST-segment more reliably for wider class of electrocardiograms at different modifications of QRS-complex form.

EFFECT: higher efficiency.

2 cl, 12 dwg

FIELD: medicine; cardiology.

SUBSTANCE: device for processing intervals of electrocardiogram has plate with Q-T (J-T) and R-R scales applied onto the plate. Plate is additionally provided with legs, rod and scale pointer at the end, arrows, and catches disposed at ends of Q-T (J-T) scale, Q-Tc (J-Tc) correlated values curves and Q-Tc (J-Tc) scale related to them. Rod is divided by axis to parts to relate as 1:5 in such a way that shorter part of rod has to be movable leg and longer part has to be the pointer of Q-T (J-T) scale. Pointer takes "0" position of Q-T (J-) scale to rest against left catch when legs close up. Motionless arrow is disposed onto longer part of rod under pointer of Q-T and/or J-T scale at level of "0" position of R-R scale. Slider with lock is mounted onto pointer to move along pointer. Slider is provided with two arrows. Formulas for building curves of Q-Tc (J-Tc) corrected values are given.

EFFECT: higher speed and comfort at processing of electrocardiograms.

3 cl, 8 dwg, 1 tbl

FIELD: medicine, cardiology.

SUBSTANCE: one should register a rhythmocardiogram, detect spectral values for variability of cardiac rhythm, calculate the value of autonomic index, calculate the value of autonomic tonicity by the following formula: AI/lnTp m sq. sec., where AI - autonomic index, lnTp - total power for the spectrum of variability of cardiac rhythm. At values above 3.1 one should diagnose severe flow of autonomic dystonia syndrome, at values being 3.1-2.2 - moderate flow of the mentioned disease, at values ranged 2.1-1.5 - light flow. The method enables to predict the development of hemodynamic disorders.

EFFECT: higher efficiency and accuracy of diagnostics.

3 ex

FIELD: medicine; functional medicine.

SUBSTANCE: method in based upon remote irradiation of human body with set of super wide-band electromagnet pulses with duration of 0,2-1,0 ns, repetition rate of 0,05-30,0 MHZ and average density of flow of energy at irradiated part of human body being equal or less than 0,2 mcW/cm2. Modulation component of pulse repetition rate is selected from received reflected signal which pulse repetition rate is determined by heart activity, which is used for forming heart beat rate signal. The latter is used additionally for estimating index of stress which value of index of stress is included into transmitted communication message of mobile phone.

EFFECT: prolonged monitoring of functional condition of human.

3 cl, 2 dwg

FIELD: medicine; cardiology.

SUBSTANCE: electrocardiogram of patients suffering from arterial hypertension is subject to twenty-four-hours monitoring. Spectral analysis of variability of heart beating is carried out. Very low frequency, low frequency and high frequency wave components are selected. General, day and night strength of wave components of heart beating is determined. Any factor is estimated according to the data taken from the spreadsheet. Generalized factor Z is calculated by original mathematical relation. Value of Z is used for judging on level of influence of hormones of adrenal gland onto pace-maker activity of sinus node.

EFFECT: comfort at usage; higher efficiency at non-invasive application.

2 ex, 2 tbl

FIELD: medical equipment.

SUBSTANCE: device can be used in practical and sports medicine. Device has breath detector and pulse rate detector, clamp having ability of fastening to frame of glasses, joint mounted onto clamp, unit in form of clip for placing light source and photo-resistor which both are parts of pulse rate detector, and pipe. Breath thermal detector is mounted at one end of pipe. The pipe is mounted in clamp for displacement to control position of breath detector in projection of jet of breath-out air. Pulse rate detector is connected with joint through flexible wires. Wires of thermal detector are placed inside pipe. Pulse rate detector and breath detector are connected with corresponding amplifiers through joint. Output of any amplifier is connected with commutator.

EFFECT: simplified design; improved comfort for patient.

2 dwg

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.

EFFECT: high accuracy in estimating functional state of human organism regulation and control system.

3 cl, 2 dwg

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.

EFFECT: high reliability of the results.

18 dwg, 3 tbl

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

SUBSTANCE: according to 4-point scale one should evaluate the state of 10 clinical, hemodynamic and instrumental values in patients: patient's skin by detecting its color and moisture; hemodynamic values: heart rate, systolic arterial pressure, central venous pressure, shock index; central nervous system by studying the value of Glasgow scale; respiratory system - the frequency of respiratory movements and blood saturation; cardio-vascular system - myocardial necessity in oxygen. Each value has its own point, moreover, 0 points corresponds to that fact that the index under inspection is within age standard, 1 point - when physiological parameters at rest are different against the standard, but their functions are compensated by organs of one or two systems, 2 points - compensation is kept due to alterations in more than 2 systems and it reaches its peak, 3 points correspond to adaptation failure or affected function of one or several systems, and the sum of points being 0-4 in patients one should diagnose the absence of hemorrhagic shock, at 5-9 points - the severity of hemorrhagic shock corresponds to degree I, at 10-19 points - to degree II, at 20 points and more - to degree III.

EFFECT: higher efficiency and accuracy of diagnostics.

4 ex, 1 tbl

FIELD: medical engineering.

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.

EFFECT: reliable removal of isoline drift.

2 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: method involves recording electrocardiogram and cardiorhythmogram on the background of medicamentous therapy beginning from 7-10 day of the disease. The cardiorhythmogram is shown to the patient. Respiratory training session is carried out. Inspiration and expiration are to be equal in duration, each making Ѕ of cardiorhythmogram breathing wave.

EFFECT: enhanced effectiveness of treatment.

2 cl, 3 tbl

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 contactless investigation of the functional state of the cardiovascular system in the electromagnetic field, harmless to humans

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

Up!