Ecg control with lower false alarms of asystole
SUBSTANCE: patient's monitor comprising: EEG recorder (14, 20) controlling patient's (10) electrocardiographic signal (40); a secondary physiological signal monitor (16, 20) controlling a second patient's physiological signal (50) simultaneously with the EEG recorder controlling patient's electrocardiographic signal; an a alarm detector (42, 44) configured to detect the alarm on the basis of the patient's electrocardiographic signal; alarm verification device (52, 54, 56) configured to verify the alarm on the basis of pulse component regular pattern of the simultaneously controlled second patient's physiological signal; and an alarm indicator (24, 26, 58) configured to generate the perceived alarm by the alarm detector and to verify the alarm by the alarm verification device.
EFFECT: alarm verification.
12 cl, 5 dwg
The present application relates to medicine, medical monitoring, physiological monitoring, patient safety and related areas.
Electrocardiographic (ECG) monitoring is well known as the traditional method of control of the patient. A qualified cardiologist or other qualified health diagnostician can extract essential information from the waveform, repetition rate and other aspects of the shape of the ECG signal as a function of time. For more routine monitoring of patients ECG provides continuous information about the frequency of cardiac contractions and the nurse or other health worker can identify the urgent problem of the patient, based on large changes in the ECG signal.
Of special interest under the supervision of the patient is quick and accurate detection of cardiac arrhythmias, such as ventricular fibrillation or asystole. Ventricular fibrillation is a condition in which the heart loses self-control and begins to beat a random or pseudo-random manner is a condition that requires attention. Asystole needs more urgent attention - colloquially it is referred to as "fading", in which the heart completely stops beating, the condition, also known as cardiac arrest. Asystole damage th the ESD of the brain and death within a few minutes and therefore should be treated immediately. In the hospital or other medical institution, the detection of the asystole triggers the event "code blue" (required resuscitation), which is called the resuscitation team to try to revive the patient.
ECG preferably provides a quick and generally accurate detection of asystole. When ECG is hard to find asistoliei because ECG directly controls the heart rate, and if the ECG device stops working, then the result will likely be a zero signal, similar to the status of "straight line", which will result in the event of the need for resuscitation. As a result, it is very unlikely that the ECG will give an indication of "false negative" events, i.e. will be unable to detect the actual occurrence of asystole.
However, the ECG may be susceptible to the event of "false positive" events, in which asystole is indicated, when in fact the patient's heart is beating normally (or, at least, is not in a state asystole). Such false positive events can be caused by disconnected electrodes or other failure of one or more ECG electrodes, caused, for example, the normal movement of the patient. Other causes of false positive events are "failures" ECG, saturation of the signal and so on. Each false positive detection is systole results in the need for medical staff to operate in an emergency mode, and may cause unnecessary event immediate resuscitation.
It is believed that approximately 90% or more of all detection events asystole are actually false positive events in which the patient is not experiencing cardiac arrest, ECG but falsely indicates a state of awe. The costs of these false positive detection events asystole include lost time medical workers, responding to a false event, the stress for all health care workers in the work zone, the stress for the patient who discovers that his medical monitor suddenly emits a loud acoustic alarm or otherwise indicate an emergency condition, and a dulling of attention of medical personnel to such condition as he may refuse to respond urgently to the actual stop of the patient's heart.
On the other hand, the price of a single false negative detection events asystole is that the patient can get brain damage or die because of the delay of medical care to the patient in cardiac arrest.
Attempts were made to reduce the number of false positive detection events asystole, analyzing the ECG signal or complementing the ECG signal other simultaneously receive information on the control of the patient, such as arterial blood pressure is. For example, Aboukhalil et al., "Reducing false alarm rates for critical arrhythmias using the arterial blood pressure waveform", Journal of Biomedical Informatics, vol. 41, pp. 442-51 (2008), revealed the approach in which the ECG signal is complemented by a heart rate arterial blood pressure (ABP). In this approach, the concern with asistoliei suppressed, if the pulse period period ABP signal less than the threshold value. This approach assumes that the frequency of the pulse APB correlated with the cardiac cycle, so that if the pulse period period ABP is shorter than the threshold value, then the pulse APB corresponds to the cardiac cycle, indicating that the sinking detected on ECG, must be an error.
The problem is that the existing methods reduce false positive detection events asystole also significantly increase the likelihood of false negative events, i.e. the ability to "skip" a real event asystole. For example, the approach Aboukhalil, etc. can potentially suppress the real alarm upon detection of asystole, if the noise or artifacts in the signal APB had to create a sequence of pulses APB with periods below the threshold value.
The following are the new and improved devices and methods that solve the above-mentioned and other tasks.
In accordance with one disclosed aspect of the patient monitor includes: electrocardiog the AF, controlling electrocardiographic signal of the patient; monitor secondary physiological signal that controls the second physiological signal of the patient simultaneously with the electrocardiograph controlling electrocardiographic signal of the patient; a detection unit alarm condition, made with the possibility of detection of the alarm condition based on the electrocardiographic signal of the patient; a device confirm the accuracy of the alarm condition, is configured to validate the alarm condition based on the regularity of the pulse of the pulsating component simultaneously controlled the second physiological signal of the patient; and alarm indicator, made with the possibility of creating a human-perceivable alarm with simultaneous detection of the alarm condition, the device detection alarm and validate the status of the alarm device confirm the accuracy of the alarm condition.
In accordance with another disclosed aspect of the method of control of a patient includes the steps are: control electrocardiographic signal of the patient; controlling the second physiological signal of the patient simultaneously with the control of the electrocardiographic signal of the patient; detect status is their anxiety, based on the electrocardiographic signal of the patient; confirm the validity of the alarm condition based on the regularity of the pulse of the pulsating component simultaneously controlled the second physiological signal of the patient; and generate a human-perceivable alarm, provided confirmation of the correctness of anxiety through validation.
In accordance with another open option opens a storage medium that stores the commands executed by the digital processor to perform a method of monitoring a patient as described in the previous paragraph.
One advantage consists in reducing the number of false positive detection events asystole without a parallel suppression of false negative detection events asystole.
Another advantage is to provide a substantial reduction in the number of false positive events asystole, increasing, thus, the accuracy of detection events asystole based on ECG.
Additional advantages will become apparent to experts in the art after reading and understanding the subsequent detailed description.
Fig.1 - schematic representation of the control system of the patient with the discovery and validation events asystole is.
Fig.2 is a schematic view additional details component calculating the index of regularity of the impulse (PRI), shown in Fig.1.
Fig.3 - schematic representation of the signal plethysmogram with the index of regularity of the impulse (PRI), computed from signal of plethysmogram.
Fig.4 is a schematic depiction of a three-channel ECG signal simultaneously controlled signal plethysmogram and index of regularity of the impulse (PRI), computed from signal of plethysmogram, for the time interval that contains two true events asystole.
Fig.5 is a schematic depiction of a three-channel ECG signal simultaneously controlled signal plethysmogram and index of regularity of the impulse (PRI), computed from signal of plethysmogram, for a time interval containing one false asystole event.
It reveals a way to validate alarms due to asystole event detected on ECG, based on the information about the rhythm and amplitude of the secondary physiological signal, such as signal arterial blood pressure or signal plethysmogram. The open method validation not only makes use of the instantaneous pulse period period secondary physiological signal, but also contains a brief indication of the regularity of the pulses of the and, to confirm the accuracy of the events asystole detected by ECG. Opens the index of regularity of the impulse (PRI), which summarizes, on merinosnoy basis, short-term symptom of rhythm and pulse amplitude secondary physiological signal from the point of view of regularity. The PRI value represents the degree of short-term regularity of the pulse and is used to validate the concerns in connection with asistoliei detected by ECG.
During asystole regular pulses (from the point of view of rhythm and amplitude) does not arise. It is unlikely that regular pulses can be chaotic noise or artifacts. Accordingly, the open approach to validation, using PRI, has a high reliability when the confirmation of the true worries in connection with asistoliei detected on ECG, with the rejection of false alarms due to asistoliei detected by ECG. PRI is calculated on merinosnoy basis, at least during the alarm in connection with asistoliei detected by ECG. The PRI value, calculated for the last discovery cycle pulses (before the event asystole), is checked to confirm the accuracy of anxiety in connection with asistoliei. This process is so efficient computationally and provides quick confirmation of the correctness of the alarm with the ides with asistoliei, detected by ECG.
With reference to Fig.1 patient 10 is located on the couch 12 or, alternatively, may stand, sit, be in an ambulance or other vehicle for emergency purposes or placed, or otherwise. Although shown in the drawing, the patient 10 is human, it is also assumed that the patient may be an animal, as it happens in the case of veterinary medicine. The electrodes 14 are attached to the patient 10 to obtain electrocardiographic (ECG) signals. The sensor 16 detects the secondary physiological signal. For example, sensor 16 may be a pulse oximeter mounted on the finger, toe or other part of the body of the patient 10, or other sensor that detects the signal plethysmogram, or sensor arterial blood pressure (ABP) or other sensor of blood pressure and so on. The sensor 16 detects the second physiological signal (i.e. in addition to the ECG signal detected by the electrodes 14). The second physiological signal is a pulsating component of the signal, essentially, with a regular pulse repetition period and pulse amplitude during normal physiological state.
The monitor 20 of the patient monitors the ECG signal detected by the electrodes 14 ECG, and controls the signal plethysmogram, the ABP signal or other WTO the ranks of the physiological signal, detected by the sensor 16. In other words, the monitor 20 of the patient at the same time serves as an electrocardiograph, which monitors the ECG signal, and as a secondary monitor a physiological signal, which controls the signal plethysmogram, the ABP signal or other secondary physiological signal detected by the sensor 16. An alternative may be provided separately ECG and monitor secondary physiological signal (not shown). The monitor 20 of the patient includes a display 22 that displays one or more monitored physiological parameters such as ECG signal, the signal plethysmogram and the respiration signal in the illustrative example shown in Fig.1.
The monitor 20 of the patient further comprises one or more indicators of anxiety for the formation of a human-perceivable alarm during alarm condition, such as shown, for example, the visual indicator 24 alarms displayed on the display 22 while the alarm condition (preferably, distinctive and conspicuous manner, such as flash in red color or etc.), and shown, for example, a speaker 26 that provides an acoustic alarm during alarm condition. Alarm condition that can visually and acoustically indicated by elements 24, 26 contain at least the event asystole and may not necessarily contain other events threatening the life and health, such as the event of ventricular fibrillation, the cessation of breathing and so on. In addition or as an alternative shown for example indicators 24, 26 alarms it is assumed that an alarm condition is indicated remote indicator, located on the post of the nurses (not shown). It also assumes a single type of alarm indicator (visual or acoustic).
The digital processor 30 is provided for the controlled processing of physiological signals, such as measured ECG signal and controlled ABP, plethysmogram or other secondary physiological signal, to detect and confirm the validity of the alarm condition. The digital processor 30 may be differently located and implemented and may contain two or more digital processors. In the shown example embodiment, the digital processor 30 is a component of the monitor 20 of the patient; alternatively or additionally, the digital processor may be located on the post of nursing and is implemented as a computer, which receives and processes physiological signals, controlled by the monitor 20 of the patient and so on. As another example, the digital processor may include a first processor located in the monitor 20 of the patient that receives the ECG signals and the second physio is logicheskie signals and performs alarm detection, and the second digital processor located in the computer for the post of nursing, which performs validation of alarm.
Also it should be understood that disclosed here are methods of detecting an alarm and confirm whether the alarm can be respectively implemented as a storage medium that stores the commands executable by the digital processor 30 to perform detection alarm and confirm the accuracy of the alarm. Such media can contain, for example, one or more of the following: hard disk, or other magnetic storage medium; an optical disk or other optical media, random access memory (RAM), a persistent storage device (ROM), flash memory or any other electric or electrostatic storage media and so on.
As shown in Fig.1, the digital processor 30 is configured to detect and confirm the correctness of an alarm detected on the ECG. The detected signal 40 ECG is processed by the detector 42 asystole to detect a status of "fading", in which the ECG signal does not show a pulsating behavior indicating a heartbeat. In block 44 the decision is determined whether the detected asystole, based only on the signal 40 ECG. No matter what, had been whether the detected asystole, the blocks 40, 42, 44 processing are repeated looping, to provide continuous monitoring of the ECG signal in the presence of state asystole. This is indicated by the arrow feedback in Fig.1, indicated by the decision of "Yes or No" (Yes or no).
If the block 44 decision based only on the signal 40 ECG, determines that the event asystole was detected (indicated by an arrow in Fig.1, indicated by the decision "Yes"), the correctness of anxiety in connection with asistoliei confirmed, based on the signal 50 plethysmogram, which is controlled by plethysmogram received by the monitor 20 of the patient and the sensor 16. It is shown, for example, the signal 50 plethysmogram may be replaced by a signal APB or other secondary physiological signal showing the pulsating component of the signal with the presence, in essence, the regularity of the pulse repetition period and pulse amplitude during normal physiological state. To acknowledge an alert in connection with asistoliei created for only one ECG signal 50 plethysmogram (or other secondary physiological signal with a pulsed component, which is not an ECG signal) is processed by a block 52 calculating the index of regularity of the impulse (PRI), to construct an index of regularity of the impulse (PRI), quantitatively assessing the regularity of the pulse is Lisa pulsating component in a controlled second physiological signal 50. The calculated PRI is compared in block 54 comparison with the criterion of confirmation. Based on this comparison, the block 56 confirm concerns asistoliei decides whether to be confirmed alarm in connection with asistoliei created based on ECG alone. If the concern with asistoliei confirmed, you receive a human-perceivable signal 58 concerns asistoliei, for example, by activating the loudspeaker 26 to radiate acoustically perceived concern with asistoliei, and/or displaying visually perceptible indicator 24 alarm on the display 24 of the monitor 20 of the patient, or activate an acoustic and/or visual alarm on duty nurses (not shown) and so on.
Criterion validate properly determined by training the discovery and confirmation of the correctness of the corresponding training set of ECG signals and the second physiological signals simultaneously received from multiple calibration patients, in which the training set is marked asystole. For example, based on this training, properly defined threshold value for PRI, so that each actual event asystole duly confirmed (no false negative events), and when compared with PRI training is surrounding the threshold of a significant number of events concerns asistoliei, created by ECG alone, are unconfirmed. In some embodiments, the implementation of the training can be performed for patients with different characteristics to create different criteria validation for different classes of patients. For example, shown in Fig.1 embodiment, is training for the various classes of ages (for example, class infancy, class pediatric age class adult class elderly), and the switch 60 definitions PRI and criterion validation selects the definitions of the PRI for use in block 52 the calculation of PRI and criterion validation for use in block 54 comparison based on entered the age of 62 patients. Adjustment for different classes of patients may take the form of adjusting the threshold criterion, or adjust the quantification formula PRI, or definition, or both.
With reference to Fig.2 is an example implementation of block 52 calculating the index of regularity of the impulse (PRI) is described as an illustrative example. In General, the calculation of PRI entails the use of the detector 70 of the pulse, which detects the pulses of the pulsating component of the secondary physiological signal and the block 80 PRI calculation based on the information from the b to the pulse amplitude and the pulse repetition period for the detected pulses. In the form shown in Fig.2 embodiment, PRI is calculated on merinosnoy the basis for the current pulse, based on the current momentum and N the immediately preceding pulses. The value of the positive integer N is selected to provide sufficient information for a meaningful evaluation of pulse amplitude and regularity of the pulse repetition period during the current pulse, but should be sufficiently small to ensure that the PRI, which has no significant effect much earlier pulsating behavior. In General, N should be greater than or equal to two, and in some embodiments, the implementation is greater than or equal to three. In some described examples use N=4, so that analyzed the N+1 pulses (including the current pulse and N immediately preceding pulses) are in the amount of five pulses. Assuming that the pulsating signal is compatible with a heart rate of approximately 60 to 150 beats per minute, N+1=5 pulses are from about two seconds to five seconds of information. Again, can use other values of N. For each current pulse PRI is calculated based on characteristics of rhythm and amplitude obtained from the current pulse and the N immediately preceding pulse. To confirm the accuracy required the OIG in connection with asistoliei, detected by ECG to confirm the correctness of the alarm events in connection with asistoliei only checks PRI from the current pulse immediately preceding or following immediately after the alarm events in connection with asistoliei.
In General, the detection of 70 pulse can be considered the peak or the beginning of the pulse as a reliable point of reference pulse. Shown for example in Fig.2 detection 70 pulse is performed using a method similar to that described in the work Zong and others, "An open-source algorithm for detection of ABP pulse onset", Computers in Cardiology, 29:345-48 (2003), which is fully incorporated into the present description by reference. This method uses the start pulse as a reliable point of reference. Controlled signal 50 plethysmogram is filtered by the filter 72 lowpass with a cutoff frequency of, for example, approximately 15 Hz (although assumed and other cut-off frequency). Filtered by the low pass filter signal plethysmogram then converted into a signal a function of the total tilt (SSF) using 74 total tilt, which facilitates the detection of the beginning of the pulse. Adaptive threshold and local search 76 are applied to the signal SSF to find the pulse and the process of local search locates the beginning of the pulse.
Here, however, a problem may occur if the secondary physiologically the cue signal 50 has no ripple component. This can, of course, be expected, for example, during actual events asystole. To resolve this situation, there is a forced detection 78 pulse, which defines one or more pulses of the set of N+1 pulses, as forced detection pulse when pulse controlled component of the second physiological signal 50 with no pulses at a pre-selected time interval. That is, when no pulse is not detected for more than 2 seconds (or other pre-selected time interval) after the last detected pulse, forced detection pulse is defined as one of the N+1 pulses. Forced detection pulse is marked as such, so that it is specially processed during computation 80 PRI. Alternatively, it is assumed to assign forced detection pulse amplitude by default, and the pulse repetition period by default (according to its nearest-neighboring pulses).
Operation 80 creation of the PRI takes a temporal sequence of N+1 pulses as input. In this illustrative example calculations PRI any force detection pulse generated by operation 78, is treated exactly the same as normal detection pulse for p the following analysis of the characteristics of the pulse repetition period and pulse amplitude. For each pulse (including in this example, any force detection pulse) information about the amplitude and the pulse repetition period is calculated as the statistical characteristics marempolskoho period (PP) and the statistical characteristics of the pulse amplitude, and analyzed for N+1 pulses. Statistics PP and amplitude can be obtained as follows: for the current pulse, denoted byPiand the N immediately preceding pulse, denoted byPi-nn=1,..., N, compute the following variables: (i) the number of forced detection, denoted byFDNUM(ii) the average value marempolskoho period (PPI), denoted byPPIMEAN, (iii) standard deviation of the PPI, denoted byPPISD; (iv) the average value of the N+1 pulse amplitudes, denoted byPPAMEAN; and (iv) the standard deviation of the amplitudes of the N+1 pulses, denoted byPPASD.
In this illustrative example of the calculation of the PRI to represent the statistical characteristics of the information about the pulse repetition period and pulse amplitude are fuzzy variables. Define the following three fuzzy variables: "PPIMEAN_is_Reasonable", "PPISD_is_Small" and "PPASD_is_Small".Standard functions, namely S-function and the Z-function, are used as membership function. S-function is a function and Z-function is defined as follows:
Using S-function and the Z-function as the membership function, the fuzzy variables for this illustrative example of the calculation of the PRI are defined as follows:
µPPI-Mean-R=S(PPIMEAN;200,400)∧Z(PPIMEAN; 1500, 2000)(3),
wherePPIMEANOZNA the AET average PPI value among the considered N+1 detection pulse; the unit of measurement parameters is MS; and the operator∧is the standard fuzzy intersection:µAnd∧µIn=min[µAnd,µIn]."PPISD_is_Small"can be specified using the Z-function as the membership function:
|µPPI-SD-S=Z(PPISD/PPIMEAN; 0,1, 0,2)||(4)|
wherePPISDis the standard deviation of the PPI from among the considered N+1 detection pulse."PPISD_is_Small"can be specified using the Z-function as the membership function:
|µPPA-SD-S=Z(PPASD/PPAMEAN; 0,1, 0,2)||(5)|
wherePPASDis the standard deviation of the amplitude from pulse to pulse (PPA) andPPIMEANmeans the average value of the PPA from among the considered N+1 detection pulse. In addition, a binary variable, "No_Forced_Detections" is specified using Boolean function:
whereFDCountis the amount of force detected from among the considered N+1 detection pulse; Boolean(True)=1, Boolean(False)=0. Composite fuzzy variable "Pulses_are_Regular" is obtained from the following reasoning fuzzy logic (i.e. fuzzy conditional operator:
µ"Pulses_are_Regular ' =µNFD∧µPPI-mean-R∧(µPPI-SD-S∨µPPA-SD-S), whereµNFD,µPPI-mean-R,µPPI-SD-S,µPPA-SD-Staken from equations (3)-(6) and the operator∨is the standard fuzzy connection:µAnd∨µIn=max[µAnd,µIn]. Fuzzy variable "Pulses_are_Regular"has a value between 0 and 1, where a value of 1 represents the best short-term regularity of the pulses and the value 0 represents the worst short-term regularity of the pulse (that is, essentially, no regularity of pulses). The PRI value is assigned to the value of the fuzzy variable" Pulses_are_Regular":
For example, the calculation of the PRI works in the following way. For secondary physiological signal (e.g., signal 50 plethysmogram or signal APB) found the beginning (or, alternatively, peak, or other reliable point) of each pulse. If no pulse is not detected for more than 2 seconds (or within another pre-selected time interval), then forced the detection pulse. For each detected pulse (or forced detection pulse) the value of PRI is calculated in accordance with equation (8) and is connected with the pulse. PRI indicates short-term regularity of the pulse associated with the pulse, where "short" is determined by the time interval N+1 pulses, including the current pulse, which is accounted for in the calculation of the PRI.
The above definition PRI made for a class of adult patients. For patients of other classes (e.g., pediatric patients) switch determine the PRI and the switch criterion validation can adjust the PRI value or threshold criterion, or both, to provide a useful confirmation operation rights is lnasty for these patients.
In Fig.3 shows an illustrative example of the calculation of the PRI. The upper curve in Fig.3 shows the original signal plethysmogram, whereas the lower curve in Fig.3 shows PRI calculated using equation (8) for N=4. Each vertical line in Fig.3 denotes the beginning of the pulse. Used single force detection pulse, which is marked "F" on the vertical line corresponding to the force detection pulse. As expected, the PRI has a value of one (1) in areas where the signal plethysmogram has a clear visual regularity, and PRI is reduced to zero (0) in the Central region of Fig.3, where the regularity of the signal plethysmogram has a clear visual irregularity.
Again referring to Fig.1, in block 54 comparison PRI is compared with the criterion of validation to confirm the accuracy of anxiety in connection with asistoliei detected by ECG. At timeiwhen an alarm is released in connection with asistoliei detected on ECG, PRI associated with the last pulse prior to the timei,or simultaneous with it, compared with the criterion validation. For an illustrative example of the calculation of the PRI criterion validation is, accordingly, a threshold validate denoted by Thr, if the PRI more than the threshold Thr validate (i.e. PRI>Thr), the concern with asistoliei created on the basis of ECG alone, is rejected as a false alarm; otherwise, the concern with asistoliei accepted as a true alarm in block 56 decision-making and activates a human-perceivable alarm 58 in communication with asistoliei.
In the shown embodiments, implementation, there is only one secondary physiological signal (shown as signal 50 plethysmogram) for use in validation. If for confirmation of correctness are two (or more) secondary physiological signal, they can be used when calculating PRI for each secondary physiological signal and selecting one of the calculated PRI. For example, in the case when more PRI indicates greater regularity of the pulse, the criterion of validation is accordingly a threshold that must be exceeded in order to dominate the concern with asistoliei detected by ECG. In this case, in block 54 comparison respectively used maximum PRI calculated from the two available secondary physiological signals (for example, when the available signals and plethysmogram, and ABP).
The window size N and the threshold Thr validation can be optimized using obecause the set of annotated with concerns in connection with asistoliei, detected by ECG and related ECG signals and secondary physiological signals (e.g., ABP or plethysmogram). When actually held a training session at the training were chosen N=4 and Thr=0,5. For training was used annotated dataset of 65 entries, of which all records had data signal plethysmogram and 11 also had a data signal ABP. This training set was composed in 756 patients of the intensive care unit and provides a total of 1916 hours (with a mean of 28 hours/write) continuous ECG signal and the parallel signals ABP and/or plethysmogram. The training set contained 147 alarms due to asistoliei specified ECG alone. Of these 147 alarms, according to the expert, 15 alarms were true positive events (i.e. the actual events asystole) and 132 were false positive events. Held training system validation using only the signal plethysmogram to confirm the correctness, declined 46% of false alarms due to asistoliei detected on ECG, not rejecting any of the 15 true events concerns asistoliei. When the system validation was used ABP signal (when available) to replace the signal plethysmogram, 52% of false alarms due to asistoliei found the Oh ECG, were rejected, and again no true alarm event in connection with asistoliei was not rejected. When used in conjunction ABP (when available) and plethysmogram 59% of false alarms defined on the ECG, were rejected, again without rejecting any true alarm events in connection with asistoliei.
In Fig.4 shows an example in which the true concern with asistoliei detected on ECG, has been properly stored (i.e. confirmed as a true alarm) system validation, shown in Fig.1, trained as described here. The upper three curves show three-channel ECG. Two (real) concerns asistoliei were issued by the device detecting asystole ECG, as indicated by thick vertical lines that pass through curves three-channel ECG. Second from the bottom curve is simultaneously received by the signal plethysmogram, whereas the lower curve is the PRI calculated from signal plethysmogram. When asystole detected ECG signal plethysmogram loses the regularity and the calculated PRI reduced to zero, even though the signal plethysmogram still ripple through breathing. During each of the two (true) alarms due to asistoliei detected on the ECG, it is observed that the value of PRI low (essentially zero and below, what is Thr=0,5, which was the threshold obtained during the training; both concerns asistoliei detected on ECG confirmed as true positive alarms due to asistoliei. On the lower two graphs thinner vertical lines that pass through only the lower two curves (i.e. curves plethysmogram and PRI), indicate the detection of the start pulse. Three forced detection pulse are indicated by vertical lines, labeled "F".
In Fig.5 shows an example of a false alarm due to asistoliei detected on the ECG, which was rejected (i.e. not confirmed) system validation, shown in Fig.1, trained as described here. The upper three curves show three-channel ECG. Only a false alarm due to asistoliei was issued by the device detection of asystole on the basis of the ECG, as indicated by a thick vertical line passing through graphics-channel ECG. Second from the bottom curve is simultaneously received by the signal plethysmogram, whereas the lower curve is the PRI calculated from signal plethysmogram. False asystole event, as determined by ECG, was issued due to the low amplitude of the ECG signals. However, the signal plethysmogram continued to behave regularly during this event asystole, detecting the negative ECG, and the calculated PRI remained equal to 1, indicating a high degree of regularity of pulsation. In the beginning (false) events asystole detected on ECG, PRI was more than established in the training Thr=0.5 and, thus, the concern with asistoliei detected on ECG was rejected (i.e. has not been confirmed).
In the preceding examples of embodiments anxiety is a state of anxiety due to asistoliei, which is detected using ECG, and confirmed, based on the quantitative assessment of the regularity of the pulse secondary physiological signal (e.g., plethysmogram and/or signal APB). However, using the disclosed methods, can be detected and confirmed by other alarm condition. For example, the alarm event due to ventricular fibrillation is easily detected by the ECG signal. Validation of detected events ventricular fibrillation can also be checked based on the quantitative assessment of the regularity of the pulse secondary physiological signal (e.g., plethysmogram and/or signal APB), as disclosed here. To validate the alarm events due to ventricular fibrillation, it may be preferable to use additional filtering to remove noise, as the alarm event in St. the zi with ventricular fibrillation entails not fully stop the pulsation of the heart, but rather random nature of the pulsations of the heart. The training criterion validation to validate the event of an alarm due to ventricular fibrillation should use training data with labeled events alarms due to ventricular fibrillation alone or in addition to marking events asystole (if present in the training data).
The present application describes one or more preferred embodiments. Specialists in the art after reading and understanding the preceding detailed description can be proposed modifications and changes. This implies that the application should be interpreted to include all such modifications and changes as they fall within the scope of the appended claims or their equivalents.
1. Patient monitor, comprising:
electrocardiograph (14, 20), controlling electrocardiographic signal (40) of the patient (10);
monitor (16, 20) secondary physiological signal that controls the second physiological signal (50) of the patient simultaneously with the electrocardiograph controlling electrocardiographic signal of the patient;
device (42, 44) detection of the alarm condition, made with the possibility of detection of anxiety in connection with asistoliei, where e is chromatographically signal of the patient does not show a pulsating behavior, specifies the beating of the heart;
device (52, 54, 56) confirm the accuracy of the alarm condition, designed to confirm the correctness of anxiety in connection with asistoliei, based on the fact whether the index (52) the regularity of the pulses (PRI), quantitatively assessing the regularity of the pulse of the pulsating component simultaneously controlled the second physiological signal of the patient, criterion validation, and PRI is calculated on the basis of a set of N+1 pulses, comprising: (i) the current pulse of the pulsating component of the controlled second physiological signal and (ii) N immediately preceding pulse of the pulsating component of the controlled second physiological signal, where N is a positive integer, greater than or equal to two; and
indicator (24, 26, 58) alarm made with the possibility of creating a human-perceivable alarm with simultaneous detection of the alarm condition in connection with asistoliei device detection alarm condition and confirm the correctness of anxiety in connection with asistoliei device confirm the accuracy of the alarm condition.
2. Monitor the patient under item 1, in which the device (52, 54, 56) confirm whether the alarm condition is executed with the capability, the capacity calculation index (52) regularity impulse (PRI), based on (i) the regularity of the amplitude of the pulses for the pulses of the set of N+1 pulses and (ii) the regularity of the time interval of pulses between the pulses of the set of N+1 pulses.
3. The patient monitor according to any one of paragraphs.1-2, in which the device (52, 54, 56) confirm whether the alarm condition is configured to determine one or more pulses of the set of N+1 pulses as force detected (78) pulse, provided that the pulsating component of the controlled second physiological signal (50) has no pulses at a pre-selected time interval.
4. Monitor the patient under item 1, in which the device (52, 54, 56) confirm whether the alarm condition is made with a choice of (60), at least one of the following: (i) the definition of PRI and (ii) the criterion of validation based on age (62) of the patient.
5. Monitor the patient under item 1, in which:
monitor (16, 20) secondary physiological signal controls at least two different second physiological signal of the patient simultaneously with the electrocardiograph controlling electrocardiographic signal of the patient; and
device (52, 54, 56) validate the alarm is made with the possibility of calculating the index (52) regularity impulse (PRI) for each, for men is our least from two different second physiological signals, and validation of anxiety in connection with asistoliei, based on the fact whether the highest calculated PRI criterion validation.
6. Monitor the patient under item 1, in which the device (52, 54, 56) confirm whether the alarm condition is arranged to retrieve the pulsating component of the controlled second physiological signal from the monitored second physiological signal using signal processing, containing, at least, low-pass filtering (72).
7. Method of monitoring a patient, comprising stages, which are:
control electrocardiographic signal (40) of the patient (10);
control of the second physiological signal (50) of the patient simultaneously with the control of the electrocardiographic signal of the patient;
find anxiety in connection with asistoliei in which the electrocardiographic signal of the patient is signal fading;
confirm the correctness of anxiety in connection with asistoliei, based on the regularity of the pulse of the pulsating component simultaneously controlled the second physiological signal of the patient, and the validation includes: detection (70) N+1 pulses, including the current momentum and N the right near St the state of the preceding pulses of the pulsating component simultaneously controlled the second physiological signal of the patient, where N is a positive integer, greater than or equal to two;
compute the index (80) regularity impulse (PRI), quantitatively determining the regularity of the pulse for N+1 detected pulses; and
compare PRI with criterion (54, 56) validation; and
create a human-perceivable signal (24, 26, 58) alarm subject to confirmation of the correctness of anxiety in connection with asistoliei through validation.
8. Method of monitoring a patient under item 7, in which detection (70) N+1 pulses includes a stage on which:
detect at least one of the N+1 pulses as force detected (78) pulse in the absence of detection of the pulse.
9. Method of monitoring a patient according to any one of paragraphs.7-8, in which N is a positive integer, greater than or equal to three.
10. Method of monitoring a patient under item 7, in which the validation contains the stage at which:
confirm the correctness of anxiety, based on the regularity of the pulses, while the regularity of the pulse amplitudes and regularity of the periods of repetition of the pulses of the pulsating component simultaneously controlled the second physiological signal (50) of the patient (10).
11. Method of monitoring a patient under item 10, in which the validation is additionally based the and average or average pulse repetition period of the pulsed component simultaneously controlled the second physiological signal (50) of the patient (10).
12. The storage medium for storing commands that are executable by the digital processor (30) to perform a method of monitoring a patient in accordance with any of paragraphs.7-11.
SUBSTANCE: invention refers to medicine, and can be used in cardiology, endocrinology, functional diagnostics and can find application in diagnostics and selecting a therapeutic approach to ischemic heart disease. The following risk factors are detected in the patients suffering from diabetes mellitus accompanied by cardiovascular disorders: blood plasma glucose, glycated haemoglobin (HbAlc), total blood plasma cholesterol, blood plasma low density lipoprotein cholesterol, blood pressure, load St segment depression, signs of carotid wall thickening, an ankle-brachial index and brachial endothelium-dependent vasodilatation as shown by the Doppler ultrasound, duration of diabetes mellitus; the derived values are scored. The derived scored values are summed up, and a risk of coronary artery atherosclerosis is stated to be low, moderate, high or very high.
EFFECT: method enables determining the risk of coronary artery atherosclerosis in the patients suffering from diabetes mellitus accompanied by cardiovascular disorders by assessing the clinical laboratory values and conducting instrumental tests, including electrocardiography, Doppler ultrasound and coronary angiography.
1 tbl, 2 ex
SUBSTANCE: mother's and foetus's heart rate variability is measured. A coefficient of variation the foetus's full array of RR intervals in the original state CV F I, a resistance index of the umbilical artery RI, a coefficient of variation of the mother's full array of RR intervals in the original state CV M, mother's RRmin in the period of recovery of a mental test RRmin M III are determined. ∑1, ∑2, ∑3 are calculated by formulas: ∑1=2 (original foetus's CV less than 5.4)+3 (RI less than 0.58)+3 (original mother's CV less than 7.8)+2 (original mother's RRmin less than 531); ∑2=2 (CV F I less than 5.4)+3 (RI more than 0.58)+2 (CV M I less than 0.78)+4 (RRmin M I less than 531); ∑3=3 (CV F I less than 5.4)+3 (CV M I less than 7.8)+3 (RI more than 0.58). The values ∑1 falling within the range of 0 to 2 show a low risk; within the range of 3 to 5 points - a moderate risk; from 6 to 10 points - a high risk; the values ∑2 from 0 to 2 show a low risk, from 3 to 5 points - a moderate risk, from 6 to 11 points - a high risk; the values ∑3 from 0 to 3 testifies to a low risk, from 4 to 9 points - to a high risk of unfavourable perinatal outcomes. The risks derived from the three values: ∑1, ∑2, ∑3 are used to evaluate a risk level of the unfavourable perinatal outcomes in intrauterine infection.
EFFECT: higher prediction accuracy.
3 ex, 6 tbl, 3 dwg
SUBSTANCE: invention refers to medicine, labour safety, vocational selection of rescue workers. The invention can be used for vocational selection in the sectors of industry using personal protective equipment, as well as for the workers labour safety in the sectors of industry with harmful working conditions. The method involves vocational selection and duty control on the basis of electroencephalogram (EEG) values and cardiological findings. The examination is performed prior to and when using the personal protective equipment. The cardiological examination involves assessing the heart rate variability with using the amplitude-frequency spectrum Fourier analysis VLF at a vibration frequency within the range of 0.0033-0.04 Hz, LF - at a frequency of 0.05-0.15 Hz and HF - at a frequency of 0.16-0.80 Hz, and is five-staged: initial resting state, mental work load, recovery of mental work load, hyperventilation load, recovery of hyperventilation load. At the beginning, the heart rate variations and EEG are examined prior to using the personal protective equipment. If any of the five stages of the heart rate variation examination shows the pulse more than 90 beats per minute, as well as changes from the normal values of: approximating entropy - less than 180, LF - less than 6 point, an alpha wave amplitude - to 12 vibrations per second and the presence of the paroxysmal activity by EEG, the prevailing sympathetic nervous system is stated, or if any stage of the heart rate variation examination shows the pulse less than 60 beats per minute, as well as changes from the normal values of: blood pressure - more than 140/90 mmHg, VLF - more than 130 points, HF - more than 16 points, an alpha wave amplitude - less than 25 mcV, the prevailing parasympathetic nervous system is stated; a low level of adaptation to the personal protective equipment is predicted, and a rescue work is not recommended during the vocational selection; the examination is terminated. If the heart rate variation and EEG prior to using the personal protective equipment fall within the normal values, the heart rate variation when using the personal protective equipment is started with the patient examined when using the personal protective equipment and performing a cycle ergometer test, and recording the hyperadaptotic changes of the assessed values: VLF - more than 130 points in relation to the normal value when using the personal protective equipment and LF and HF vibrations; an incomplete or unfinished adaptation to the personal protective equipment, and the rescue worker is suspended from work for several hours; if VLF is more than 130 points recorded 10-15 min after activating the personal protective equipment, a good adaptation level to the personal protective equipment is predicted.
EFFECT: method enables assessing the vegetative nervous function and predicting the rescue workers' adaptation level to the personal protective equipment.
11 tbl, 5 ex
SUBSTANCE: cardiorhythmography is recorded during an active orthostatic test, and a heart rate variability (HRV) is analysed. During the active orthostatic test, the patient is placed in an initial horizontal position, then transferred into the vertical position, and then into the horizontal position again. If the amplitude of HF waves initially increases more than LF waves in the horizontal position by more than 30%, a prevailing parasympathetic effect is diagnosed. If the amplitude of HF and LF waves decreases after the patient is transferred into the vertical position by more than 30% of the values in the initial horizontal position, vegetative insufficiency is diagnosed. If the amplitude of HF waves decreases after the patient is transferred into the vertical position by more than 80% of the initial value in the horizontal position, a fast adjustment of the parasympathetic department to the changes is diagnosed. If the amplitude of VLF waves increases after the patient is transferred into the vertical position by more than 30% of the initial value in the horizontal position, activation of the supra-segmentary vegetative nervous system is diagnosed.
EFFECT: method provides more reliable diagnosing that is ensured by determining the mechanism of orthostatic test adaptation.
2 tbl, 2 ex
SUBSTANCE: intraoesophageal pH monitoring and Holter monitoring are recorded daily. The heart rate variability is estimated in the aggregate with an analysis of a nocturnal heart rate trend. If finding more than 5 episodes of high heart rate dispersion coinciding with reflux episodes, or if a nocturnal structure comprises more than 50% of the episodes, the disturbed vegetative regulation of heart rhythm related to gastrooesophageal reflux disease is diagnosed.
EFFECT: technique enables diagnosing the extra-oesophageal manifestations of gastrooesophageal reflux disease at the early stage of the disease after the subjective manifestations have been observed.
SUBSTANCE: invention relates to medical equipment. An ECG monitoring system for detecting infarct-related coronary artery associated with acute myocardial infarction comprises the number of electrodes for data collection by electrical cardiac activity from various observing points spaced from the heart. An ECG data collection unit is related to the electrodes. An ECG processor responses to electrode signals to form a set of lead signals and detects ST rises in the lead signals. The display responses to the detected ST rises and graphically displays each set of the given ST rise in relation to the anatomical positions of the leads. The graphical display identifies the suspected infarct-related coronary artery or branch associated with acute ischemic stroke. The ECG signals is n-leads are received. The ECG signals are analysed for the consistency with the ST rise data. The each set of ST rises is graphically displayed in relation to the anatomical body positions. The stages of receiving and analysing are repeated some time later. The each set of ST rises derived some time later are graphically displayed and compared to the previous displayed ST rises. A comparative graphic display is used to display the time variation of a coronary disease symptom associated with the specifically identified coronary artery or branch.
EFFECT: using the invention enables reducing the length of diagnosing.
15 cl, 18 dwg
SUBSTANCE: invention relates to medicine, namely to cardiology. ECG examination is performed to patient. Registration of signal-averaged ECG and transesophageal electrocardiostimulation (TE ECS) are carried out. Duration of filtered wave "P" (FiP-P) of signal-averaged ECG, dispersion of wave "P" (Pd), frequency threshold of arrhythmia induction (FTAI) and its duration are determined by means of TE ECS, risk of atrium fibrillation development (RAFD) being determined by original mathematical formula. If RAFD values are to 0.5, high during 1-3 months risk of AF development is identified. If values are from 0.5 to 1.5 - average from 3 months to 1 year risk of AF development. If values are higher than 1.5 - low, more than 1 year risk of AF development is identified after the first examination of patient.
EFFECT: method increases accuracy of determining risk of AF development after the first examination due to analysis of interaction of ECG and TEECS indices.
5 tbl, 4 ex
SUBSTANCE: invention refers to medicine, specifically surgery and functional diagnostics. The supine heart rate is recorded and represents a baseline test, while the standing heart rate measured is an orthostatic test for 30 sec. The regulatory system activity index (RSAI) is described in points 1 to 10. An increase of this value relates to the deteriorating body adaptive possibilities; the RSAI value of 3-10 points enables predicting the postoperative wound complications.
EFFECT: method enables predicting the postoperative complications following the replacing hernia repair for postoperative hernias.
4 dwg, 3 tbl
SUBSTANCE: invention relates to medicine, particularly endocrinology and diabetology. There are involved examining heart rate variability (HRV) followed by spectroscopic analysis and functional testing. Those are added with determining non-linear values: deterrent fluctuation analysis (DFA) and approximated entropy (ApEn). If observing the initial amplitude decay of the HRV spectral components - VLF less than 30 points, LF less than 15 points, HF less than 15 points, DFA more than 0.7, ApEn less than 180, lack of functional response - autonomic cardiac sympathovagal neuropathy is diagnosed. If observing the normal amplitude of the HRV spectral component -VLF more than 30 points, low LF values less than 15 points, HF less than 15 points, DFA more than 0.7, ApEn less than 180, lack of functional response LF, HF - autonomic cardiac vagal neuropathy is diagnosed. If observing the initially normal amplitudes of the HRV spectral component -VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, ApEn more than 180, lack of functional response LF, HF - autonomic cardiac subclinical neuropathy is diagnosed.
EFFECT: method enables early diagnosing and typing of autonomic cardiac neuropathy for the purpose of specifying a therapeutic approach.
3 tbl, 3 ex
SUBSTANCE: invention relates to medicine, namely to neurology, therapy, family medicine, and can be used for selection of tactics for treatment of tension headache. For this purpose level of peripheral heart vegetative balance is determined in patient by analysis of index of sympathetic-parasympathetic relationship (LF/HF) in spectral analysis of cardiac rhythm. If LF/HF index increases higher than 2.0 conv. units, psychotropic drugs are introduced into therapy for relief of anxiety and/or depression.
EFFECT: method ensures possibility to stratify patients, requiring introduction of psychotropic drugs, thus making it possible to optimise treatment and increase its efficiency due to account of individual peculiarities of heart vegetative balance.
3 tbl, 2 ex
SUBSTANCE: method involves immersing in a decompression chamber at a depth of 30 metres, staying at this depth for 1 hour and decompressing for 63 minutes. The following values are determined 30 minutes before the immersion: systolic blood pressure (SBPbi), heart rate (HR) and moving object response (MOR). The following values are determined 30 minutes after the immersion in the decompression chamber: systolic blood pressure (SBPai) and critical flicker fusion frequency (CFFF). That is followed by determining an index of persistence to decompression disease (DD) in the females aged 30-40 (IPDDF30-40) by formula: IPDDF30-40=0.442+0.032×SBPbi+0.017×SBPai-0.032×HR-0.009×MOR-0.017×CFFF-0.048×age, wherein SBPbi is the systolic blood pressure measured before the immersion, mm Hg; SBPai is the systolic blood pressure measured after the immersion, mm Hg; HR is the heart rate measured before the immersion, beats per minute; MOR is the moving object response measured before the immersion, ms; CFFF is the critical flicker fusion frequency measured after the immersion, Hz; age is the age, completed years. If IPDDF30-40 is 1.1 included, the high persistence to DD is stated in the female; the value falling within the range of 1.1 to 2.19 included shows the moderate persistence to DD is stated; and if the value of more than 2.19, the low persistence to DD is shown.
EFFECT: method provides the differentiated assessment of the persistence to DD in the females of certain age with using no additional equipment.
SUBSTANCE: invention refers to medicine, namely to preventive medicine, and aims at detecting young individuals suffering from a high risk of cardiovascular diseases for the timely correction. The individuals are presented with a questionnaire to detect major risk factors of the cardiovascular diseases in accordance with the National Cardiovascular Disease Prevention Guidelines. The questionnaire results are appraised by points: if observing psychological stress 3.01-4 for males and 2.83-4 for females, 0 points are assigned; 2.01-3 for males and 1.83-2.82 for females, 1 point is assigned; 2 and less for males and 1.82 and less for females, 2 points are assigned; if the respondent doesn't smoke, 0 points are assigned; if he/she smokes less than 1 cigarette a day, 1 point is assigned; smoking 1 and more cigarettes a day implies assigning 2 points; if the patient intakes ethanol in an amount of 13.7 g a day and less, 0 points are assigned; an intake of ethanol in an amount of 13.8 g to 27.4 g a day and less enables assigning 1 point; using ethanol 27.5 g and more requires assigning 2 points; if blood pressure is less than 129/84 mm Hg, 0 point is assigned; if the blood pressure value falls within the range of 130-139/85-89 mm Hg, 1 point is assigned, and 2 points are assigned, if the blood pressure value is 140/90 mm Hg or more; if a body weight index is 24.9 kg/m2 and less, 0 points are assigned; if the range is 25-29.9 kg/m2, 1 point is assigned; the value of 30 kg/m2 provides assigning 2 points; if the physical activity is accompanied by energy burning of 3 MET/min and more over six late months and more, 0 points are assigned; the physical activity accompanied by energy burning of 3 MET/min under six late months, 1 point is assigned; if the physical activity is accompanied by energy burning of less than 3 MET/min, 2 points are assigned; if the individual consumes more than 500 g of vegetables and fruit a day, 0 point is assigned; consuming less than 500 g provides assigning 1 point, and if a daily ratio contains no fruit and vegetables, 2 points are assigned; if a rest heart rate is 50 to 69 beats per minute, 0 points are assigned; the heart rate falling within the range of 70 to 79 beats per minute provides assigning 1 point, and the heart rate of 80 beats per minute and more ensures assigning 2 points; a negative past medical history of the cardiovascular diseases with manifested ischemic heart disease or cardiovascular diseases in the male relatives in the first degree aged 55 years old or less and in the female relatives in the first degree aged 65 years old or less shows assigning 0 point, while a positive past medical history of the cardiovascular diseases makes it possible to assign 1 point. The total score is derived, and if the calculated value is 8 points and more, the respondent is referred to a group of a high risk of cardiovascular diseases, and preventive measures are recommended.
EFFECT: method enables evaluating a risk of cardiovascular diseases in the young individuals by evaluating the risk factors.
1 tbl, 1 ex
SUBSTANCE: invention refers to medicine, forensic medicine, diagnostic measurements, including in investigative practice. An interactive psychophysiological testing (PPT) involves presenting a person being tested test questions, determining, analysing the psychogenesis parameters with using the person's physical parameter sensors, indicating the results and estimating. The test questions are typed as follows: first-version questions Q1, second-version questions Q2, neutral questions N. The questions Q1 and Q2 have an alternative meaning and equal power and are characterised by an equal presentation time, a consistency of comparing the questions according to the alternative versions, a minimised subjective personal effect of the PPT test expert by sound colour and level, an unconscious emotional support on the person's question perception, as well as an identity of putting the questions to be compared, their length and a fixation of the meaningful word and/or word combination in similar segments of both questions to be compared. The test is put in accordance with a concatenation as follows X:0→C,…,C→Q11.Q21→N→ →Q21.Q22→N→…→Q1n.Q2n→N, wherein X is a person's identification index; 0 is a non-estimated zero question; C is a question relieving an expectation stress; Q1i is the first-version question, wherein i=1, 2,…, n; Q2i is the second-version question, wherein i=1, 2,…, n; N is a neutral question; n is a number of specific circumstances of the event or action; ":", "→", "." are devisors. The questions are put taking into account the staging of the tested event, including the confirmed facts or data only and excluding the expert's conjectures or versions. The results are used to state one of the two alternative versions and to estimate the respective status of the person being tested. The psychogenesis is determined and analysed with using a polygraph, while putting the questions of the two alternative versions, indicating and processing the PPT data are conducted with a computer with relevant software.
EFFECT: method provides higher information value, accuracy, reliability, objectiveness of the PPT results as compared to the previously known tests up to 90-95% with avoiding the distortion and ambivalence of the results.
5 cl, 1 dwg
SUBSTANCE: invention refers to agents for non-contact respiratory monitoring. A method for detecting a patient's expiration to inspiration variations or vice versa involving the stages of emitting an electromagnetic signal towards the patient and receiving the signal reflected from the patient, transforming the reflected signal to produce the first signal, dephasing the reflected electromagnetic signal and transforming it to produce the second signal, using a computing unit to detect simultaneous first zero transients in a time derivative of the first signal and in a time derivative of the second signal, simultaneous second zero transients in the time derivative of the first signal and in the time derivative of the second signal, and simultaneous third zero transients in the time derivative of the first signal and in the time derivative of the second signal, determining the first and second vectors and calculating their scalar product as an indicator value for the patient's expiration to inspiration variations or vice versa comparing the indicator value to the pre-set threshold value and specifying the patient's expiration to inspiration variations or vice versa, if the indicator value is less than the threshold value. A device for implementing the method involves a two-channel Doppler radar sensor and the computing unit.
EFFECT: using the invention enables providing more accurate measurement and detection of the respiratory rate.
6 cl, 6 dwg
SUBSTANCE: invention refers to medicine, namely to surgery, and can be used in cholecystectomy in patients with cholelithiasis. That is preceded by determining a patient's body weight index (BWI), glycaemia, glucosuria; blood pressure is measured; spinal osteochondrosis and gonarthrosis are detected. The derived results are assessed and scored. If the BWI equals to 28-30 kg/m2,10 points are assigned. If the BWI equals to 30-35 kg/m2,15 points are assigned. If the BWI is more than 35 kg/m2,20 points are assigned. If glycemia is more than 5.5 mmole/l, 3 points are assigned. If the patient suffers from glucosuria, 5 points are assigned. Arterial hypertension of more than 140/190 mm Hg requires assigning 3 points. The detected spinal osteochondrosis is assigned with 3 points, diagnosed gonarthrosis is assigned as 3 points. The derived points are summed up. If the total score is 23, a cholecystectomy with a biliopancreatic diversion is performed. If the total score is 14 to 22 points, laparoscopic cholecystectomy is performed. If the derived value makes 13 points, conventional cholecystectomy is performed.
EFFECT: invention provides selecting the type of cholecystectomy taking into account the metabolic status and a degree of obesity and as a consequence, normalizing the body weight and compensating the components of the metabolic syndrome.
2 tbl, 3 ex
FIELD: oil and gas industry.
SUBSTANCE: treating bronchial asthma (BA) in a child suffering from a mild, moderate or severe episode involves measuring a peak expiratory flow rate (PEFR). The child's age, height and sex are stated. The derived data are used to determine the adequate peak expiratory flow rate. That is followed by calculating the peak expiratory flow rate coefficient by specific formula. The following data of the past medical history are taken into account: the child's duration of the disease, the length of basic therapy, completed months, for one year preceding the acute period of the disease, as well as the presence of allergic diseases in immediate maternal and paternal relatives. A severity of the BA episodes is assessed. Each value derived from the past medical history is assigned with numerical values reflecting their prognostic significance. Heart rates are measured. Cardiointervalography is performed, and a vagosympathetic balance coefficient is determined. That is followed by calculating a risk of cardiohaemodynamic disorders (CHD) taking into account the above criteria by specific formula. If CHD<0.34, Fenoterol selective β2-adrenoceptor agonist is selected as a bronchial spasmolytic in the acute period of the disease. If 0.34≤CHD≤0.46, ipratropium bromide m-cholinoblocker is selected as the bronchial spasmolytic. If CHD>0.46, combined ipratropium bromide + Fenoterol is used as the bronchial spasmolytic.
EFFECT: reduced number of cardiovascular complications in the above category of children.
SUBSTANCE: quick recording and remote transmission of the physiological parameters of human and animal cardiovascular and respiratory systems experimentally is enabled by using a receiver comprising three recording units of signal picking-up and transmission from three patients or animals simultaneously. Each of them comprises three piezoelectric detectors for ECG recording and one strain gauge for respiration depth and rate recording - a respiratory potential. The receiver is provided with a bioelectrical amplifier, an analogue-to-digital converter, RS485 interface with a board providing digital signal coding, conversion and transmission in the form of a radio signal. The latter is trapped by means of Bluetooth adapter with using a radio signal receiving and ECG and respiratory potential transmission unit. Each unit channel is checked up to receive signals from its recorder and to transmit to an ECG and respiration processing and storage unit arranged at a distance up to 30 m from the recorder. It comprises a laptop with a screen displaying one channel of cardio signal and respiratory potential channels independently from each patient or animal. Each patient or animal's data can be saved as a separate file on the signal processing and storage unit.
EFFECT: method provides fast, qualitative real-time recording of the physiological parameters with creating the conditions of a distant control of the patients both in hospitals and polyclinics, and in remote locations, in emergency and other abnormal situations.
SUBSTANCE: method enables a cycloergometric pre-measurement of exercise tolerance according to PWC170 test, a minute pulmonary ventilation (MPV) by means of pneumotachography, and arterial oxygenation by means of an ear sensor of an oxyhemograph. If observing a decrease of exercise tolerance at power less than 1 W/kg for 2 minutes, an increase of MPV more than 350% of initial values, with an increase of arterial saturation more than 98%, a treatment starts with a manual therapy covering spinal motion segments in the number of 3 procedures every two days. That is followed by a balneotherapy in the form of thermal low-radon siliceous baths at temperature 38°C, for 10 minutes in the number of 6 procedures within the therapeutic course.
EFFECT: method reduces probability of chronic processes in bronchi, reduces rate of recurrent bronchitis ensured by normalising the external respiration function by eliminating the functional blocks in the spinal motor segments.
SUBSTANCE: invention can be used for diagnosing alexithymia in patients with chronic obstructive pulmonary disease (COPD) complicated with chronic cor pulmonale. That is ensured by evaluating clinical-anamnestic data, determining respiratory function, blood gas, and a patient's pulmonary hemodynamic status. An alexithymia value is calculated by the certain formula and used to state the presence or absence of alexithymia in the patient, or the presence of psychopathological borderline cases.
EFFECT: diagnosing alexithymia without using the known alexithymia scale leading to the higher clinical and preventive effectiveness and improved disease prognosis in the COPD patients.
SUBSTANCE: apparatus (1) for detecting pulse wave and breathing cycle signals of a person has two current-conducting electrodes (2, 3) to be attached to the human body, a first (4) and a second (6) operational amplifier, an amplitude detector (5), a switched frequency-dependent voltage divider (8) and a microcontroller (7). The electrodes (2, 3) are connected in the negative feedback circuit of the first operational amplifier (4). The microcontroller (7) is configured to generate a high-frequency carrier signal at the output of a first input/output port (L). The upper (10) and lower (11) arms of the voltage divider (8) are formed by two circuits, having a common end at the mid-point of the voltage divider and two separate ends. The second operational amplifier (6) and the voltage divider (8) form an active band-pass filter with upper and lower cut-off frequencies defined by parameters of the upper (10) and lower (11) arms of the voltage divider (8), respectively. The frequency response of such a filter when the second input/output port (M) of the microcontroller (7) is connected to zero potential enables signal detection in a frequency band which corresponds to the frequency band the pulse wave signal, and enables signal detection in the frequency band corresponding to the frequency band of the breathing cycle signal when the third input/output port (N) of the microcontroller (7) is connected to zero potential.
EFFECT: detecting pulse wave and breathing cycle signals of a person based on measuring the impedance of a body area using a simple non-adjustable electrical circuit.
14 cl, 12 dwg
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