基于脉搏波传导时间变异性的低血压预测研究

发布时间：2019-04-02 02:32

【摘要】：择期剖宫产麻醉后低血压极大威胁着母婴的安全,实现麻醉前的低血压风险预测具有重要的临床意义。与常用的心率变异性研究相比,脉搏波信号蕴含丰富的血管特性信息,可以更为直接准确地反映血压的调节机制,因此论文围绕脉搏波传导时间变异性(Pulse Transit Time Variability, PTTV)对剖宫产麻醉后低血压的风险评估进行了深入研究。论文的主要内容包括：基于脉搏波传导时间与血压的关系,提出了应用脉搏波传导时间变异性进行低血压预测的分析方法。研究了心电及脉搏波信号的特征点检测方法、适合短时程序列分析的自回归(Auto Regressive, AR)模型的频域分析方法。提出了相对心率频率(Relative Frequency of Heart Rate, RFHR)与相对心动周期(Relative Cardiac Cycle, RCC)两个新概念,进行了基于相对心率频率的功率谱分析。将谷点位置作为频段划分依据,聚集范围分别为0.2559±0.0096、0.4213+0.01、0.6006±0.0116和0.7706+0.01817,离散程度小,具有很高的一致性,其中0.1-0.26谱段、0.26-0.42谱段及0.42-0.6谱段包含的谱峰分别对应于五倍心动周期调节、三倍心动周期调节和两倍心动周期调节,物理含义清晰,解决了频谱峰谷位置的聚类问题。基于相对心率频率的功率谱分析方法,对69例临床数据术前一天、手术当天扩容前、扩容后至麻醉前三个阶段的数据进行统计学分析,结果表明,参数RCC5/RCC3(五倍心动周期调节频段与三倍心动周期调节频段的能量比值)的判别阈值设置为0.7057时,预测敏感度达80%,特异性达79.7%,在扩容后对重度低血压具有潜在的预测能力,对择期剖宫产麻醉后低血压的风险预测具有一定临床指导意义。
[Abstract]:Hypotension after elective cesarean section greatly threatens the safety of mothers and infants. It is of great clinical significance to predict the risk of hypotension before anesthesia. Compared with common heart rate variability (HRV) studies, pulse wave signals contain abundant information of blood vessel characteristics and can reflect the regulation mechanism of blood pressure more directly and accurately. Therefore, the thesis focuses on the pulse wave conduction time variability (Pulse Transit Time Variability,). PTTV) studied the risk assessment of hypotension after cesarean section anesthesia. The main contents of this paper are as follows: based on the relationship between pulse wave conduction time and blood pressure, a method for predicting hypotension using pulse wave conduction time variability is proposed. The characteristic point detection method of ECG and pulse wave signal is studied, and the frequency domain analysis method of autoregressive (Auto Regressive, AR) model is suitable for short-time program analysis. Two new concepts of relative heart rate frequency (Relative Frequency of Heart Rate, RFHR) and relative cardiac period (Relative Cardiac Cycle, RCC) are proposed, and the power spectrum analysis based on relative heart rate frequency is carried out. Taking the valley position as the basis for frequency band division, the aggregation ranges are 0.2559 卤0.0096, 0.4213 0.01, 0.6006 卤0.0116 and 0.7706 0.01817, respectively. 0.26 and 0.42, respectively, correspond to five-fold, three-fold, and two-fold cardiac period regulation, respectively. The physical meaning of the peak is clear. The clustering problem of peak and valley position of spectrum is solved. Based on the power spectrum analysis method of relative heart rate frequency, the data of 69 cases of clinical data were analyzed statistically one day before operation, and after volume expansion to three stages before anaesthesia. When the discriminant threshold of the parameter RCC5/RCC3 (the energy ratio between the five-fold and triple-cycle regulation bands) is set to 0.7057, the sensitivity and specificity of the prediction are 80% and 79.7%, respectively, when the threshold value is set to 0.7057. It has the potential to predict severe hypotension after expansion, and has some clinical significance in predicting the risk of hypotension after elective cesarean section anesthesia.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：TN911.7

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