基于光电容积脉搏波形态的伤害感受指数的研究

发布时间：2018-04-17 21:11

本文选题：全身麻醉 + 伤害感受监测　；参考：《浙江大学》2012年博士论文

【摘要】：全身麻醉中伤害感受的监测具有重要的临床意义,近来研究者基于光电容积脉搏波(PPG)的幅度建立了伤害感受的监测指标,比如外科应激指数SSI和伤害感受响应指标RN。然而,PPG的幅度易受测量条件的影响,且所采用的标准化方法理论适用性不高。因此,本论文的研究目的是从PPG的形态方面提出参数,并建立了一个基于其形态的伤害感受的监测指数SPMI。本论文的主要内容和创新成果如下： (1)PPG特征点的检测算法采用局部查找方法,结合一阶、二阶导数和逻辑判断条件建立了PPG的特征点检测算法。算法评估结果表明,在含有干扰信号的情况下,此算法的灵敏度和阳性预测率可达95%以上,该检测算法可靠。 (2)PPG幅度和形态的特异度和灵敏度研究根据弹性腔理论,解析推导出了PPG的5个形态参数,QRC、ARD、ARA、ART和PBI。另外也研究了PPG的幅度参数PPGA。以PPGA和ART为例对比了血流灌注、测量位置和测量体位变化时PPG幅度和形态的相对变化率,统计分析表明ART的相对变化率小于PPGA,表明PPG形态的特异度更高。采用气管插管为伤害性刺激,并用不同的抗伤害感受药物浓度产生不同程度的伤害感受,以预测概率为指标评估了所有参数的灵敏度。结果表明表征气管插管时,灵敏度次序为PBIARTPPGAARDARAQRC,形态参数和幅度参数不相上下。表征不同程度的伤害感受时,灵敏度次序PBI ARTARAARDQRPPGA,形态参数均高于幅度参数。 (3)基于PPG形态的外科指数SPMI的建立采用多参数结合方法,经多元线性回归得到SPMI=30-43×PBI+45×ART。性能评估表明,插管前SPMI和瑞芬太尼药物浓度的Spearman相关系数为-0.30,插管时为-0.52,均高于SSI的-0.21。SPMI预测CSSA的预测概率为0.819,高于文献所报道的RN的0.78。本论文基于PPG的形态特征,建立了一个抗伤害感受的指数SPMI,其性能优于基于PPG幅度的其它指数,有利于获得更好的麻醉效果。
[Abstract]:The monitoring of injury feeling in general anesthesia has important clinical significance . Recently , researchers have established monitoring indexes of injury perception based on the amplitude of photoelectric volume pulse wave ( PPG ) , such as surgical stress index ( SSI ) and damage feeling response indicator RN . However , the amplitude of PPG is easily influenced by the measurement conditions , and the applicability of the standardized method is not high .

Therefore , the purpose of this paper is to propose parameters from the aspect of PPG and to establish a monitoring index SPMI based on its morphology . The main contents and innovations of this paper are as follows :

( 1 ) Detection algorithm of PPG feature points

The feature point detection algorithm of PPG is established by means of local searching method combining first order , second order derivative and logic judgment condition . The results show that the sensitivity and positive predictive rate of this algorithm can reach more than 95 % when the interference signal is contained , and the detection algorithm is reliable .

( 2 ) Specific Degree and Sensitivity of PPG Amplitude and Morphology

Five morphological parameters , QRC , ARD , ARA , ART and PBI of PPG were derived based on the theory of elastic cavity . The amplitude parameters PPGA of PPG were also studied .

The relative rates of change of PPG amplitude and morphology were compared with PPGA and ART as examples . The statistical analysis showed that the relative change rate of PPG was less than PPGA , indicating that the specific degree of PPG was higher .

The results showed that the sensitivity order was PBIARTPPGAARDARAQRC . The sensitivity order PBI ARTARAARDQRPPGA and the morphological parameters were higher than the amplitude parameters when the tracheal intubation was characterized by PBIARTPPGAARDARAQRC , morphological parameters and amplitude parameters .

( 3 ) Establishment of SPMI for Surgical Index Based on PPG Morphology

A multivariate linear regression was used to obtain SPMI = 30 - 43 脳 PBI + 45 脳 ART .

Based on the morphological characteristics of PPG , this paper establishes an index SPMI with anti - injury feeling , which is superior to other indexes based on PPG amplitude , which is beneficial to obtaining better anesthetic effect .

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R318

【参考文献】