基于脉搏波速度和中心动脉压的大动脉功能无创评估方法研究
发布时间：2018-07-22 16:57
【摘要】：动脉硬化是多种心血管病的共同病理生理学基础。动脉功能异常是动脉硬化病变早期征兆,早期筛查并积极干预大动脉功能异常是防治心血管病的重要措施。颈股脉搏波速度(carotid femoral pulse wave velocity, CFPWV)和中心动脉压(central arterial pressure, CAP)是无创评估大动脉功能主要指标。CFPWV测量依赖于脉搏波传递时间(pulse transit time, PTT)的准确估计。然而,现有的"foot-to-foot"方法估计PTT可能存在精度不足的问题且不同方法产生的CFPWV存在本质差异。因此,需要建立新的PTT估计方法提高CFPWV评估主动脉硬度的准确性。颈动脉张力法是无创估计CAP常用方法,但颈动脉埋藏较深且相对移动,导致信号采集困难,且压迫颈动脉会给患者带来不适。颈动脉波形可以通过广义传递函数(generalized transfer function, GTF)从易于测量的桡动脉位置获取,但GTF主要在外国人群中构建并验证。在中国人群构建中GTF并研制相应的检测设备对于无创评估CAP具有重要意义。基于上述需求,本文围绕PTT估计方法和基于GTF的无创CAP获取方法开展研究,主要内容包括：1.基于区域匹配的PTT估计方法研究通过对脉搏波形上升阶段形态的分析,提出了一种波形匹配法(waveform matching, WFMA)估计PTT。WFMA法选择颈动脉和股动脉压力波形舒张期极小值点至斜率最大值点之间的波形作为待匹配区域,通过时移匹配技术确定PTT。采集颈股动脉脉搏数据,使用参考方法、"foot-to-foot"法和WFMA法分别估计PTT计算CFPWV。结果表明WFMA法比"foot-to-foot"法测量的CFPWV具有更好的准确性和重复性。WFMA法提高了CFPWV测量的可靠性,具有潜在的临床应用价值。2. WFMA法测量CFPWV影响因素研究进一步研究脉搏波形的标定、匹配区域的选择和年龄对WFMA法的影响。通过比较WFMA法在标定前后的颈股动脉脉搏波形中测量的CFPWV结果,我们发现WFMA法在标定后的压力波形中产生的CFPWV具有更小的偏差,测量的CFPWV更加准确。分别选择压力波形上升段的部分和全部区域估计PTT,结果表明当选择脉搏波形整个上升阶段估计PTT时,WFMA法测量CFPWV的准确性显著降低。根据年龄将研究对象分为青年、中年和老年三组,结果表明WFMA法在这三个组群中测量CFPWV的准确性依次降低,但都产生了准确的CFPWV估计结果。这一发现说明WFMA法具有很好的年龄适用性,为其在临床实践中的应用奠定了基础。3.基于自回归外生模型的GTF构建方法研究利用系统辨识中的自回归外生(autoregressive exogenous, ARX)模型在中国人群中构建(individual transfer function, ITF)和GTF。65位研究对象被分为构建组和验证组。在构建组中采用交叉验证技术和Akaike's信息准则确定模型的最佳阶次(10阶),并构建桡动脉至颈动脉GTF；在验证组中对GTF的准确性进行验证,同时将其与ITF对比。GTF能够从桡动脉压力波形中准确估计中心动脉收缩压(systolic blood pressure, SBP),但不能精确地重构中心动脉压力波形,在对某些依赖于脉搏波形高频分量的参数的估计上表现不佳。与GTF相比,ITF提高了中心动脉压力和波形估计的准确性。研究结果为无创中心动脉压分析仪的研制提供了理论和技术支持。4.中心动脉压力波形形态对GTF重构中心动脉血流动力学特征影响研究根据颈动脉压力波形形态(A类和C类)将研究对象分为A组和C组,构建组平均传递函数(MTFA和MTFC)和GTF。研究结果表明形态特定的TF稍微但没有显著提高某些波形参数的估计,包括中心动脉SBP,收缩期和舒张期压力时间积分,但改善了某些依赖于波形轮廓的参数(如增强指数)的估计。这一发现表明在利用传递函数从外周动脉估计中心血流动力学指标时,使用形态特定的TF可能更合适。5.动脉功能评估仪器的研制和示范应用根据上述研究建立的方法和技术,研制了动脉硬化检测仪(BX-CFTI-200)和无创中心动脉压分析仪(BX-CAP-100),并在中国人民解放军总医院运动干预门诊中进行示范应用。BX-CFTI-200运用WFMA法测量CFPWV评估大动脉弹性。BX-CAP-100利用平面张力法记录桡动脉压力波形,经GTF转换获取中心动脉压力和波形,随后,利用波形分析技术提取包括中心动脉SBP、AIx和SEVR在内的多项血流动力学指标。这两台设备成本低廉、操作简单,满足动脉硬化的早期筛查需求。
[Abstract]:Arteriosclerosis is the common pathophysiological basis of various cardiovascular diseases. Abnormal arterial function is an early sign of arteriosclerosis. Early screening and active intervention of abnormal arterial function are important measures for the prevention and treatment of cardiovascular disease. Carotid femoral pulse wave velocity (CFPWV) and central arterial pressure (central arteri) Al pressure, CAP) is a noninvasive assessment of the major arterial function,.CFPWV measurement depends on the accurate estimation of the pulse transit time (PTT). However, the existing "foot-to-foot" method estimates that PTT may have a lack of precision and there are essential differences in the production CFPWV of different methods. Therefore, a new PTT estimate is needed. This method improves the accuracy of CFPWV to evaluate the hardness of the aorta. The carotid tension method is a noninvasive method to estimate CAP, but the carotid artery is buried deeper and relatively moving, which leads to the difficulty of signal acquisition, and the compression of the carotid artery will bring discomfort to the patient. The carotid waveform can be from the generalized transfer function (GTF). The location of the measured radial artery is obtained, but GTF is mainly constructed and verified in the foreign population. In the construction of the Chinese population, GTF and the development of the corresponding detection equipment are of great significance for non-invasive evaluation of CAP. Based on the above requirements, this paper focuses on the PTT estimation method and the GTF based CAP acquisition method based on GTF. The main contents include: 1. base In the study of PTT estimation method of regional matching, a waveform matching method (waveform matching, WFMA) is proposed to estimate the waveform between the diastolic minimum point of the carotid and femoral artery pressure waveform and the maximum point of the slope by the PTT.WFMA method. The time shift matching technique is used. PTT. acquisition of carotid femoral artery pulse data, using reference methods, "foot-to-foot" and WFMA methods to estimate PTT CFPWV. results, respectively, indicating that WFMA method has better accuracy and repeatability.WFMA method than "foot-to-foot" method to improve the reliability of CFPWV measurement, and it has potential clinical application value.2. WFMA method measurement. PWV influence factor research further study the pulse waveform calibration, the selection of matching area and the influence of age on the WFMA method. By comparing the CFPWV results measured in the pulse waveform of the carotid femoral artery before and after the WFMA method, we find that the CFPWV produced in the calibrated pressure waveform has smaller deviation, and the measured CFPWV is more than the WFMA method. Accurate. Select the partial and all regions of the rise section of the pressure waveform to estimate PTT. The results show that the accuracy of the WFMA method for measuring CFPWV is significantly reduced when the pulse waveform is estimated to be PTT in the whole rising stage. According to age, the research objects are divided into three groups of youth, middle age and old age. The results show that the WFMA method is used to measure CFPWV in these three groups. The accuracy is reduced in turn, but all of the accurate CFPWV estimation results are produced. This discovery shows that the WFMA method has a good age applicability, laying a foundation for its application in clinical practice, based on the GTF construction method based on the autoregressive exogenous model of.3., and using the autoregressive exogenous (ARX) model in system identification. In the Chinese population, the individual transfer function (ITF) and GTF.65 sites were divided into the construction group and the verification group. In the construction group, the best order (10 order) of the model was determined by cross validation and Akaike's information criteria, and the radial artery to the carotid artery GTF was constructed, and the accuracy of GTF was verified in the validation group. Compared with ITF,.GTF can accurately estimate the systolic pressure of central artery (systolic blood pressure, SBP) from the radial artery pressure waveform, but it can not accurately reconstruct the central arterial pressure waveform, which is not good in the estimation of some parameters which depend on the high frequency component of the pulse wave. Compared with GTF, ITF improves the central arterial pressure and waveform. The results of the study provide theoretical and technical support for the development of the noninvasive central arterial pressure analyzer for the study of the influence of the.4. central arterial pressure waveform on the hemodynamic characteristics of the central artery of the GTF reconstruction. According to the shape of the carotid pressure waveform (Class A and the C class), the image is divided into the A group and the C group, and the average transfer function of the construction group is constructed. The results of the (MTFA and MTFC) and GTF. studies showed that the form specific TF slightly but did not significantly increase the estimation of certain waveform parameters, including the central artery SBP, the systolic and diastolic pressure time integral, but improved the estimation of some parameters (such as the enhancement index) that depended on the contour of the waveform. This discovery shows that the transfer function is used to move from the peripheral movement. The use of morphologic specific TF may be more appropriate for the development and demonstration of.5. arterial function assessment instruments when the pulse estimation center hemodynamic indicators are developed and applied in accordance with the methods and techniques established above, and developed an arteriosclerosis detector (BX-CFTI-200) and a noninvasive central arterial pressure analyzer (BX-CAP-100), and in General Hospital of PLA The demonstration application of.BX-CFTI-200 in the exercise intervention clinic uses the WFMA method to measure CFPWV and evaluate the elastic.BX-CAP-100 of the large artery by using the plane tension method to record the radial pressure wave. After GTF conversion, the central artery pressure and waveform are obtained. Then, a number of hemodynamic forces, including the middle heart artery SBP, AIx and SEVR, are extracted by the waveform analysis technique. These two devices are cheap and simple to operate, and meet the early screening needs of arteriosclerosis.
【学位授予单位】：中国科学技术大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R543.5
本文编号：2138137
[Abstract]:Arteriosclerosis is the common pathophysiological basis of various cardiovascular diseases. Abnormal arterial function is an early sign of arteriosclerosis. Early screening and active intervention of abnormal arterial function are important measures for the prevention and treatment of cardiovascular disease. Carotid femoral pulse wave velocity (CFPWV) and central arterial pressure (central arteri) Al pressure, CAP) is a noninvasive assessment of the major arterial function,.CFPWV measurement depends on the accurate estimation of the pulse transit time (PTT). However, the existing "foot-to-foot" method estimates that PTT may have a lack of precision and there are essential differences in the production CFPWV of different methods. Therefore, a new PTT estimate is needed. This method improves the accuracy of CFPWV to evaluate the hardness of the aorta. The carotid tension method is a noninvasive method to estimate CAP, but the carotid artery is buried deeper and relatively moving, which leads to the difficulty of signal acquisition, and the compression of the carotid artery will bring discomfort to the patient. The carotid waveform can be from the generalized transfer function (GTF). The location of the measured radial artery is obtained, but GTF is mainly constructed and verified in the foreign population. In the construction of the Chinese population, GTF and the development of the corresponding detection equipment are of great significance for non-invasive evaluation of CAP. Based on the above requirements, this paper focuses on the PTT estimation method and the GTF based CAP acquisition method based on GTF. The main contents include: 1. base In the study of PTT estimation method of regional matching, a waveform matching method (waveform matching, WFMA) is proposed to estimate the waveform between the diastolic minimum point of the carotid and femoral artery pressure waveform and the maximum point of the slope by the PTT.WFMA method. The time shift matching technique is used. PTT. acquisition of carotid femoral artery pulse data, using reference methods, "foot-to-foot" and WFMA methods to estimate PTT CFPWV. results, respectively, indicating that WFMA method has better accuracy and repeatability.WFMA method than "foot-to-foot" method to improve the reliability of CFPWV measurement, and it has potential clinical application value.2. WFMA method measurement. PWV influence factor research further study the pulse waveform calibration, the selection of matching area and the influence of age on the WFMA method. By comparing the CFPWV results measured in the pulse waveform of the carotid femoral artery before and after the WFMA method, we find that the CFPWV produced in the calibrated pressure waveform has smaller deviation, and the measured CFPWV is more than the WFMA method. Accurate. Select the partial and all regions of the rise section of the pressure waveform to estimate PTT. The results show that the accuracy of the WFMA method for measuring CFPWV is significantly reduced when the pulse waveform is estimated to be PTT in the whole rising stage. According to age, the research objects are divided into three groups of youth, middle age and old age. The results show that the WFMA method is used to measure CFPWV in these three groups. The accuracy is reduced in turn, but all of the accurate CFPWV estimation results are produced. This discovery shows that the WFMA method has a good age applicability, laying a foundation for its application in clinical practice, based on the GTF construction method based on the autoregressive exogenous model of.3., and using the autoregressive exogenous (ARX) model in system identification. In the Chinese population, the individual transfer function (ITF) and GTF.65 sites were divided into the construction group and the verification group. In the construction group, the best order (10 order) of the model was determined by cross validation and Akaike's information criteria, and the radial artery to the carotid artery GTF was constructed, and the accuracy of GTF was verified in the validation group. Compared with ITF,.GTF can accurately estimate the systolic pressure of central artery (systolic blood pressure, SBP) from the radial artery pressure waveform, but it can not accurately reconstruct the central arterial pressure waveform, which is not good in the estimation of some parameters which depend on the high frequency component of the pulse wave. Compared with GTF, ITF improves the central arterial pressure and waveform. The results of the study provide theoretical and technical support for the development of the noninvasive central arterial pressure analyzer for the study of the influence of the.4. central arterial pressure waveform on the hemodynamic characteristics of the central artery of the GTF reconstruction. According to the shape of the carotid pressure waveform (Class A and the C class), the image is divided into the A group and the C group, and the average transfer function of the construction group is constructed. The results of the (MTFA and MTFC) and GTF. studies showed that the form specific TF slightly but did not significantly increase the estimation of certain waveform parameters, including the central artery SBP, the systolic and diastolic pressure time integral, but improved the estimation of some parameters (such as the enhancement index) that depended on the contour of the waveform. This discovery shows that the transfer function is used to move from the peripheral movement. The use of morphologic specific TF may be more appropriate for the development and demonstration of.5. arterial function assessment instruments when the pulse estimation center hemodynamic indicators are developed and applied in accordance with the methods and techniques established above, and developed an arteriosclerosis detector (BX-CFTI-200) and a noninvasive central arterial pressure analyzer (BX-CAP-100), and in General Hospital of PLA The demonstration application of.BX-CFTI-200 in the exercise intervention clinic uses the WFMA method to measure CFPWV and evaluate the elastic.BX-CAP-100 of the large artery by using the plane tension method to record the radial pressure wave. After GTF conversion, the central artery pressure and waveform are obtained. Then, a number of hemodynamic forces, including the middle heart artery SBP, AIx and SEVR, are extracted by the waveform analysis technique. These two devices are cheap and simple to operate, and meet the early screening needs of arteriosclerosis.
【学位授予单位】：中国科学技术大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R543.5
【相似文献】
相关期刊论文 前10条
1 金慰鄂;;检查动脉功能不全的新方法:血小板聚集的定量测定[J];国外医学参考资料(内科学分册);1975年09期
2 胡德良;;偶尔吸烟也会削弱动脉功能[J];科学养生;2009年01期
3 胡德良;;偶尔吸烟也会削弱动脉功能[J];保健医苑;2010年04期
4 姜一农;;动脉功能评价与降压质量[J];医学与哲学(临床决策论坛版);2007年07期
5 李新立;徐琼;;检测你的动脉功能用哪些方法[J];求医问药;2009年12期
6 李萍;冯平;何臣;邹盛智;秦大德;;大动脉功能的临床研究近况[J];现代中西医结合杂志;2008年12期
7 马志敏;;第三届中国血管病变和动脉功能学术会议暨第一届国际血管健康学会亚太地区会议纪要[J];中华老年医学杂志;2006年09期
8 马志敏;;第五届中国血管病变和动脉功能学术会议暨第三届国际血管健康学会亚太地区会议纪要[J];中国民康医学;2008年15期
9 王宏宇,龚兰生,张维忠,胡大一;动脉功能检测方法学研究[J];中国民康医学;2005年08期
10 马志敏;;第三届中国血管病变和动脉功能学术会议暨第一届国际血管健康学会亚太地区会议纪要[J];中国民康医学;2006年15期
相关博士学位论文 前1条
1 胡福松;基于脉搏波速度和中心动脉压的大动脉功能无创评估方法研究[D];中国科学技术大学;2016年
相关硕士学位论文 前1条
1 王晓静;瞬时波强（WI）评价糖尿病患者颈动脉内皮功能[D];中南大学;2009年
，本文编号：2138137
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2138137.html
最近更新
教材专著
