基于脉搏波信号和血管弹性腔模型的动脉血压连续测量方法

目的为满足健康监护中的连续测量血压的要求,研究并实现一种基于脉搏波信号和血管弹性腔模型的动脉血压拟合计算方法。方法利用自制的穿戴式人体生理参数监测系统收集测试对象的脉搏波信号、心电信号以及血压数据。根据心电信号与脉搏波信号的时间关系,推导出收缩压和脉搏波传导时间的回归分析方程,而舒张压的测量,则是通过脉搏波的波形系数分析以及血管单弹性腔模型的参数计算完成。结果试验结果表明,该方法血压测量结果的平均偏差和标准偏差为(0.51±0.74)kPa([384±5.54)mmHg],达到了美国医疗仪器促进协会建议的(0.665±1.064)kPa([5±8)mmHg]标准。结论结合脉搏波信号和弹性腔模型可以估算人体血压值,为连续血压测量提供了新的实现方法。     

Noninvasive measurement of arterial blood pressure and elastic properties using photoelectric plethysmography technique

The objective of this paper is to review our developed method for measuring noninvasively the arterial blood pressure as well as the mechanical properties of the vascular system in a thin portion of the biological segment such as human fingers or small animal extremities like rat tails and rabbit forelegs. This measurement is based on a principle called the 'volume-oscillometric method'. During the gradual change in cuff pressure, the amplitude of consecutive arterial volume pulsations associated with pulse pressure shows change characteristically due to the nonlinearity of arterial pressure-volume(P-V) relation. Arterial pressure can be accurately determined by detecting this characteristic change in the amplitude, while the arterial elastic properties such as P-V relationship and volume elastic modulus can be noninvasively obtained as a function of arterial transmural pressure, provided that the arterial volume changes are quantitatively determined during this pressure measurement. The validity and accuracy of this pressure and elasticity measurement with photoelectric plethysmography technique for detecting arterial volume changes are clearly demonstrated on the in vitro and in vivo experiments. Considering the simplicity and practicability of this measurement using the photoelectric plethysmography, we present a new portable instrument for the long-term ambulatory monitoring of indirect arterial pressure and a handy fully-automatic instrument for the noninvasive measurement of arterial elastic properties, and a few examples obtained by each instrument are also described.     

Pulse pressure waveform estimation using distension profiling with contactless optical probe

The pulse pressure waveform has, for long, been known as a fundamental biomedical signal and its analysis is recognized as a non-invasive, simple, and resourceful technique for the assessment of arterial vessels condition observed in several diseases. In the current paper, waveforms from non-invasive optical probe that measures carotid artery distension profiles are compared with the waveforms of the pulse pressure acquired by intra-arterial catheter invasive measurement in the ascending aorta. Measurements were performed in a study population of 16 patients who had undergone cardiac catheterization. The hemodynamic parameters: area under the curve (AUC), the area during systole (AS) and the area during diastole (AD), their ratio (AD/AS) and the ejection time index (ETI), from invasive and non-invasive measurements were compared. The results show that the pressure waveforms obtained by the two methods are similar, with 13% of mean value of the root mean square error (RMSE). Moreover, the correlation coefficient demonstrates the strong correlation. The comparison between the AUCs allows the assessment of the differences between the phases of the cardiac cycle. In the systolic period the waveforms are almost equal, evidencing greatest clinical relevance during this period. Slight differences are found in diastole, probably due to the structural arterial differences. The optical probe has lower variability than the invasive system (13% vs 16%). This study validates the capability of acquiring the arterial pulse waveform with a non-invasive method, using a non-contact optical probe at the carotid site with residual differences from the aortic invasive measurements.     

Measurement and spectral analysis of fibrillation in the normothermic and hypothermic myocardium

The amplitude of the fibrillation waveform transduced from the myocardium was found to decrease as the heart was cooled from 37°C to 8°C. The administration of potassium-rich cardioplegia to the hypothermic myocardium further reduced the fibrillation amplitude by a factor of 100 compared with the normothermic amplitude. A measurement system is presented which is capable of reliably monitoring fibrillation waveforms in the cold cardioplegia arrested myocardium. This measurement system is shown to be impervious to the omnipresent electrical and mechanical artefacts which normally mask low-level signals. Subjecting the fibrillation waveforms to spectral analysis revealed that only the fundamental and the first six harmonics of the waveform are of significance. The results and methodology provide a means of correlating the temperature of the myocardium and the concentration of the potassium in the perfused cardioplegia, with the presence or absence of electrical activity in the myocardial cells.     

Scatter correction for three-dimensional PET based on an analytic model dependent on source and attenuating object

Three-dimensional positron emission tomography admits a significant scatter fraction due to the large aperture of the detectors, and requires accurate scatter subtraction. A scatter-correction method, applicable to both emission and transmission imaging, calculates the projections of the single-scatter distribution, using an approximate image of the source and attenuating object. The scatter background is subtracted in projection space for transmission data and in image space for emission data, yielding corrected attenuation and emission images. The accuracy of this single-scatter distribution is validated for the authors' small imaging system by comparison with Monte Carlo simulations. The correction is demonstrated using transmission and emission data obtained from measurements on the authors' QPET imaging system using two acrylic phantoms. For the transmission data, generated with a flood source, errors of up to 24% in the linear attenuation coefficients resulted with no scatter subtraction, but the correction yielded an accurate value of mu =0.11+or-0.01 cm-1. For the emission data, the corrected images show that the scattered background has been removed to within the level of the background noise outside the source. The residual amplitude within a cold spot in one of the phantoms was reduced from 21% to 3% of the image amplitude.     

Application of dynamic computed tomography for measurements of local aortic elastic modulus

A novel computed tomographic (CT) technique used for the instantaneous measurement of the dynamic elastic modulus of intact excised porcine aortic vessels subjected to physiological pressure waveforms is described. This system was comprised of a high resolution X-ray image intensifier based computed tomographic system with limiting spatial resolution of 3.2mm⁻¹ (for a 40mm field of view) and a computer-controlled flow simulator. Utilising cardiac gating and computer control, a time-resolved sequence of 1 mm thick axial tomographic slices was obtained for porcine aortic specimens during one simulated cardiac cycle. With an image acquisition sampling interval of 16.5 ms, the time sequences of CT slices were able to quantify the expansion and contraction of the aortic wall during each phase of the cardiac cycle. Through superficial tagging of the adventitial surface of the specimens with wire markers, measurement of wall strain in specific circumferential sectors and subsequent calculations of localised dynamic elastic modulus were possible. The precision of circumferential measurements made from the CT images utilising a cluster-growing segmentation technique was approximately ±0.25mm and allowed determination of the dynamic elastic modulus (E_dyn) with a precision of ±8kPa. Dynamic elastic modulus was resolved as a function of the harmonics of the physiological pressure waveform and as a function of the angular position around the vessel circumference. Application of this dynamic CT (DCT) technique to seven porcine thoracic aortic specimens produced a circumferential average (over all frequency components) E_dyn of 373±29kPa. This value was not statistically different (p<0.05) from the values of 430±77 and 390±47kPa obtained by uniaxial tensile testing and volumetric measurements respectively.     

A Technical Assessment of Pulse Wave Velocity Algorithms Applied to Non-invasive Arterial Waveforms

Non-invasive assessment of arterial stiffness through pulse wave velocity (PWV) analysis is becoming common clinical practice. However, the effects of measurement noise, temporal resolution and similarity of the two waveforms used for PWV calculation upon accuracy and variability are unknown. We studied these effects upon PWV estimates given by foot-to-foot, least squared difference, and cross-correlation algorithms. We assessed accuracy using numerically generated blood pressure and flow waveforms for which the theoretical PWV was known to compare with the algorithm estimates. We assessed variability using clinical measurements in 28 human subjects. Wave shape similarity was quantified using a cross correlation-coefficient (CC_Coefficient), which decreases with increasing distance between waveform measurements sites. Based on our results, we propose the following criteria to identify the most accurate and least variable algorithm given the noise, resolution and CC_Coefficient of the measured waveforms. (1) Use foot-to-foot when the noise-to-signal ratio ≤10%, and/or temporal resolution ≥100 Hz. Otherwise (2) use a least squares differencing method applied to the systolic upstroke.     

Correlation between computer-assisted femoral arteriography and physiological tests in hypercholesterolaemic patients: a methodological study with special reference to clinical trials.

The validity of computer-assisted femoral arteriography, for the study of regression/progression of atherosclerosis in follow-up clinical trials, was investigated by comparison with routine physiological estimates of peripheral circulatory function. Thus, in 114 hypercholesterolaemic patients, the results of aorto-femoral arteriography were compared with those of leg segmental blood pressure measurement, oscillometry, digital pulse plethysmography, and bicycle and treadmill exercise tests. In 107 patients, 18 with symptoms of peripheral vascular disease (PVD) and 89 asymptomatic, magnification arteriograms of a 20 cm segment of the right or left superficial femoral artery were obtained. These arteriograms were digitized and the following variables were calculated: arterial lumen volume (corrected for body size), per cent stenosis, and edge roughness. The correlation between arteriographic and physiological variables was investigated with a linear regression model, taking into account the possible interaction with sex, and presence or absence of symptoms of PVD. Lumen volume correlated significantly with all five physiological variables, and per cent stenosis correlated significantly with four of the physiological variables. For the roughness measure, however a significant correlation was found only with plethysmography. By using logistic multiple regression analysis linear functions of physiological variables were constructed to detect ilio-femoral arterial occlusion. The sensitivity/specificity for detection of right-sided, left-sided, and bilateral occlusion was 0.83/0.98, 0.78/0.98, and 0.60/1.00 respectively (N = 108-111). Systolic blood pressure (ankle-arm ratio) was the single variable most closely correlated to the likelihood of arterial occlusions. It is concluded that arterial lumen volume and per cent stenosis, measured for the digitized femoral arteriogram, correlate well with physiological variables, which reflect the state of atherosclerosis both in the femoral arteries and in other arterial beds including the heart, and that routine physiological tests can be used to identify patients with arterial occlusions in the iliac and femoral arteries.     

Impulse propagation in rubber-tube analogues of arterial stenoses and aneurysms

Analogues of arterial stenoses and aneurysms were constructed from latex tubing containing inserts of various lengths, and with diameters and elastic properties that differed from those of the surrounding tube. A pressure impulse (duration <10ms). was generated at one end of the tube and its transmission and reflection were monitored at various points within the system using a catheter-tip manometer. The complex waveforms produced by multiple reflections from either end of the insert were analysed and compared with those generated by a numerical model in which the reflection sites were regarded as isolated junctions between two tubes of infinite length. There was close agreement between the synthesised and measured waveforms.     

Multi-branched model of the human arterial system

A model of the human arterial system was constructed based on the anatomical branching structure of the arterial tree. Arteries were divided into segments represented by uniform thin-walled elastic tubes with realistic arterial dimensions and wall properties. The configuration contains 128 segments accounting for all the central vessels and major peripheral arteries supplying the extremities including vessels of the order of 2·0 mm diameter. Vascular impedance and pressure and flow waveforms were determined at various locations in the system and good agreement was found with experimental measurements. Use of the model is illustrated in investigating wave propagation in the arterial system and in simulation of arterial dynamics in such pathological conditions as arteriosclerosis and presence of a stenosis in the femoral artery.     

Estimation of arterial compliance in aortic regurgitation: three methods evaluated in pigs

Three methods for measuring arterial compliance when aortic regurgitation is present are examined. The first two methods are based on a Windkessel model composed of two elements, compliance C and resistance R. Arterial compliance was estimated from diastolic pressure waveforms and diastolic regurgitant flow for one method, and from systolic aortic pressure waveforms and systolic flow for the other method. The third method was based on a three-element Windkessel model, composed of characteristic resistance r, compliance C and resistance R. In this method arterial compliance was calculated by adjusting the model to the modulus and phase of the first harmonic term of the aortic input impedance. The three methods were compared and validated in six anaesthetised pigs over a broad range of aortic pressures. The three methods were found to give quantitatively similar estimates of arterial compliance at mean aortic pressures above 60 mm Hg. Below 60 mm Hg, estimates of arterial compliance varied widely, probably because of poor validity of the Windkessel models in the low pressure range.     

人体脉搏波传播时差检测系统

脉搏波的波形和传播速度与血管的几何和物理性质有密切关系,可通过检测脉搏波形和传播速度的变异判别动脉血管的弹性功能。作者采用固体压阻式脉压传感器,脉搏信号预处理装置,TP—801单板机组成检测脉搏波及其传播时差的系统,可对脉搏信号进行无创提取,贮存及处理,以供临床分析应用。     

Wave propagation with different pressure signals: An experimental study on the latex tube

To have deeper insight into the main factors affecting wave propagation in real hydraulic lines, we measured the true propagation coefficient in two latex rubber tubes via the three-point pressure method. The measurements were performed using both sinusoidal pressure signals of different amplitudes and periodic square waves as well as aperiodic pressure impulses. The results obtained were then compared with those predicted by a classic linear model valuable for a purely elastic maximally tethered tube. Our measurements demonstrate that the three-point pressure method may introduce significant errors at low frequencies (below 1 Hz in the present experiments) when the distance between two consecutive transducers becomes much lower than the wavelength. The pattern of phase velocity in the range 2–20 Hz turns out to be about 10 per cent higher than the theoretical one computed using the static value of the Young modulus. This result supports the idea that the dynamic Young modulus of the material is slightly higher than that measured in static conditions. The experimental attenuation, per wavelength is significantly higher than the theoretical one over most of the frequencies examined, and settles at a constant value as frequency increases. Introduction of wall viscoelasticity in the theoretical model can explain only a portion of the observed high frequency damping and wave attenuation. Finally, increasing the amplitude of pressure changes significantly affects the measured value of the propagation coefficient, especially at those frequencies for which direct and reflected waves sum together in a positive fashion. In these conditions we observed a moderate increase in phase velocity and a much more evident increase in attenuation per wavelength.     

Comparing two methods for calculating phantom scatter

Two methods are compared for calculating the field-size dependence of the phantom scatter component of dose for x-ray beams. One model sums three Gaussian distributions; the other model is a two-parameter function. With a measurement of the beam quality as input to determine parameters, both models accurately reproduce the relative phantom scatter. However, there are important differences between the models. For all beam energies, the two-parameter model characterizes the absolute phantom scatter as a function of depth and field size, while, also for all beam energies, the six-parameter Gaussian model characterizes the relative phantom scatter at a single depth of 10 cm. For small field sizes, the phantom scatter calculated from the two-parameter model agrees with Monte Carlo calculations better than the Gaussian model. In the Gaussian model, the parameters can be obtained for beam energies between 60Co and 25 MV by linear interpolation based on the measured beam quality. In the two-parameter model, and for energies above 4 MV, the parameters can be obtained using linear functions of the dose-weighted average linear attenuation coefficient, which is related to beam quality.     

Simultaneous determination of wave speed and arrival time of reflected waves using the pressure–velocity loop

In a previous paper we demonstrated that the linear portion of the pressure–velocity loop (PU-loop) corresponding to early systole could be used to calculate the local wave speed. In this paper we extend this work to show that determination of the time at which the PU-loop first deviates from linearity provides a convenient way to determine the arrival time of reflected waves (Tr). We also present a new technique using the PU-loop that allows for the determination of wave speed and Tr simultaneously. We measured pressure and flow in elastic tubes of different diameters, where a strong reflection site existed at known distances away form the measurement site. We also measured pressure and flow in the ascending aorta of 11 anaesthetised dogs where a strong reflection site was produced through total arterial occlusion at four different sites. Wave speed was determined from the initial slope of the PU-loop and Tr was determined using a new algorithm that detects the sampling point at which the initial linear part of the PU-loop deviates from linearity. The results of the new technique for detecting Tr were comparable to those determined using the foot-to-foot and wave intensity analysis methods. In elastic tubes Tr detected using the new algorithm was almost identical to that detected using wave intensity analysis and foot-to-foot methods with a maximum difference of 2%. Tr detected using the PU-loop in vivo highly correlated with that detected using wave intensity analysis (r ² = 0.83, P < 0.001). We conclude that the new technique described in this paper offers a convenient and objective method for detecting Tr, and allows for the dynamic determination of wave speed and Tr, simultaneously.     

Analyzing Event-Related Potentials: The Utility of High and Low Pass Filtering in Improving the Relationship Between Various Amplitude Measures and Principal Components Analysis Factor Scores

The present investigation sought to determine whether the relationship between event-related potential (ERP) principal components analysis (PCA) factor scores and analogous waveform amplitude measures could be improved by high- and low-pass filtering the waveforms at a suitable cutoff value. Visual oddball ERPs were submitted to a varimax-rotated PCA performed on the variance/covariance matrix. Principal components corresponding to P300 and Slow Wave were obtained. In keeping with the fact that the variance/covariance PCA analyzes sources of variance around the grand mean waveform, the grand mean waveform was subtracted from each of the original waveforms, and baseline-referenced amplitude measurements were then made of P300 and Slow Wave. P300 was measured both as the maximum positive peak between 275 and 425 ms, and as the average amplitude during that interval. Slow Wave was measured as the average amplitude during the interval 400–700 ms. The P300 measurements were then repeated after high-pass filtering the difference waveforms at 2 Hz. Slow Wave measurements were repeated after low-pass filtering at 2 Hz. The value of 2 Hz was chosen as giving a reasonable cutoff based upon estimates of the wavelengths of the two components derived from inspection of their respective factor loading vectors. The correlation between factor scores and amplitude measurements was .94 for unfiltered Slow Wave and actually declined slightly but significantly to .91 when the waveforms were low-pass filtered. It would appear that Slow Wave factor scores emerging from a PCA can be fairly well approximated by a time-band measurement algorithm, and that this approximation is not improved by low-pass filtering. For both filtered and unfiltered measurements of P300, the amplitude/factor score correlation was significantly higher for the time-band method than for the peak method. Further, high-pass filtering at 2 Hz improved the time-band/factor score correlation significantly from .62 to .75. This improvement is probably because the unfiltered measurements were tapping sources of variance due both to the higher frequency P300 component as well as a simultaneously active, lower frequency Slow Wave component. Theoretical implications of these findings are discussed.     

Model-based noninvasive estimation of intracranial pressure from cerebral blood flow velocity and arterial pressure

Intracranial pressure (ICP) is affected in many neurological conditions. Clinical measurement of pressure on the brain currently requires placing a probe in the cerebrospinal fluid compartment, the brain tissue, or other intracranial space. This invasiveness limits the measurement to critically ill patients. Because ICP is also clinically important in conditions ranging from brain tumors and hydrocephalus to concussions, noninvasive determination of ICP would be desirable. Our model-based approach to continuous estimation and tracking of ICP uses routinely obtainable time-synchronized, noninvasive (or minimally invasive) measurements of peripheral arterial blood pressure and blood flow velocity in the middle cerebral artery (MCA), both at intra-heartbeat resolution. A physiological model of cerebrovascular dynamics provides mathematical constraints that relate the measured waveforms to ICP. Our algorithm produces patient-specific ICP estimates with no calibration or training. Using 35 hours of data from 37 patients with traumatic brain injury, we generated ICP estimates on 2665 nonoverlapping 60-beat data windows. Referenced against concurrently recorded invasive parenchymal ICP that varied over 100 millimeters of mercury (mmHg) across all records, our estimates achieved a mean error (bias) of 1.6 mmHg and SD of error (SDE) of 7.6 mmHg. For the 1673 data windows over 22 hours in which blood flow velocity recordings were available from both the left and the right MCA, averaging the resulting bilateral ICP estimates reduced the bias to 1.5 mmHg and SDE to 5.9 mmHg. This accuracy is already comparable to that of some invasive ICP measurement methods in current clinical use.     

Mathematical modelling of non-invasive oscillometric finger mean blood pressure measurement by maximum oscillation criterion

A mathematical study is performed to assess how the arterial pressure-volume (P-V) relationship, blood pressure pulse amplitude and shape affect the results of non-invasive oscillometric finger mean blood pressure estimation by the maximum oscillation criterion (MOC). The exponential models for a relaxed finger artery and for a partly contracted artery are studied. A new modification of the error equation is suggested. This equation and the results of simulation demonstrate that the value of pressure estimated by the MOC does not exactly agree with the value of the true mean blood pressure (the latter being defined as pressure corresponding to maximum arterial compliance). The error depends on the arterial pressure pulse amplitude, as well as on the difference between the arterial pressure pulse shape index and the arterial P-V curve shape index. In the case of contracted finger arteries, the MOC can give an overestimation of up to 19 mmHg, the pressure pulse shape index being 0.21 and the pulse amplitude 60 mmHg. In the case of relaxed arteries, the error is less evident.     

Mathematical modelling of non-invasive oscillometric finger mean blood pressure measurement by maximum oscillation criterion

A mathematical study is performed to assess how the arterial pressure-volume (P-V) relationship, blood pressure pulse amplitude and shape affect the results of non-invasive oscillometric finger mean blood pressure estimation by the maximum oscillation criterion (MOC). The exponential models for a relaxed finger artery and for a partly contracted artery are studied. A new modification of the error equation is suggested. This equation and the results of simulation demonstrate that the value of pressure estimated by the MOC does not exactly agree with the value of the true mean blood pressure (the latter being defined as pressure corresponding to maximum arterial compliance). The error depends on the arterial pressure pulse amplitude, as well as on the difference between the arterial pressure pulse shape index and the arterial P-V curve shape index. In the case of contracted finger arteries, the MOC can give an overestimation of up to 19 mmHg, the pressure pulse shape index being 0.21 and the pulse amplitude 60 mmHg. In the case of relaxed arteries, the error is less evident.     

Simple and accurate way for estimating total and segmental arterial compliance: The pulse pressure method

We derived and tested a new, simple, and accurate method to estimate the compliance of the entire arterial tree and parts thereof. The method requires the measurements of pressure and flow and is based on fitting the pulse pressure (systolic minus diastolic pressure) predicted by the two-element windkessel model to the measured pulse pressure. We show that the two-element windkessel model accurately describes the modulus of the input impedance at low harmonics (0–4th) of the heart rate so that the gross features of the arterial pressure wave, including pulse pressure, are accounted for. The method was tested using a distributed nonlinear model of the human systemic arterial tree. Pressure and flow were calculated in the ascending aorta, thoracic aorta, common carotid, and iliac artery. In a linear version of the systemic model the estimated compliance was within 1% of the compliance at the first three locations. In the iliac artery an error of 7% was found. In a nonlinear version, we compared the estimates of compliance with the average compliance over the cardiac cycle and the compliance at the mean working pressure. At the first three locations we found the estimated and “actual” compliance to be within 12% of each other. In the iliac artery the error was larger. We also investigated an increase and decrease in heart rate, a decrease in wall elasticity and exercise conditions. In all cases the estimated total arterial compliance was within 10% of mean compliance. Thus, the errors result mainly from the nonlinearity of the arterial system. Segmental compliance can be obtained by subtraction of compliance determined at two locations.