基于柯氏音延迟时间的无创伤动脉血压连续测量的研究

项目名称： 基于柯氏音延迟时间的无创伤动脉血压连续测量的研究

项目编号： No.30800238

项目类型： 青年科学基金项目

立项/批准年度： 2009

项目学科： 轻工业、手工业

项目作者： 向海燕

作者单位： 中国人民解放军空军航空医学研究所

项目金额： 20万元

中文摘要： 在医学临床和科学研究过程中，因为人体动脉血压时刻处在变化之中，常常需要了解在一段时间内每个心动周期的血压连续变化规律。从心动周期中的一个固定时刻到柯氏音前沿的时刻，称为柯氏音延迟时间，记为KDT，它是袖带内压力P的函数，柯氏音延迟时间随着袖带压力的下降而逐渐变小，它们之间的关系可以用一次拟合或者二次拟合曲线来近似逼近KDT=f(P)。当袖带压力固定在介于收缩压和舒张压之间的一个相对恒定值时，动脉内压力的变化将引起动脉血管壁跨壁压的变化，从而使柯氏音延迟时间发生变化。在血压不变时袖带压力的下降对延迟时间的影响，和袖带压力不变时血压的变化引起的延迟时间的变化方向相反，大小成比例。事实上，柯氏音延迟时间就是跨壁压的函数，所以，无论是动脉内压（血压）还是动脉外压（袖带压）的变化，都会引起柯氏音延迟时间的变化。本研究基于柯氏音延时现象构建了一种无创动脉血压逐拍测量技术，并用人体有创血压进行了对比试验。试验结果表明，本研究提出的无创方法得到的结果和有创血压的平均偏差为0.51mmHg，标准差为2.65mmHg。这种方法可用于 压力敏感性测试、冷加压试验、头高位倾斜实验以及作为根据脉搏波传导时间法。

中文关键词： 血压；无创测量；柯氏音延迟时间；跨壁压；逐拍

英文摘要： Background Noninvasive measurement of arterial blood pressure is important for clinical and basic research. Because blood pressure usually changes significantly within a few seconds, noninvasive continuous measurement of blood pressure is more important in determining cardiovascular status. The purpose of the study is to propose a novel noninvasive beat-to-beat arterial blood pressure measurement method based on the Korotkoff sound delay time (KDT) and evaluate its accuracy in preliminary experiments. Methods KDT decreases as the cuff pressure P deflates, which can be described by a function. Actually, KDT is a function of arterial transmural pressure. Therefore, the variation in blood pressure can be obtained by the transmural pressure, which is estimated by the KDT. Holding the cuff pressure at an approximate constant pressure between systolic pressure and diastolic pressure, the variation in blood pressure between successive heartbeats can be estimated according to KDT and , which represents the variation of KDT corresponding to unit pressure. Then the blood pressure for each heartbeat can be obtained by calculating the.Invasive and noninvasive blood pressure values of six subjects were measured simultaneously to evaluate the method. Results The average of the correlation coefficients between the invasive mean arterial pressure (MAP) and the KDT for six subjects was -0.91. The average of the correlation coefficients between the invasive MAP and the estimated mean blood pressure (EBP) was 0.92. The mean difference between EBP and MAP was 0.51 mmHg, and the standard deviation was 2.65 mmHg. The mean blood pressure estimated by the KDT is consistent with the invasive MAP. Conclusion The beat-to-beat blood pressure estimated by KDT provides an accurate estimate of mean arterial pressure in the preliminary experiments and represents a potential acceptable alternative to invasive blood pressure monitoring during laboratory studies.

英文关键词： blood pressure; noninvasive measurement; Korotkoff sound delay time; transmural pressure; beat-to-beat