首页|两种波形分析模型与术中患者血流动力学变化的相关性

两种波形分析模型与术中患者血流动力学变化的相关性

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目的 储存压力波模型巧妙地将动脉系统的功能分为导管功能和储集功能,从而引入更多变量以解释血流动力学的变化.本研究旨在对比储存压力波模型与"金标准"波分离模型在反映患者血流动力学变化的优劣,探究储存压力波模型是否比其他同类型波形分析技术更具价值.方法 选取30例进行全身麻醉膝关节置换手术的患者,围绕患者因术中干预而产生血流动力学变化的时间节点,进行动脉压力波形采集,对信号进行预处理后使用上述两种波形分析模型进行分析,引入储存波上升斜率(Pr/tr)、储波幅值与脉压比值(Pr/PP)、储存波波峰在心动周期的位置(tr/T)、反向波上升斜率(Pb/tb)等波形特征参量.使用配对样本t检验对诱导前后和给药前后的生命体征参数、波形参量分别进行比较,并对术中5个时间点的波形参量变化与生命体征参数变化进行Spearman相关性分析.结果 诱导前后和给药前后的生命体征参数、波形特征参量的变化具有较高的统计学显著性.波分离模型中仅有Pb/tb与心输出量(cardiac output,CO)呈负相关(r=-0.312,P<0.05),其他参量均与术中生命体征参数相关性不高.而储存压力波模型的波形参量中Pr/tr与CO、静脉-动脉二氧化碳分压(Pcv-aCO2)相关系数分别为-0.766、0.616(P<0.01),tr/T与CO相关系数为0.483(P<0.01).储存压力波模型特征参量与生命体征参数的相关更加密切.结论 储存压力波模型在反映高血压患者血流动力学变化中,比同类型的波形分析技术更具价值.
Correlation between two waveform analysis models and intraoperative hemodynamic changes
Objective The reservoir-pressure wave model ingeniously divides the arterial system's function into conduit function and storage function,introducing more variables to explain hemodynamic changes. This study aims to compare the reservoir-pressure wave model with the "gold standard" wave separation model in reflecting hemodynamic changes in patients and investigate whether the reservoir-pressure wave model is more valuable than other similar waveform analysis techniques. Methods Thirty patients undergoing general anesthesia for knee joint replacement surgery were selected. Arterial pressure waveforms were collected around the time points when hemodynamic changes occurred due to intraoperative interventions. The signals were preprocessed and analyzed using the two waveform analysis models mentioned above, incorporating waveform parameters such as reservoir-wave rising slope (Pr/tr),reservoir-wave amplitude to pulse pressure ratio (Pr/PP),position of the reservoir-wave peak in the cardiac cycle (tr/T),reverse wave rising slope (Pb/tb),etc. Pairwise sample t-tests were used to compare life sign parameters and waveform parameters before and after induction and drug administration. Spearman correlation analysis was performed between the changes in waveform parameters at five intraoperative time points and life sign parameter changes. Results Changes in life sign parameters and waveform feature parameters before and after induction and drug administration showed statistically significant differences. In the wave separation model, only the negative correlation between the upslope of the backward wave (Pb/tb) and cardiac output (CO) was significant (r=-0. 312,P<0. 05),while other parameters showed low correlations with intraoperative life sign parameters. In the reservoir-pressure wave model,the correlation coefficients of Pr/tr with CO and Pcv-aCO2 were -0. 766 and 0. 616 ( P<0. 01) ,and tr/T had a correlation coefficient of 0. 483 ( P<0. 01 ) with CO. The reservoir-pressure wave model ' s feature parameters exhibited a stronger correlation with life sign parameters. Conclusions The reservoir-pressure wave model is more valuable than similar waveform analysis techniques in reflecting hemodynamic changes in patients with hypertension.

arterial pressure waveformhemodynamicsphysiological indicatorswave separation modelreservoir-pressure wave model

林懋时、程云章、曹阳、梁冰、文小琴

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上海理工大学健康科学与工程学院,上海 200093

暨南大学附属广州市红十字会医院麻醉科,广州 510220

华南理工大学自动化科学与工程学院,广州 510641

动脉压力波形 血流动力学 生命体征参数 波分离模型 储存压力波模型

上海介入医疗器械工程技术研究中心资助项目广州市科学技术局农业与社会发展重点项目广州市临床特色技术项目广州市临床特色技术项目广州市2023年度市校(院)企联合资助专题

18DZ22509002021030000222023C-TS432023C-TS392023A03J0596

2024

10.3969/j.issn.1002-3208.2024.03.004

北京生物医学工程
北京市心肺血管疾病研究所

北京生物医学工程

CSTPCD
影响因子：0.474
ISSN：1002-3208
年,卷(期)：2024.43(3)
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