CN103830783B - A perfusion decision system for extracorporeal circulation - Google Patents

Abstract

A kind of Cardiopulmonary bypass decision system, belongs to biomedical engineering technology field, mainly comprises decision-making module and detection module.Decision-making module, according to the data of detection module acquisition and processing, comprises output pressure and the blood flow of parameters of left ventricular function and oxygen supply index and outer circulation filling system, calculates perfusion subsidiary index number.This perfusion subsidiary index number represents the ratio of the acting of external counterpulsation system and patient's heart perfusion acting, and perfusion subsidiary index number value is higher, and the energy that external counterpulsation system provides for patient is higher.Decision-making module judges according to the parameters of left ventricular function of acquisition module collection and oxygen supply index, makes a policy: if index is within normal range, then pouring into subsidiary index number is recommendation, namely with reference to decision value; If index is outside normal range, then make warning.The reference decision value that doctor or control system propose according to decision-making module, selects to perform.By with reference to control agent outer filling flow based on decision value, the psychological need of patient can be adapted to, reduce complication.

Description

A perfusion decision system for extracorporeal circulation

technical field

The invention relates to an extracorporeal circulation perfusion decision-making system, which belongs to the field of biomedical engineering.

Background technique

Extracorporeal circulation perfusion system is a commonly used auxiliary means in surgical operations. Internationally, the arterial device, system and method CN201080025371.5 of Cardio-Guard Medical Company adopts a suction lumen arrangement to provide a suction flow leaving the aorta at a suction flow rate. The target perfusion flow rate and the suction flow rate can be controlled simultaneously and selectively, but this flow control does not take into account the patient's physiological parameters. Rand Co., Ltd. CN200710093658.1, a system for monitoring the extracorporeal circulation and perfusion of medical fluid during cardiopulmonary bypass, monitors and controls the blood circulation circuit of the blood pump, but its monitoring parameters are not fed back to the control of the perfusion blood pump. In China, CN201220067806.9, an integrated extracorporeal circulation perfusion system developed by the Fourth Military Medical University of the Chinese People's Liberation Army, has not realized the control of perfusion flow according to the patient's physiological parameters.

The perfusion flow rate of the current extracorporeal perfusion system is controlled by the doctor's experience, and the perfusion flow rate is not coupled with the patient's physiological parameter changes, so there is a risk of over-perfusion or under-perfusion.

A low perfusion oxygen saturation measurement method based on autocorrelation modeling method CN103027690A of Huazhong University of Science and Technology. Although a method for measuring blood perfusion index is designed, this index only reflects the pulsation of blood flow and cannot express The ratio relationship between in vitro perfusion flow and patient's own heart perfusion cannot provide a basis for adjusting in vitro perfusion flow.

During the perfusion process, physiological parameters such as cardiac output, heart rate, blood pressure, etc. are related to the perfusion flow in vitro in real time, and these parameters will change with the flow change caused by the rotation of the blood pump. These parameters are also important influencing factors in the decision to control the blood pump.

Contents of the invention

In order to adjust the extracorporeal perfusion flow rate according to the patient's physiological parameters and reduce complications, the present invention provides an extracorporeal circulation perfusion decision-making system to maintain the perfusion volume in a range suitable for the patient's state.

In order to achieve the above object, the present invention has taken the following technical solutions:

An extracorporeal circulation perfusion decision-making system, the system includes a detection module and a decision-making module, the detection module cyclically collects the patient's physiological data and parameters of the extracorporeal perfusion system, the patient's physiological data includes cardiac output, heart rate, blood pressure, venous oxygen saturation degree and arterial blood oxygen saturation, the parameters of the extracorporeal perfusion system include output pressure and flow, and the detection module fits the cardiac output, blood pressure, output pressure, and flow into the waveform of arterial pressure, arterial blood flow, The outlet pressure waveform of the extracorporeal circulation perfusion blood pump, the waveform of the perfusion blood flow of the extracorporeal circulation perfusion blood pump, and the above data are displayed at the same time and sent to the decision-making module; the decision-making module is based on the formula

$\mathrm{<span\; class="notranslate">\; P</span>}\mathrm{<span\; class="notranslate">\; A</span>}\mathrm{<span\; class="notranslate">\; I</span>}<span\; class="notranslate">\; (</span>\mathrm{<span\; class="notranslate">\; \&omega;</span>}<span\; class="notranslate">\; )</span><span\; class="notranslate">\; =</span>\frac{\mathrm{<span\; class="notranslate">\; 1</span>}}{{\mathrm{<span\; class="notranslate">\; T</span>}}_{\mathrm{<span\; class="notranslate">\; c</span>}}}{<span\; class="notranslate">\; \&Integral;</span>}_{\mathrm{<span\; class="notranslate">\; 0</span>}}^{{\mathrm{<span\; class="notranslate">\; T</span>}}_{\mathrm{<span\; class="notranslate">\; c</span>}}}<span\; class="notranslate">\; (</span>\frac{{\mathrm{<span\; class="notranslate">\; P</span>}}_{\mathrm{<span\; class="notranslate">\; p</span>}}<span\; class="notranslate">\; (</span>\mathrm{<span\; class="notranslate">\; t</span>}<span\; class="notranslate">\; )</span>{\mathrm{<span\; class="notranslate">\; f</span>}}_{\mathrm{<span\; class="notranslate">\; p</span>}}<span\; class="notranslate">\; (</span>\mathrm{<span\; class="notranslate">\; t</span>}<span\; class="notranslate">\; )</span>}{{\mathrm{<span\; class="notranslate">\; P</span>}}_{\mathrm{<span\; class="notranslate">\; a</span>}\mathrm{<span\; class="notranslate">\; p</span>}}<span\; class="notranslate">\; (</span>\mathrm{<span\; class="notranslate">\; t</span>}<span\; class="notranslate">\; )</span>{\mathrm{<span\; class="notranslate">\; f</span>}}_{\mathrm{<span\; class="notranslate">\; a</span>}\mathrm{<span\; class="notranslate">\; p</span>}}<span\; class="notranslate">\; (</span>\mathrm{<span\; class="notranslate">\; t</span>}<span\; class="notranslate">\; )</span>}<span\; class="notranslate">\; )</span>\mathrm{<span\; class="notranslate">\; d</span>}\mathrm{<span\; class="notranslate">\; t</span>}$

Get the reference decision PAI, and display the reference decision PAI, or output it to the in vitro perfusion system at the same time;

In the formula, PAI(ω)—work relationship between extracorporeal circulation perfusion and cardiac perfusion,

P _p (t)——the outlet pressure waveform of extracorporeal circulation perfusion blood pump,

F _p (t)—the waveform of the perfusion blood flow of the extracorporeal circulation perfusion blood pump,

P _ap (t) - waveform of arterial pressure,

F _ap (t)—the waveform of arterial blood flow,

T _c ——cardiac cycle, obtained from heart rate;

The venous blood oxygen saturation and arterial blood oxygen saturation are used as the basis for judging whether PAI(ω) is a reference decision-making PAI. If the arterial blood oxygen saturation is >90%, the venous blood oxygen saturation is maintained between 64% and 88%. , PAI(ω) is the recommended value, and the reference decision PAI is output.

The optimal value of the reference decision PAI can be obtained on the basis of the following conditions:

1) Arterial oxygen saturation >90%, and venous oxygen saturation maintained between 64% and 88%;

2) The heart rate is near the value calculated according to the formula 118.1-(0.57×age);

3) The cardiac output is 4-7L/min or the average cardiac output is 4-6.5L/min;

4) Blood pressure systolic blood pressure ≤ 140mmHg (18.6kPa), diastolic blood pressure ≤ 90mmHg (12kPa).

The beneficial effect of the present invention is that: the extracorporeal circulation perfusion decision-making system can be used to make perfusion decisions according to the physiological parameters of patients, and based on this, the extracorporeal perfusion flow can be adjusted to meet the physiological needs of patients and reduce complications.

Description of drawings

Fig. 1 is a schematic structural diagram of an extracorporeal circulation perfusion decision-making system according to the present invention.

detailed description

The specific structure of the present invention will be described in detail below in conjunction with accompanying drawing 1 .

The extracorporeal circulation perfusion flow decision-making system includes a detection module and a decision-making module, and the structural block diagram is shown in Figure 1. The detection module collects the physiological data of the patient and the parameters of the extracorporeal perfusion system, and transmits the data to the decision-making module. Physiological data include indicators of cardiac function, such as cardiac output, heart rate, blood pressure, and oxygen supply indicators (including venous oxygen saturation and arterial oxygen saturation). The parameters of extracorporeal perfusion system include output pressure and flow. The decision-making module receives the data from the detection module and performs calculations to obtain the reference decision-making PAI.

Among them, the patient's cardiac output, heart rate, blood pressure, and blood oxygen saturation can be obtained by conventional detection methods, such as Doppler flow sensor to detect cardiac output, dual invasive pressure sensors to detect blood pressure, ECG electrodes to detect heart rate, photoelectric sensor Check blood oxygen saturation.

The detection module is composed of a computer and a multi-channel signal selection switch circuit (such as a multi-channel signal selection switch circuit composed of a chip CD4051), and the multi-channel data acquisition module sequentially collects signals from various channels to the computer and collects them cyclically. The computer fits the waveforms of the arterial pressure and blood flow, as well as the waveforms of the outlet pressure and flow of the extracorporeal circulation perfusion blood pump.

The decision-making module can be composed of a simple single-chip microcomputer and its peripheral circuits. By writing a program, the reference decision PAI is obtained. The principle is as follows:

In order to evaluate the work relationship between cardiopulmonary bypass perfusion and cardiac perfusion, the perfusion assistance index PAI(ω) was introduced to describe the work distribution between the two. The algorithm program for calculating PAI(ω) is installed in the decision-making module, which is determined by the formula

$PAI\left(\mathrm{\&omega;}\right)=\frac{1}{T_c}{\&Integral;}_0^{T_c}\left(\frac{P_p\left(t\right)f_p\left(t\right)}{P_{ap}\left(t\right)f_{ap}\left(t\right)}\right)dt$ get;

In the formula, P _p (t)——the outlet pressure waveform of extracorporeal circulation perfusion blood pump,

F _p (t)—the waveform of the perfusion blood flow of the extracorporeal circulation perfusion blood pump,

P _ap (t) - waveform of arterial pressure,

F _ap (t)—the waveform of arterial blood flow,

T _c ——cardiac cycle.

Since the outlet pressure and blood flow waveforms are generated by the extracorporeal circulation perfusion system and can be adjusted, they are obtained by the detection module, so PAI(ω) is a personalized decision factor that changes with the patient's physiological parameters. PAI(ω) can evaluate the work relationship between the heart and the extracorporeal perfusion system, and describe the work distribution between the two. The unit is "%", and its normal range is within 0%-100%. When PAI(ω)<100%, the extracorporeal perfusion system is partially assisted. When PAI(ω)=100%, the extracorporeal perfusion system is fully assisted. The higher the PAI(ω) value, the higher the energy provided by the extracorporeal perfusion system to the patient.

The decision-making module calculates a reference decision, namely PAI(ω), based on the physiological data collected by the detection module, such as cardiac output, heart rate, blood pressure, and blood oxygen saturation. When these physiological data are at normal values, PAI(ω) is the reference decision value PAI, and the doctor or the control system can refer to the decision value PAI to adjust the perfusion volume. If the physiological data is not within the normal range, the decision module issues a warning. The normal values of the physiological parameters referenced by the decision-making module PAI are as follows: arterial oxygen saturation >90%, venous oxygen saturation maintained between 64% and 88%; The normal value of heart rate is calculated according to the following formula: 118.1-(0.57×age); the normal value of cardiac output is 4-7L/min, and the average value of cardiac output is 4-6.5L/min; systolic blood pressure≤140mmHg (18.6kPa), diastolic pressure ≤ 90mmHg (12kPa).

Claims (2)

1. a Cardiopulmonary bypass decision system, system comprises detection module and decision-making module, it is characterized in that: the described physiological data of detection module circle collection patient and the parameter of external counterpulsation system, the physiological data of patient comprises heart stroke, heart rate, blood pressure, Svo2 and arterial oxygen saturation, the parameter of external counterpulsation system comprises output pressure and flow, and detection module is by heart stroke wherein, blood pressure, output pressure, flow fits to the waveform of arterial pressure respectively, the waveform of blood flow volume, the outlet pressure waveform of Cardiopulmonary bypass blood pump, the waveform of the perfusion blood flow of Cardiopulmonary bypass blood pump, simultaneously by the physiological data of above-mentioned all patients, the parameter of external counterpulsation system, and detection module matching waveform out shows and delivers to described decision-making module, described decision-making module is according to formula

$PAI\left(\mathrm{\&omega;}\right)=\frac{1}{T_c}{\&Integral;}_0^{T_c}\left(\frac{P_p\left(t\right)F_p\left(t\right)}{P_{ap}\left(t\right)F_{ap}\left(t\right)}\right)dt$

Obtain with reference to decision-making PAI, and show with reference to decision-making PAI, or export to external counterpulsation system simultaneously;

In formula, the acting relation of PAI (ω)---Cardiopulmonary bypass and heart perfusion,

P _pthe outlet pressure waveform of (t)---Cardiopulmonary bypass blood pump,

F _pthe waveform of the perfusion blood flow of (t)---Cardiopulmonary bypass blood pump,

P _apthe waveform of (t)---arterial pressure,

F _apthe waveform of (t)---blood flow volume,

T _c---cardiac cycle, is obtained by heart rate;

Described Svo2 and arterial oxygen saturation are as differentiating that whether PAI (ω) is the foundation with reference to decision-making PAI, if arterial oxygen saturation >90%, Svo2 maintains between 64 ~ 88%, PAI (ω) is recommendation, exports with reference to decision-making PAI.

2. a kind of Cardiopulmonary bypass decision system as claimed in claim 1, is characterized in that: the described foundation with reference to decision-making PAI is,

1) arterial oxygen saturation >90%, Svo2 maintains between 64 ~ 88%;

2) heart rate is near the value calculated according to formula 118.1-(0.57 × age);

3) heart stroke is 4 ~ 7L/min, and heart stroke meansigma methods is 4 ~ 6.5L/min;

4) blood pressure systolic pressure≤140mmHg (18.6kPa), diastolic pressure≤90mmHg (12kPa).