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WO2018095083A1 - 脉搏波传播时间的校正方法 - Google Patents

脉搏波传播时间的校正方法 Download PDF

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Publication number
WO2018095083A1
WO2018095083A1 PCT/CN2017/098155 CN2017098155W WO2018095083A1 WO 2018095083 A1 WO2018095083 A1 WO 2018095083A1 CN 2017098155 W CN2017098155 W CN 2017098155W WO 2018095083 A1 WO2018095083 A1 WO 2018095083A1
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Prior art keywords
toe
pulse wave
ear
pressure correction
correction variable
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English (en)
French (fr)
Inventor
陈妍
陈瑜
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Zhejiang Mailian Medical Equipment Co Ltd
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Zhejiang Mailian Medical Equipment Co Ltd
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Priority claimed from CN201611046184.0A external-priority patent/CN106377238B/zh
Priority claimed from CN201611045054.5A external-priority patent/CN106580303B/zh
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
    • A61B5/02125—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics of pulse wave propagation time
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/026—Measuring blood flow
    • A61B5/0285—Measuring or recording phase velocity of blood waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/01—Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
    • A61B5/02116—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics of pulse wave amplitude

Definitions

  • the invention relates to the technical field of arterial blood pressure measurement, in particular to a pulse wave propagation time correction method.
  • Arterial blood pressure is one of the main indicators reflecting the state of the circulatory system and assessing organ perfusion. It is an important vital sign parameter for perioperative monitoring.
  • the blood pressure monitoring methods commonly used in perioperative period can be divided into invasive measurement and non-invasive measurement.
  • Invasive measurement refers to the technique of placing a dedicated pipe into the circulation system of the body, and converting the mechanical potential energy into an electronic signal through a converter to display the blood pressure change in real time on the monitoring device.
  • Invasive measurement methods can measure pulse blood pressure continuously and accurately, but the dangers and injuries that can be caused can not be ignored.
  • a commonly used method for non-invasive measurement is the cuff oscillometric method, which is simple and accurate in clinical practice and is widely used for health checkups and perioperative monitoring.
  • the cuff oscillometric method only measures blood pressure intermittently every 3-5 minutes, and it is impossible to track changes in arterial blood pressure in real time.
  • the medical community has proposed continuous non-invasive pulse blood pressure measurement technology, in which pulse wave propagation time / speed (PTT / PWV) continuous non-invasive measurement of blood pressure per wave has gradually become a research hotspot.
  • the measurement method obtains a volume pulse wave (PhotoPlethysmoGraphy PPG) and an electrocardiogram signal (ECG) by one or more photosensors and a set of electrocardiographic electrodes, and calculates the time difference between the PPG and the ECG or the time difference between the two PPGs.
  • PTT/PWV explore the functional relationship between PTT/PWV and blood pressure and establish a mathematical model to estimate blood pressure using measurable PTT/PWV.
  • Patents disclose specific methods or devices for continuously measuring non-invasive blood pressure using PTT/PWV, such as Chinese patents CN101229058A, CN102811659A, CN1127939C, U.S. Patents 5,865,755, 5,587,975, 5,649,543, 9364,158 and European Patent 0413267.
  • the existing methods have certain limitations and can only be applied under the condition that the circulation system is not subject to external interference. Because only in the absence of interference, the relationship between PTT and blood pressure is more regular for individuals, and it can be described by certain functions and mathematical models. However, during the perioperative period, the patient's circulatory system under the influence of fluid therapy, drugs, surgical operations, temperature and other confounding factors, PTT will undergo a series of abnormal changes, using abnormal PTT and inherent mathematical models to estimate blood pressure will produce Larger error. Because the relationship between abnormal PTT and blood pressure no longer has certain regularity, even the frequent adjustment of mathematical model parameters to adapt to PTT changes does not solve the fundamental problem, and can not meet the accuracy and real-time requirements of clinical measurement.
  • the present invention provides a method for correcting pulse wave transit time PTT, which can be directed to a pulse caused by blood transfusion, vasoactive drugs, surgical intervention, etc. under clinical conditions.
  • the variation of the wave propagation time is corrected for self-adaptation and the accuracy is high.
  • a method for correcting pulse wave transmission time includes the following steps:
  • T 3 calculating a pulse wave propagation time T d associated with diastolic blood pressure and a pulse wave propagation time T s associated with systolic blood pressure, the T d being a time difference from a starting point of the ear pulse wave to a starting point of the toe pulse wave;
  • the T s refers to the time difference of the aortic valve closing point on the ear pulse wave to the aortic valve closing point on the toe pulse wave;
  • h is the amplitude of the ear pulse wave or the toe pulse wave in the longitudinal direction;
  • step S5 obtaining a correction variable under the cardiac cycle according to step S4, and calculating a correction matrix under the cardiac cycle;
  • step S6 Continuously obtaining correction matrices in a plurality of cardiac cycles, and correcting T s and T d obtained in step S3.
  • the correction matrix in the step S5 comprises a diastolic pressure correction matrix B and a systolic pressure correction matrix A; b i is the i-th correction variable in the diastolic pressure correction variable; a i is the ith correction variable in the systolic pressure correction variable.
  • step S6 is specifically:
  • T dmb T dm (1-B m )
  • T sma T sm (1-A m );
  • B i is the diastolic pressure correction matrix in the i-th cardiac cycle
  • T di is the T d in the i-th cardiac cycle
  • a i is the systolic pressure correction matrix in the i-th cardiac cycle
  • T si is T s in the i-th cardiac cycle.
  • the first diastolic pressure correction variable b 1 is calculated by the following formula:
  • the first systolic pressure correction variable a 1 is calculated by the following formula:
  • the second diastolic pressure correction variable b 2 is calculated by the following formula:
  • the second systolic pressure correction variable a 2 is calculated by the following formula:
  • d 2-b 1.33 to 1.43
  • d 2 1.17 to 1.27
  • age is age.
  • the third diastolic pressure correction variable b 3 and the third systolic pressure correction variable a 3 are calculated by the following formula:
  • the fourth diastolic pressure correction variable b 4 and the fourth systolic pressure correction variable a 4 are calculated by the following formula:
  • the fifth diastolic pressure correction variable b 5 and the fifth systolic pressure correction variable a 5 are calculated by the following formula:
  • the sixth diastolic pressure correction variable b 6 and the sixth systolic pressure correction variable a 6 are calculated by the following formula:
  • the seventh diastolic pressure correction variable b 7 and the seventh systolic pressure correction variable a 7 are calculated by the following formula:
  • the method for correcting the pulse wave propagation time provided by the present invention is implemented by The ear pulse wave and the toe pulse wave in the same cardiac cycle are detected, the pulse wave propagation time associated with diastolic blood pressure and the pulse wave propagation time related to the systolic pressure are calculated, and the correction variable is extracted and corrected according to the morphological characteristics of the pulse wave.
  • the matrix performs adaptive correction on the above-mentioned variation of the pulse wave propagation time, and the corrected propagation time can be used in the existing mathematical model to continuously and accurately measure the blood pressure of each cardiac cycle under clinical conditions.
  • Perioperative changes in PTT can be divided into two categories: one type of change: PTT changes caused by changes in blood pressure; and two types of changes: changes in PTT and blood pressure that are not synchronized (the direction or magnitude of change between the two does not conform to the regular function rule).
  • PTT changes caused by changes in blood pressure and two types of changes: changes in PTT and blood pressure that are not synchronized (the direction or magnitude of change between the two does not conform to the regular function rule).
  • PTT changes caused by changes in blood pressure the blood volume is mildly insufficient
  • PTT will increase, but due to the adjustment of the body's own peripheral resistance, blood pressure may not change much; the use of the hook in chest and abdomen surgery may seriously affect PTT, but has little effect on blood pressure; norepinephrine
  • the present invention extracts various variables according to the morphological changes of the pulse wave to indirectly identify and adaptively correct various types of changes of the PTT, and overcomes the above principle errors; and can form an adaptive calibration function by combining existing mathematical models. Continuous non-invasive measurement of blood pressure does not require repeated methods such as cuff oscillometry.
  • the position of the human body detecting the pulse wave is preferably the ear and the toe, and the pulse waves of the two parts can be large.
  • Physiological and pathological information of arteries and peripheral arteries are representative of the route of transmission.
  • the sensor for detecting the pulse signal is preferably an infrared photoplethysmograph (PPG).
  • the morphological changes of the ear and toe pulse waves themselves and the relative changes in the morphology between the two pulse waves provide a wealth of information for identifying the two types of changes in PTT and the differences in blood pressure between different parts of the body.
  • the invention collects a large number of surgical cases of invasive arterial blood pressure, pulse waveforms of the ears and toes and PTT for several years, and extracts various variables according to the two pulse waves themselves and relative morphological changes, and studies different variables different from PTT. The relationship between the two types of changes, and defines the scope of application of various variables.
  • the pulse waveform is analyzed in real time and variables are extracted, and whether the PTT has two types of changes according to whether the variable falls within the applicable range, and the nature of the PTT type II change is determined according to the nature of the applicable variable. Degree, if a variable exceeds the applicable range, indicating that the corresponding two types of changes do not occur in the PTT, the variable is not applicable; the applicable variables are fused, the correction amount is calculated to correct the PTT, and the corrected PTT/PWV is applied. Accurately calculate blood pressure in existing mathematical models.
  • the invention utilizes a finite variable to express the most important and basic changes of the pulse wave morphology, and studies the relationship between these laws and PTT.
  • the ordinate is the amplitude h
  • the abscissa is the time t
  • the pulse wave starting point is the coordinate origin.
  • the method of correcting the pulse propagation time includes the following steps:
  • step S5 calculating a correction matrix under the cardiac cycle according to the correction variable in the cardiac cycle obtained in step S4;
  • step S6 Continuously obtaining correction matrices in a plurality of cardiac cycles, and correcting T s and T d obtained in step S3.
  • the method can detect the ear pulse wave and the toe pulse wave in the same cardiac cycle in real time, calculate the pulse wave propagation time related to the diastolic pressure and the pulse wave propagation time related to the systolic pressure, and extract the correction variable according to the morphological characteristics of the pulse wave.
  • the correction matrix is obtained, and the variation of the pulse wave propagation time is corrected, and the corrected propagation time can be used in the existing mathematical model to continuously measure the diastolic pressure and the systolic pressure of each cardiac cycle under clinical conditions.
  • the first diastolic pressure correction variable b 1 and the first systolic pressure correction variable a 1 are identical to each other.
  • the correction variable obtained in the step S4 includes a first diastolic pressure correction variable b 1 and a first systolic pressure correction variable a 1 , b 1 and a 1 for respectively adjusting the propagation time associated with diastolic blood pressure and systolic blood pressure in the hypotensive state.
  • two types of variation T d, T s a, b of the scope 1 b 1> 0, a suitable range of 1 to a 1> 0, b 1, a 1 indicates that the larger the lower the blood pressure.
  • k sd-m-0 represents the ratio of h sd to the average height of the ear pulse wave systolic phase.
  • the pulse wave peak appears as a forward-inclined triangle, h sd decreases a lot, and k sd-m-0 becomes smaller, indicating that the waveform of the end of the aortic systole is much lower, and the sustained power of the pusher wave propagation is insufficient.
  • the propagation time is extended. In this state, the diastolic information is unstable and should not be used.
  • d 1-b 74 to 82, preferably 78.
  • the second diastolic pressure correction variable b 2 and the second systolic pressure correction variable a 2 are identical to each other.
  • the correction variable obtained in the step S4 further includes a second diastolic pressure correction variable b 2 and a second systolic blood pressure correction variable a 2 , b 2 for correcting the propagation time T d related to diastolic blood pressure in the hypertensive state.
  • a 2 and a process of change from a state of high blood pressure in normotensive state to a state of hypertension, two types of variation correction associated with the systolic pressure pulse wave propagation time T s a, b of the scope 2 b 2> 0, 2 is a scope of a 2> 0, b 2, a 2 indicates that the larger the higher the diastolic and systolic blood pressure.
  • k sd-m-ts represents the ratio of h sd to the average height of the ear pulse wave diastolic period t s -2t s , and is used to determine the variation of the pulse wave diastolic phase.
  • the use of a hook in a thoracoabdominal surgery causes a change in the force of the aorta, which reduces the waveform of the diastolic phase of the ear pulse wave, and the k sd-m-ts becomes larger.
  • k sd-m-2 represents the ratio of h sd to the average height of the ear pulse wave 0-2t s segment, including the systolic and partial diastolic waveform information, mainly used for hypertension, such as tracheal intubation leading to heart rate and blood pressure Raise.
  • the peak of the pulse wave of the ear gradually changes into a triangle with a positive triangle or a backward tilt, h sd gradually increases, and k sd-m-2 gradually becomes larger.
  • the entire ear pulse wave becomes an equilateral triangle or a backward-inclined triangle, h sd rises a lot, and k sd-m-2 becomes large.
  • the triangular tip of the above two waveforms ie, the highest blood pressure
  • the sustained power corresponding to the highest blood pressure is insufficient, and the propagation time T s is relatively extended.
  • the slope of the rising edge of the waveform in the hypertensive state becomes small, the power for pushing the arterial wave wave is insufficient, and the propagation time T d is prolonged.
  • k sd-m k Sd-m-2 .
  • d 2-b 1.33 to 1.43, preferably 1.38.
  • d 2 1.17 to 1.27, preferably 1.22.
  • the third diastolic pressure correction variable b 3 and the third systolic pressure correction variable a 3 are identical to each other.
  • the correction variable obtained in the step S3 further includes a third diastolic pressure correction variable b 3 and a third systolic pressure correction variable a 3 , b 3 , a 3 for use in a state in which the blood volume changes or the body temperature of the sensor placement portion changes. T d , T s are corrected.
  • t s-toe represents the systolic time identified on the toe pulse wave
  • t d-toe represents the diastolic time identified on the toe pulse wave
  • the two variables with the same nature of the ear and toe pulse wave are combined, and the average value is taken as a variable for calibrating the pulse wave propagation time; if the waveform of the pulse wave diastolic phase is mutated, the k dma is corrected.
  • the correction variable obtained in the step S4 further includes a fourth diastolic blood pressure correction variable b 4 and a fourth systolic blood pressure correction variable a 4 , a 4 , b 4 in which peripheral blood vessel dilation causes lower limb blood pressure (relative to brachial blood pressure) to decrease.
  • T d and T s are corrected.
  • the range of application of a 4 and b 4 is a 4 >0, b 4 >0. The larger the a 4 and b 4 , the more the lower limb blood pressure is lowered relative to the brachial blood pressure. .
  • the correction variable obtained in the step S4 further includes a fifth diastolic pressure correction variable b 5 and a fifth systolic pressure correction variable a 5 , a 5 , b 5 have the same action and properties as a 4 and b 4 , and the lower limb blood pressure is relatively T d and T s were corrected in the case of a decrease in brachial blood pressure.
  • k sm-toe is the ratio of the average height of the toe pulse wave systolic period to the maximum height h max-toe ; k sm-toe is large, indicating that the toe pulse wave peak is broad and gentle, suggesting that the toe vasodilation, lower limb blood pressure relative to the radial artery Lowering.
  • the correction variable obtained in the step S4 further includes a sixth diastolic pressure correction variable b 6 and a sixth systolic pressure correction variable a 6 , a 6 , b 6 representing relative changes in the area of the two pulse waves, for toe vasodilation, T d and T s were corrected when the lower limb blood pressure was lower than the radial artery blood pressure.
  • 6 is a scope of a 6> 0; b scope of 6 b 6> 0;
  • k sm-toe-ear is the ratio of the area of the systolic period of the toe pulse wave to the area of the systolic phase of the ear pulse wave, 100 is the adjustment coefficient; k sm-toe-ear has the same action and properties as k ts-toe-ear .
  • the correction variable obtained in the step S4 further includes a seventh diastolic pressure correction variable b 7 and a seventh systolic pressure correction variable a 7 , the functions and properties of a 7 , b 7 being the same as a 6 and b 6 , a 7 , b 7 represents the relative change in the systolic width (systolic time) of the two pulse waves.
  • k ts-toe-ear is the ratio of the time of systole identified on the toe pulse wave to the time of the systolic phase identified on the ear pulse wave, 825 is the adjustment factor; k ts-toe-ear increases suggesting toe vasodilation, Lower limb blood pressure is lower than radial blood pressure.
  • the step S6 is specifically: continuously acquiring the diastolic pressure correction matrix and the systolic pressure correction matrix under 8 cardiac cycles, and using the average of the correction matrix of 8 cardiac cycles to overcome the disturbance of the respiratory fluctuation, and the 8 variables adopt the recursive manner. Select to eliminate one of the oldest variables for each new variable calculated.
  • B i is the diastolic pressure correction matrix in the i-th cardiac cycle
  • T di is the T d in the i-th cardiac cycle
  • a i is the systolic pressure correction matrix in the i-th cardiac cycle
  • T si is T s in the i-th cardiac cycle.

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Abstract

脉搏波传播时间的校正方法能够对临床条件下由输血输液、血管活性药物、手术介入等原因导致的脉搏波传播时间的异变进行自适性校正，通过实时检测同一个心动周期下的耳朵脉搏波和脚趾脉搏波，计算与舒张压相关的脉搏波传播时间和与收缩压相关的脉搏波传播时间，并根据脉搏波的形态特征提取校正变量、获得校正矩阵，对脉搏波传播时间的异变进行校正，校正后的传播时间可用于现有的数学模型，在临床条件下连续测量每个心动周期的血压，准确性高。

Description

脉搏波传播时间的校正方法 技术领域
本发明涉及动脉血压测量技术领域，具体涉及脉搏波传播时间校正方法。
背景技术
动脉血压是反映循环系统状态、评估器官灌注的主要指标之一，是围手术期监护的重要生命体征参数。目前围术期常用的血压监测方法可以分为有创测量和无创测量。有创测量是指将专用管道置入机体的循环系统内，通过转换器将机械势能转化为电子信号后在监护设备上实时显示血压变化的技术。有创测量方法可以连续、准确地测量脉搏血压，但其可能造成的危险与伤害也不容忽视。无创测量常用的方法是袖带示波法，这种技术操作简单且精确度已得到临床认可，被广泛用于健康体检和围术期监护。但是，袖带示波法只能每隔3-5分钟间断地测量血压，无法实时跟踪动脉血压的变化。
为此，医学界提出了连续无创脉搏血压测量技术，其中利用脉搏波传播时间/速度(PTT/PWV)连续无创测量每博血压的方法逐渐成为研究的热点。该测量方法通过一个或多个光电传感器和一组心电电极同步获得容积脉搏波(PhotoPlethysmoGraphy PPG)和心电信号(ECG)，利用PPG与ECG之间的时间差或两个PPG之间的时间差计算出PTT/PWV；探索PTT/PWV与血压之间的函数关系并建立数学模型，利用可测量的PTT/PWV来估算血压。很多学术论文报道了利用PTT/PWV连续无创测量每博血压的原理，例如Yan Chen，Changyun Wen,Guocai Tao,Min Bi,and Guoqi Li《A Novel Modeling Methodology of the Relationship Between Blood Pressure and Pulse Wave Velocity》；Yan Chen，Changyun Wen,Guocai Tao and Min Bi《Continuous and Noninvasive Measurement of Systolic and Diastolic Blood Pressure by One Mathematical Model with the Same  Model Parameters and Two Separate Pulse Wave Velocities》；Younhee Choi,Qiao Zhang,Seokbum Ko《Noninvasive cuffless blood pressure estimation using pulse transit time and Hilbert–Huang transform》；Zheng Y,Poon CC,Yan BP,Lau JY《Pulse Arrival Time Based Cuff-Less and 24-H Wearable Blood Pressure Monitoring and its Diagnostic Value in Hypertension》；Mukkamala R,Hahn JO,Inan OT,Mestha LK,Kim CS,
Figure PCTCN2017098155-appb-000001
H,Kyal S《Toward Ubiquitous Blood Pressure Monitoring via Pulse Transit Time:Theory and Practice》。很多专利公开了利用PTT/PWV连续无创测量每博血压的具体实施方法或装置，例如中国专利CN101229058A、CN102811659A、CN1127939C，美国专利5865755、5857975、5649543、9364158和欧洲专利0413267等。
现有的利用PTT/PWV测量血压的方法和技术都需要采用传统的袖带示波法测量一个或一组血压值来进行初始校准，校准的理由是PTT/PWV与血压的相关关系是对象依赖的，即每个个体的PTT/PWV与血压之间存在确定的关系，校准的目的是确定与对象相适应的数学模型参数。
然而，现有方法具有一定局限性，只能应用在循环系统没有受到外界干扰的条件下。因为只有在无干扰的条件下，对个体而言PTT与血压的关系才具有较强的规律性，才可能通过确定的函数和数学模型来描述。但在围手术期，病人的循环系统在液体治疗、药物、手术操作、温度等混杂因素的影响下，PTT会发生一系列异常变化，使用异变的PTT和固有的数学模型来估算血压会产生较大的误差。由于异变的PTT与血压的关系不再具有确定的规律性，即使通过频繁校准数学模型参数来适应PTT的异变也没有解决根本问题，无法满足临床测量对准确性和实时性的要求。
发明内容
针对现有技术中的缺陷，本发明提供一种脉搏波传播时间PTT的校正方法，能够针对临床条件下由输血输液、血管活性药物、手术介入等原因导致的脉搏 波传播时间的异变进行自适性校正，准确性高。
脉搏波传输时间的校正方法，包括以下步骤：
S1)实时检测每个心动周期下耳朵处脉搏波并分析得到耳朵脉搏波的以下数据：耳朵脉搏波上主动脉瓣关闭点的高度hsd，耳朵脉搏波的收缩期时间ts，单位为毫秒，耳朵脉搏波的舒张期时间td，单位为毫秒，耳朵脉搏波的最大高度hmax；
S2)实时检测每个心动周期下脚趾处脉搏波并分析得到脚趾脉搏波的以下数据：脚趾脉搏波的收缩期时间ts-toe，单位为毫秒，脚趾脉搏波的舒张期时间td-toe，单位为毫秒，脚趾脉搏波的最大高度hmax-toe，脚趾脉搏波的起始点到波峰中点的时间tch-toe，单位为毫秒，脚趾脉搏波的起始点到波峰最高点的时间tmax-toe，单位为毫秒；所述波峰中点是指波峰处的上升沿转折点和下降沿转折点的中点；
S3)计算与舒张压相关的脉搏波传播时间Td和与收缩压相关的脉搏波传播时间Ts，所述Td是指耳朵脉搏波的起始点到脚趾脉搏波的起始点的时间差；所述Ts是指耳朵脉搏波上的主动脉瓣关闭点到脚趾脉搏波上的主动脉瓣关闭点的时间差；h为耳朵脉搏波或脚趾脉搏波在纵轴方向上的幅值；
S4)利用同一个心动周期下通过步骤S1、S2获得的数据，计算得到该心动周期下校正变量；
S5)根据步骤S4获得心动周期下的校正变量，计算得到该心动周期下校正矩阵；
S6)连续获得多个心动周期下的校正矩阵，对通过步骤S3获得的Ts、Td进行校正。
优选地，所述步骤S5中的校正矩阵包括舒张压校正矩阵B和收缩压校正矩阵A；其中
Figure PCTCN2017098155-appb-000002
bi为舒张压校正变量中第i个校正变量；
Figure PCTCN2017098155-appb-000003
ai为收缩压校正变量中第i个校正变量。
优选地，所述步骤S6具体为：
连续获取8个心动周期下的舒张压校正矩阵和收缩压校正矩阵；校正方法为：Tdmb＝Tdm(1-Bm)，Tsma＝Tsm(1-Am)；
其中，
Figure PCTCN2017098155-appb-000004
Bi为第i个心动周期下的舒张压校正矩阵，Tdi为第i个心动周期下的Td；
Figure PCTCN2017098155-appb-000005
Ai为第i个心动周期下的收缩压校正矩阵，Tsi为第i个心动周期下的Ts。
优选地，所述第一舒张压校正变量b1通过以下公式计算得到：
若d1-b≤ksd-m-0≤d1-2-b，则b1＝(d1-2-b-ksd-m-0)×0.4；
若ksd-m-0<d1-b，则b1＝24×0.4；
若ksd-m-0>d1-2-b，则b1＝0；
所述第一收缩压校正变量a1通过以下公式计算得到：
若d1≤ksd-m-0≤d1-2，则a1＝(d1-2-ksd-m-0)×0.50；
若ksd-m-0<d1，则a1＝28×0.50；
若ksd-m-0>d1-2，则a1＝0；
其中，
Figure PCTCN2017098155-appb-000006
d1-b＝74～82，d1-2-b＝98～106，d1＝76～84，d1-2＝104～112。
优选地，所述第二舒张压校正变量b2通过以下公式计算得到：
若ksd-m>(d2-b+(age-14)/15/100)，则b2＝(ksd-m-(d2-b+(age-14)/15/100))×0.5；
若ksd-m≤(d2-b+(age-14)/15/100)，则b2＝0；
所述第二收缩压校正变量a2通过以下公式计算得到：
若ksd-m>(d2+(age-14)/15/100)，则a2＝ksd-m-(d2+(age-14)/15/100)；
若ksd-m≤(d2+(age-14)/15/100)，则a2＝0；
其中，
若|ksd-m-0-ksd-m-ts|≥40且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2，
则ksd-m＝2×ksd-m-2-(ksd-m-0+ksd-m-ts)/2，否则ksd-m＝ksd-m-2；
Figure PCTCN2017098155-appb-000007
d2-b＝1.33～1.43，d2＝1.17～1.27，age为年龄。
优选地，所述第三舒张压校正变量b3和第三收缩压校正变量a3通过以下公式计算得到：
若c4<kd-m-a<c5，则a3＝b3＝0；
若ksd-m-0<d6或ksd-m-2>d7，则a3＝b3＝0；
若ksd-m-0≥d6+0.10且ksd-m-2≤d8且kd-m-a≤c4，则a3＝b3＝(c4-kd-m-a)×67/100；
若
Figure PCTCN2017098155-appb-000008
或
Figure PCTCN2017098155-appb-000009
则a3＝b3＝(c4-kd-m-a)×50/100；
若ksd-m-0≥d6+0.10且ksd-m-2≤d8且kd-m-a≥c5，则a3＝b3＝(c5-kd-m-a)×62/100；
若
Figure PCTCN2017098155-appb-000010
或
Figure PCTCN2017098155-appb-000011
则a3＝b3＝(c5-kd-m-a)×45/100；
其中，
若|ksd-m-0-ksd-m-ts|≥40且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2且ksd-m-ts≥d3-2，
则
Figure PCTCN2017098155-appb-000012
否则
Figure PCTCN2017098155-appb-000013
若ksd-m-ts≤d3-2，则
Figure PCTCN2017098155-appb-000014
若
Figure PCTCN2017098155-appb-000015
则
Figure PCTCN2017098155-appb-000016
若
Figure PCTCN2017098155-appb-000017
则
Figure PCTCN2017098155-appb-000018
Figure PCTCN2017098155-appb-000019
Figure PCTCN2017098155-appb-000020
c4＝(d4+(age-14)/8)/100，d4＝23～35，c5＝(d5+(age-14)/8)/100，d5＝27～39，d6＝0.97～1.03，d7＝1.52～1.58，d8＝1.42～1.48，d3-2＝1.21～1.31，d3＝0.02～0.14，age为年龄。
优选地，所述第四舒张压校正变量b4和第四收缩压校正变量a4通过以下公式计算得到：
若ks-t-toe>0.8，则a4＝b4＝ks-t-toe-0.8；
若ks-t-toe≤0.8，则a4＝b4＝0；
其中，若tmax-toe≥tch-toe，则
Figure PCTCN2017098155-appb-000021
否则
Figure PCTCN2017098155-appb-000022
优选地，所述第五舒张压校正变量b5和第五收缩压校正变量a5通过以下公式计算得到：
若ks-m-toe<d9，则a5＝b5＝0；
若ks-m-toe≥d9且ks-t-toe≥0.8，则a5＝b5＝ks-m-toe-d9；
若ks-m-toe≥d9且ks-t-toe<0.8，则a5＝b5＝(ks-m-toe-d9)/2；
其中，d9＝0.67～0.73，
Figure PCTCN2017098155-appb-000023
优选地，所述第六舒张压校正变量b6和第六收缩压校正变量a6通过以下公式计算得到：
若ks-m-toe-ear<1.0，则a6＝b6＝0；
当ks-m-toe-ear>1.08，则c6＝1.08，
此时，
若ts>220且ksd-m-0>0.88，则a6＝b6＝c6-1.0，
若ts<160或ksd-m-0<0.80，则a6＝b6＝(c6-1.0)×0.34，
若160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝(c6-1.0)×0.67；
当1.0≤ks-m-toe-ear≤1.08，则c6＝ks-m-toe-ear-1.0，
此时，
若ts>220且ksd-m-0>0.88，则a6＝b6＝c6，
若ts≤160或ksd-m-0≤0.80，则a6＝b6＝c6×0.34，
若160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝c6×0.67；
其中，
Figure PCTCN2017098155-appb-000024
优选地，所述第七舒张压校正变量b7和第七收缩压校正变量a7通过以下公式计算得到：
若kts-toe-ear<1.0，则a7＝b7＝0；
当kts-toe-ear>1.08，则c7＝1.08，
此时，
若ts>220且ksd-m-0>0.88，则a7＝b7＝c7-1.0，
若ts<160或ksd-m-0<0.80，则a7＝b7＝(c7-1.0)×0.34，
若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝(c7-1.0)×0.67；
当1.0≤kts-toe-ear≤1.08，则c7＝kts-toe-ear-1.0，
此时，
若ts>220并且ksd-m-0>0.88，则a7＝b7＝c7，
若ts≤160或ksd-m-0≤0.80，则a7＝b7＝c7×0.34，
若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝c7×0.67；
其中，
Figure PCTCN2017098155-appb-000025
由上述技术方案可知，本发明提供的脉搏波传播时间的校正方法，通过实 时检测同一个心动周期下的耳朵脉搏波和脚趾脉搏波，计算与舒张压相关的脉搏波传播时间和与收缩压相关的脉搏波传播时间，并根据脉搏波的形态特征提取校正变量、获得校正矩阵，对上述脉搏波传播时间的异变进行自适性校正，校正后的传播时间可用于现有的数学模型，在临床条件下连续、准确地测量每个心动周期的血压。
具体实施方式
下面将对本发明技术方案的实施例进行详细的描述。以下实施例仅用于更加清楚地说明本发明的技术方案，因此只是作为示例，而不能以此来限制本发明的保护范围。
围手术期PTT的变化可分为两类：一类变化：血压变化引起的PTT变化；二类变化：PTT和血压不同步的变化(两者的变化方向或变化量不符合常规函数规律)。例如，血容量轻度不足时PTT会增加，但由于机体自身对外周阻力的调节，血压可能变化不大；胸腹手术中使用拉钩可能严重影响PTT，但对血压的影响较小；去甲肾上腺素使小动脉强烈收缩，血压明显升高，但对全身平均的PTT影响较小。
当PTT发生一类变化时，其与血压的关系仍然能够用确定函数的来表达，可通过数学模型来估算血压的变化。而当PTT发生二类变化时，使用基于常规循环系统的数学模型来估算血压会产生较大的误差。这类误差是利用PTT测量血压的原理性误差，不能通过初始定标和定期校准数学模型参数来解决。不同个体之间PTT的差异与同一个体的PTT异变是性质不同的两类问题，需要用不同的方法来解决。为此，本发明根据脉搏波的形态变化提取多种变量来间接识别和自适应校正PTT的各种二类变化，克服上述原理性误差；可结合现有的数学模型形成具备自适应校准功能的连续无创测量血压的方法，不需要依靠常规方法如袖带示波法来反复校准。
检测脉搏波的人体位置优选耳朵和脚趾，这两个部位的脉搏波可以获得大 动脉和外周动脉的生理、病理信息，在传播途径中具备代表性。检测脉搏信号的传感器优选红外光电容积描记仪(PPG)。
耳朵和脚趾脉搏波自身的形态变化和两种脉搏波之间形态的相对变化，对识别PTT的二类变化以及人体不同部位血压之差的变化提供了丰富的信息。本发明历时数年采集大量手术病例的有创动脉血压、耳朵和脚趾的脉搏波形以及PTT进行分析，根据两个脉搏波自身及相对的形态变化提取多种变量，研究出不同的变量与PTT不同的二类变化之间的关系，并且界定各种变量的适用范围。
临床应用时，利用PPT连续测量血压的过程中，实时分析脉搏波形并提取变量，根据变量是否落入适用范围判断PTT是否发生二类变化，并根据适用变量的性质确定PTT二类变化的性质和程度，如果某个变量超出适用范围说明PTT没有发生相应的二类变化，则该变量不适用；将适用的数种变量进行融合，计算出校正量对PTT进行校正，校正后的PTT/PWV适用于现有的数学模型精确计算血压。
本发明利用有限的变量来表达脉搏波形态最主要、最基本的变化规律，并研究出这些规律与PTT之间的关系。以下所述脉搏波在平面坐标上纵坐标为幅度h，横坐标为时间t，脉搏波起始点为坐标原点。
实施例：
脉搏传播时间的校正方法，包括以下步骤：
S1)实时检测每个心动周期下耳朵处脉搏波并分析得到耳朵脉搏波的以下数据：耳朵脉搏波上主动脉瓣关闭点的高度hsd，即收缩期与舒张期在耳朵脉搏波上呈现的交界处高度，耳朵脉搏波的收缩期时间ts，单位为毫秒，耳朵脉搏波的舒张期时间td，单位为毫秒，耳朵脉搏波的最大高度hmax；
S2)实时检测每个心动周期下脚趾处脉搏波并分析得到脚趾脉搏波的以下数据：脚趾脉搏波的收缩期时间ts-toe，单位为毫秒，脚趾脉搏波的舒张期时间td-toe，单位为毫秒，脚趾脉搏波的最大高度hmax-toe，脚趾脉搏波的起始点到波 峰中点的时间tch-toe，单位为毫秒，脚趾脉搏波的起始点到波峰最高点的时间tmax-toe，单位为毫秒；所述波峰中点是指波峰处的上升沿转折点和下降沿转折点的中点；波峰中点的定义可参考文献YAN CHEN,CHANGYUN WEN,GUOCAI TAO,and MIN BI《Continuous and Noninvasive Measurement of Systolic and Diastolic Blood Pressure by One Mathematical Model with the Same Model Parameters and Two Separate Pulse Wave Velocities》理解。
S3)计算与舒张压相关的脉搏波传播时间Td和与收缩压相关的脉搏波传播时间Ts，其定义可参考文献YAN CHEN,CHANGYUN WEN,GUOCAI TAO,and MIN BI《Continuous and Noninvasive Measurement of Systolic and Diastolic Blood Pressure by One Mathematical Model with the Same Model Parameters and Two Separate Pulse Wave Velocities》理解；h为耳朵脉搏波或脚趾脉搏波在纵轴方向上的幅值；
S4)利用同一个心动周期下通过步骤S1、S2获得的数据，计算得到该心动周期下校正变量；
S5)根据步骤S4获得的该心动周期下校正变量，计算得到该心动周期下校正矩阵；
S6)连续获得多个心动周期下的校正矩阵，对通过步骤S3获得的Ts、Td进行校正。
该方法能够实时检测同一个心动周期下的耳朵脉搏波和脚趾脉搏波，计算与舒张压相关的脉搏波传播时间和与收缩压相关的脉搏波传播时间，并根据脉搏波的形态特征提取校正变量、获得校正矩阵，对上述脉搏波传播时间的异变进行校正，校正后的传播时间可用于现有的数学模型，在临床条件下连续测量每个心动周期的舒张压和收缩压。
第一舒张压校正变量b1和第一收缩压校正变量a1：
所述步骤S4中获得的校正变量包括第一舒张压校正变量b1和第一收缩压校 正变量a1，b1和a1分别用于低血压状态校正与舒张压、收缩压相关的传播时间Td、Ts的二类变化，b1的适用范围为b1>0，a1的适用范围为a1>0，b1、a1越大则表明血压越低。
Figure PCTCN2017098155-appb-000026
ksd-m-0表示hsd与耳朵脉搏波收缩期平均高度之比。一部分病例在低血压状态下，脉搏波波峰呈现为前倾的三角形，hsd降低很多，ksd-m-0变小，说明主动脉收缩期末段波形降低很多，推动脉搏波传播的持续动力不足，传播时间延长。在这种状态下舒张期信息不稳定，不宜使用。
d1-b＝74～82，优选为78。d1-2-b＝98～106，优选为102，d1＝76～84，优选为80；d1-2＝104～112，优选为108。
当推动脉搏波传播的持续动力不足时，传播时间Td、Ts延长，需要b1、a1来校正。即若d1-b≤ksd-m-0≤d1-2-b，则b1＝(d1-2-b-ksd-m-0)×0.4；若d1≤ksd-m-0≤d1-2，则a1＝(d1-2-ksd-m-0)×0.50。
当推动脉搏波传播的持续动力严重不足时，传播时间Td、Ts延长很多，b1、a1取上限值来校正。即若ksd-m-0<d1-b，则b1＝24×0.4；若ksd-m-0<d1，则a1＝28×0.50。
当推动脉搏波传播的持续动力充足时，不需要校正Td、Ts，b1、a1不适用。即若ksd-m-0>d1-2-b，则令b1＝0。若ksd-m-0>d1-2，则a1＝0。
第二舒张压校正变量b2和第二收缩压校正变量a2：
所述步骤S4中获得的校正变量还包括第二舒张压校正变量b2和第二收缩压校正变量a2，b2用于高血压状态下校正与舒张压相关的传播时间Td的二类变化，a2用于高血压状态以及从正常血压状态到高血压状态的变化过程，校正与收缩压相关的脉搏波传播时间Ts的二类变化，b2的适用范围为b2>0，a2的适用范围为a2>0，b2、a2越大则表明舒张压和收缩压越高。
Figure PCTCN2017098155-appb-000027
ksd-m-ts表示hsd与耳朵脉搏波舒张期ts-2ts段平均高度之比，用于判断脉搏波舒张期的变异。例如，胸腹手术中使用拉钩导致主动脉受力变化，使耳朵脉搏波舒张期的波形降低，ksd-m-ts变大。
Figure PCTCN2017098155-appb-000028
ksd-m-2表示hsd与耳朵脉搏波0-2ts段平均高度之比，包含了收缩期和部分舒张期的波形信息，主要用于高血压状态，如气管插管导致心率和血压升高。从正常血压状态到高血压状态的变化过程中，耳朵脉搏波的波峰逐渐变化成正三角形或后倾的三角形，hsd逐渐升高，ksd-m-2逐渐变大。在高血压状态下，整个耳朵脉搏波变为正三角形或后倾的三角形，hsd升高很多，ksd-m-2变得很大。上述两种波形的三角形顶端(即最高血压)持续时间都非常短，与最高血压相对应的持续动力不足，传播时间Ts相对延长。另外，与正常血压状态的波形相比，高血压状态下的波形上升沿斜率变小，推动脉搏波传播的动力不足，传播时间Td延长。
若|ksd-m-0-ksd-m-ts|≥40而且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2，
则ksd-m＝2×ksd-m-2-(ksd-m-0+ksd-m-ts)/2，
否则ksd-m＝ksd-m-2；
若耳朵脉搏波舒张期的波形变异，例如，胸腹手术上拉钩导致主动脉受力变化，脉搏波舒张期的形态出现显著变化，则对ksd-m进行校正，否则ksd-m＝ksd-m-2。d2-b＝1.33～1.43，优选为1.38。d2＝1.17～1.27，优选为1.22。
若ksd-m>(d2-b+(age-14)/15/100)，其中age为年龄，与舒张压相对应的持续动力不足，传播时间Td相对延长，需要b2校正，则b2＝(ksd-m-(d2-b+(age-14)/15/100))×0.5，b2的变化与脉搏波上升沿斜率的变化呈反比，其中0.5为比例系数。
若ksd-m>(d2+(age-14)/15/100)，其中age为年龄，age≥14岁，指示整个耳朵 脉搏波或其波峰变为正三角形或后倾的三角形，与最高血压相对应的持续动力不足，传播时间Ts相对延长，需要a2来校正，则a2＝ksd-m-(d2+(age-14)/15/100)。
若ksd-m≤(d2-b+(age-14)/15/100)，与舒张压相对应的持续动力充足，b2不适用，则令b2＝0。
若ksd-m≤(d2+(age-14)/15/100)，脉搏波波峰部分平缓，与最高血压相对应的持续动力充足，不需要a2来校正，则令a2＝0。
第三舒张压校正变量b3和第三收缩压校正变量a3：
所述步骤S3中获得的校正变量还包括第三舒张压校正变量b3和第三收缩压校正变量a3，b3、a3用于在血容量变化或传感器安放部位体温变化的状态下对Td、Ts进行校正。
Figure PCTCN2017098155-appb-000029
为耳朵脉搏波舒张期平均高度与最大高度hmax之比。在手术前病人禁食禁饮导致血容量降低，
Figure PCTCN2017098155-appb-000030
减小，脉搏波传播时间延长，当手术中输血输液使得血容量增加时，
Figure PCTCN2017098155-appb-000031
增大，传播时间缩短。
若ksd-m-ts≤d3-2，指示耳朵脉搏波舒张早期的波形升高且超越正常范围，需要对
Figure PCTCN2017098155-appb-000032
进行修正，修正结果记为
Figure PCTCN2017098155-appb-000033
Figure PCTCN2017098155-appb-000034
若
Figure PCTCN2017098155-appb-000035
可判断出耳朵脉搏波受到干扰，则
Figure PCTCN2017098155-appb-000036
d3＝0.02～0.14，优选为0.08；d3-2＝1.21～1.31，优选为1.26。
Figure PCTCN2017098155-appb-000037
Figure PCTCN2017098155-appb-000038
为脚趾脉搏波舒张期平均高度与最大高度hmax-toe之比，ts-toe表示脚趾脉搏波上识别的心脏收缩期时间，td-toe表示脚趾脉搏波上识别的舒张期时间。若
Figure PCTCN2017098155-appb-000039
则
Figure PCTCN2017098155-appb-000040
与
Figure PCTCN2017098155-appb-000041
的作用和性质相同。
Figure PCTCN2017098155-appb-000042
将耳朵和脚趾脉搏波性质相同的两个变量合并，取其平均值作为校准脉搏波传播时间的变量；如果脉搏波舒张期的波形发生变异，对kd-m-a进行校正。
若|ksd-m-0-ksd-m-ts|≥40且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2且ksd-m-ts≥d3-2，
则
Figure PCTCN2017098155-appb-000043
在血容量正常而且传感器安放部位体温也正常的状态，a3、b3不适用。即若c4<kd-m-a<c5，则令a3＝b3＝0。c4＝(d4+(age-14)/8)/100，d4＝23～35，优选为29；c5＝(d5+(age-14)/8)/100，d5＝27～39，优选为33。
在血压很低或很高的状态，舒张期信息不稳定，a3、b3不适用。即若ksd-m-0<d6或ksd-m-2>d7，则令a3＝b3＝0。d6＝0.97～1.03，优选为1.00；d7＝1.52～1.58，优选为1.55。
在正常血压状态，血容量降低或传感器安放部位体温降低时，a3、b3取正值的67％。即若ksd-m-0≥d6+0.10而且ksd-m-2≤d8并且kd-m-a≤c4，则a3＝b3＝(c4-kd-m-a)×67/100。d8＝1.42～1.48，优选为1.45。
在血压较低或较高的状态，血容量降低或传感器安放部位体温降低时，a3、b3取正常血压状态数值的50％。即若
Figure PCTCN2017098155-appb-000044
或
Figure PCTCN2017098155-appb-000045
则a3＝b3＝(c4-kd-m-a)×50/100；
在正常血压状态，血容量增加或传感器安放部位体温升高时，a3、b3取负值的62％。即若ksd-m-0≥d6+0.10而且ksd-m-2≤d8并且kd-m-a≥c5，则a3＝b3＝(c5-kd-m-a)×62/100；
在血压较低或较高的状态，血容量增加或传感器安放部位体温升高时，a3、b3取正常血压状态负值的45％。即若
Figure PCTCN2017098155-appb-000046
或
Figure PCTCN2017098155-appb-000047
则a3＝b3＝(c5-kd-m-a)×45/100。
第四舒张压校正变量b4和第四收缩压校正变量a4：
所述步骤S4中获得的校正变量还包括第四舒张压校正变量b4和第四收缩压校正变量a4，a4、b4在外周血管扩张导致下肢血压(相对于桡动脉血压)降低的情况下，对Td、Ts进行校正，a4、b4的适用范围为a4>0，b4>0，a4、b4越大表明下肢血压相对于桡动脉血压降低得越多。
外周血管的收缩和扩张会引起脚趾脉搏波的波峰在时间轴上的位置前后移动。若tmax-toe≥tch-toe，则
Figure PCTCN2017098155-appb-000048
否则
Figure PCTCN2017098155-appb-000049
ks-t-toe为脚趾脉搏波起始点到波峰的时间与收缩期的时间之比，200为调节系数。当波峰的最高点后移超过中点，即tmax-toe≥tch-toe时，对ks-t-toe进行校正；ks-t-toe的值较大时，提示脚趾血管扩张，下肢血压降低。即若ks-t-toe>0.8，则a4＝b4＝ks-t-toe-0.8。若ks-t-toe≤0.8，a4、b4不适用，则令a4＝b4＝0。
第五舒张压校正变量b5和第五收缩压校正变量a5；
所述步骤S4中获得的校正变量还包括第五舒张压校正变量b5和第五收缩压校正变量a5，a5、b5的作用和性质与a4、b4相同，在下肢血压相对于桡动脉血压降低的情况下对Td、Ts进行校正。
Figure PCTCN2017098155-appb-000050
ks-m-toe为脚趾脉搏波收缩期平均高度与最大高度hmax-toe之比；ks-m-toe很大表示脚趾脉搏波波峰宽阔而且平缓，提示脚趾血管扩张，下肢血压相对于桡动脉而言在降低。
脚趾血管没有扩张时，a5、b5不适用。即若ks-m-toe<d9，则令a5＝b5＝0。d9＝0.67～0.73，优选为0.7。
脚趾血管扩张且脉搏波波峰的最高点后移超过中点时，a5、b5取正值。即若ks-m-toe≥d9而且ks-t-toe≥0.8，则a5＝b5＝ks-m-toe-d9。
脚趾血管扩张而脉搏波波峰的最高点位置没有超过中点时，a5、b5取正值减半。即若ks-m-toe≥d9而且ks-t-toe<0.8，则a5＝b5＝(ks-m-toe-d9)/2。
第六舒张压校正变量b6和第六收缩压校正变量a6；
所述步骤S4中获得的校正变量还包括第六舒张压校正变量b6和第六收缩压校正变量a6，a6、b6代表两个脉搏波面积的相对变化，用于脚趾血管扩张、下肢血压相对于桡动脉血压降低时对Td、Ts进行校正。a6的适用范围为a6>0；b6的适用范围为b6>0；
Figure PCTCN2017098155-appb-000051
ks-m-toe-ear为脚趾脉搏波收缩期的面积与耳朵脉搏波收缩期的面积之比，100为调节系数；ks-m-toe-ear与kts-toe-ear的作用和性质相同。
当脚趾波面积小于耳朵波面积，脚趾血管没有相对扩张，a6、b6不适用。即若ks-m-toe-ear<1.0，则令a6＝b6＝0。
第一种先决条件下，脚趾面积大于耳朵面积很多，脚趾血管扩张较多，c6取常数1.08作为最大值备用。即若ks-m-toe-ear>1.08，则令c6＝1.08。
若耳朵脉搏波形态正常，a6、b6取最大校正值。即若ts>220而且ksd-m-0>0.88，则a6＝b6＝c6-1.0。
若耳朵脉搏波出现非常尖锐的前倾三角形或波形非常狭窄，表示耳朵脉搏波形态严重异变，此时两个脉搏波之间的相对变化被放大，需要将校准值减小来使用，a6、b6取最大校准值的1/3。即若ts<160或ksd-m-0<0.80，则a6＝b6＝(c6-1.0)×0.34。
耳朵脉搏波形态异变不太严重时，a6、b6取最大校正值的2/3。即若 160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝(c6-1.0)×0.67。
第二种先决条件下，脚趾面积大于耳朵面积，脚趾血管的相对扩张不太严重，c6取正变量备用。即若1.0≤ks-m-toe-ear≤1.08，则c6＝ks-m-toe-ear-1.0。
若耳朵脉搏波形态正常，a6、b6取正变量作校正值。即若ts>220并且ksd-m-0>0.88，则a6＝b6＝c6。
若耳朵脉搏波形态严重异变时，脉搏波之间的相对变化被放大，需要将校准值减小来使用，a6、b6取正变量的1/3。即若ts≤160或ksd-m-0≤0.80，则a6＝b6＝c6×0.34。
若耳朵脉搏波不太严重的异变时，a6、b6取正变量的2/3，即若160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝c6×0.67。
第七舒张压校正变量b7和第七收缩压校正变量a7；
所述步骤S4中获得的校正变量还包括第七舒张压校正变量b7和第七收缩压校正变量a7，a7、b7的作用和性质与a6、b6用相同，a7、b7代表两个脉搏波收缩期宽度(收缩期时间)的相对变化。
Figure PCTCN2017098155-appb-000052
kts-toe-ear为脚趾脉搏波上识别的心脏收缩期的时间与耳朵脉搏波上识别的收缩期的时间之比，825为调节系数；kts-toe-ear增大提示脚趾血管扩张，下肢血压相对于桡动脉血压在降低。
当脚趾血管没有相对扩张时，a7、b7不适用。即若kts-toe-ear<1.0，则令a7＝b7＝0。
第一种先决条件下，当脚趾血管相对扩张较多时，c7取常数1.08作为最大值备用。即若kts-toe-ear>1.08，则令c7＝1.08。
若耳朵脉搏波形态正常，a7、b7取最大校正值。即若ts>220而且ksd-m-0>0.88，则a7＝b7＝c7-1.0。
若耳朵脉搏波形态严重变异时，脉搏波之间的相对变化被放大，需要将校准值减小来使用，a7、b7取最大校正值的1/3。即若ts<160或ksd-m-0<0.80，则a7＝b7＝(c7-1.0)×0.34。
若耳朵脉搏波形态变异不太严重时，a7、b7取最大校正值的2/3。即若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝(c7-1.0)×0.67。
第二种先决条件下，当脚趾宽度大于耳朵宽度，脚趾血管的相对扩张不太严重，c7取正变量备用。即若1.0≤kts-toe-ear≤1.08，则c7＝kts-toe-ear-1.0。
若耳朵脉搏波形态正常，a7取正变量作校正值。即若ts>220并且ksd-m-0>0.88，则a7＝b7＝c7。
若耳朵脉搏波形态严重变异，a7取正变量的1/3。即若ts≤160或ksd-m-0≤0.80，则a7＝b7＝c7×0.34。
若耳朵脉搏波形态的变异不太严重，a7取正变量的2/3。即若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝c7×0.67。
所述步骤S5中的校正矩阵包括舒张压校正矩阵B和收缩压校正矩阵A；其中
Figure PCTCN2017098155-appb-000053
bi为舒张压校正变量中第i校正变量；
Figure PCTCN2017098155-appb-000054
ai为收缩压校正变量中第i校正变量，其中若有ai＝0时表示该ai不适用，若有bi＝0时表示该bi不适用。
所述步骤S6具体为：连续获取8个心动周期下的舒张压校正矩阵和收缩压校正矩阵，用8个心动周期的校正矩阵的平均值来克服呼吸波动的干扰，8个变量采用递推方式选取，每计算出一个最新变量就淘汰一个最老变量。校正方法为：Tdmb＝Tdm(1-Bm)，Tsma＝Tsm(1-Am)；
其中，
Figure PCTCN2017098155-appb-000055
Bi为第i个心动周期下的舒张压校正矩阵，Tdi为第i个心动周期下的Td；
Figure PCTCN2017098155-appb-000056
Ai为第i个心动周期下的收缩压校正矩阵，Tsi为第i个心动周期下的Ts。
最后应说明的是：以上各实施例仅用以说明本发明的技术方案，而非对其限制；尽管参照前述各实施例对本发明进行了详细的说明，本领域的普通技术人员应当理解：其依然可以对前述各实施例所记载的技术方案进行修改，或者对其中部分或者全部技术特征进行等同替换；而这些修改或者替换，并不使相应技术方案的本质脱离本发明各实施例技术方案的范围，其均应涵盖在本发明的权利要求和说明书的范围当中。

Claims (10)

  1. 脉搏波传输时间的校正方法，其特征在于，包括以下步骤：
    S1)实时检测每个心动周期下耳朵处脉搏波并分析得到耳朵脉搏波的以下数据：耳朵脉搏波上主动脉瓣关闭点的高度hsd，耳朵脉搏波的收缩期时间ts，单位为毫秒，耳朵脉搏波的舒张期时间td，单位为毫秒，耳朵脉搏波的最大高度hmax；
    S2)实时检测每个心动周期下脚趾处脉搏波并分析得到脚趾脉搏波的以下数据：脚趾脉搏波的收缩期时间ts-toe，单位为毫秒，脚趾脉搏波的舒张期时间td-toe，单位为毫秒，脚趾脉搏波的最大高度hmax-toe，脚趾脉搏波的起始点到波峰中点的时间tch-toe，单位为毫秒，脚趾脉搏波的起始点到波峰最高点的时间tmax-toe，单位为毫秒；所述波峰中点是指波峰处的上升沿转折点和下降沿转折点的中点；
    S3)计算与舒张压相关的脉搏波传播时间Td和与收缩压相关的脉搏波传播时间Ts，所述Td是指耳朵脉搏波的起始点到脚趾脉搏波的起始点的时间差；所述Ts是指耳朵脉搏波上的主动脉瓣关闭点到脚趾脉搏波上的主动脉瓣关闭点的时间差；h为耳朵脉搏波或脚趾脉搏波在纵轴方向上的幅值；
    S4)利用同一个心动周期下通过步骤S1、S2获得的数据，计算得到该心动周期下校正变量；
    S5)根据步骤S4获得心动周期下的校正变量，计算得到该心动周期下的校正矩阵；
    S6)连续获得多个心动周期下的校正矩阵，对通过步骤S3获得的Ts、Td进行校正。
  2. 根据权利要求1所述脉搏波传播时间的校正方法，其特征在于，所述步骤S5中的校正矩阵包括舒张压校正矩阵B和收缩压校正矩阵A；其中
    Figure PCTCN2017098155-appb-100001
    bi为舒张压校正变量中第i个校正变量；
    Figure PCTCN2017098155-appb-100002
    ai为收缩压校正变量中第i个校正 变量。
  3. 根据权利要求1所述脉搏波传播时间的校正方法，其特征在于，所述步骤S6具体为：
    连续获取8个心动周期下的舒张压校正矩阵和收缩压校正矩阵；校正方法为：Tdmb＝Tdm(1-Bm)，Tsma＝Tsm(1-Am)；
    其中，
    Figure PCTCN2017098155-appb-100003
    Bi为第i个心动周期下的舒张压校正矩阵，Tdi为第i个心动周期下的Td；
    Figure PCTCN2017098155-appb-100004
    Ai为第i个心动周期下的收缩压校正矩阵，Tsi为第i个心动周期下的Ts。
  4. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第一舒张压校正变量b1通过以下公式计算得到：
    若d1-b≤ksd-m-0≤d1-2-b，则b1＝(d1-2-b-ksd-m-0)×0.4；
    若ksd-m-0<d1-b，则b1＝24×0.4；
    若ksd-m-0>d1-2-b，则b1＝0；
    所述第一收缩压校正变量a1通过以下公式计算得到：
    若d1≤ksd-m-0≤d1-2，则a1＝(d1-2-ksd-m-0)×0.50；
    若ksd-m-0<d1，则a1＝28×0.50；
    若ksd-m-0>d1-2，则a1＝0；
    其中，
    Figure PCTCN2017098155-appb-100005
    d1-b＝74～82，d1-2-b＝98～106，d1＝76～84，d1-2＝104～112。
  5. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第二舒张压校正变量b2通过以下公式计算得到：
    若ksd-m>(d2-b+(age-14)/15/100)，则b2＝(ksd-m-(d2-b+(age-14)/15/100))×0.5；
    若ksd-m≤(d2-b+(age-14)/15/100)，则b2＝0；
    所述第二收缩压校正变量a2通过以下公式计算得到：
    若ksd-m>(d2+(age-14)/15/100)，则a2＝ksd-m-(d2+(age-14)/15/100)；
    若ksd-m≤(d2+(age-14)/15/100)，则a2＝0；
    其中，
    若|ksd-m-0-ksd-m-ts|≥40且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2，
    则ksd-m＝2×ksd-m-2-(ksd-m-0+ksd-m-ts)/2，否则ksd-m＝ksd-m-2；
    Figure PCTCN2017098155-appb-100006
    d2-b＝1.33～1.43，d2＝1.17～1.27，age为年龄。
  6. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第三舒张压校正变量b3和第三收缩压校正变量a3通过以下公式计算得到：
    若c4<kd-m-a<c5，则a3＝b3＝0；
    若ksd-m-0<d6或ksd-m-2>d7，则a3＝b3＝0；
    若ksd-m-0≥d6+0.10且ksd-m-2≤d8且kd-m-a≤c4，则a3＝b3＝(c4-kd-m-a)×67/100；
    若
    Figure PCTCN2017098155-appb-100007
    或
    Figure PCTCN2017098155-appb-100008
    则a3＝b3＝(c4-kd-m-a)×50/100；
    若ksd-m-0≥d6+0.10且ksd-m-2≤d8且kd-m-a≥c5，则a3＝b3＝(c5-kd-m-a)×62/100；
    若
    Figure PCTCN2017098155-appb-100009
    或
    Figure PCTCN2017098155-appb-100010
    则a3＝b3＝(c5-kd-m-a)×45/100；
    其中，
    若|ksd-m-0-ksd-m-ts|≥40且(ksd-m-0+ksd-m-ts)/2≥ksd-m-2且ksd-m-ts≥d3-2，
    则
    Figure PCTCN2017098155-appb-100011
    否则
    Figure PCTCN2017098155-appb-100012
    若ksd-m-ts≤d3-2，则
    Figure PCTCN2017098155-appb-100013
    若
    Figure PCTCN2017098155-appb-100014
    则
    Figure PCTCN2017098155-appb-100015
    若
    Figure PCTCN2017098155-appb-100016
    则
    Figure PCTCN2017098155-appb-100017
    Figure PCTCN2017098155-appb-100018
    Figure PCTCN2017098155-appb-100019
    c4＝(d4+(age-14)/8)/100，d4＝23～35，c5＝(d5+(age-14)/8)/100，d5＝27～39，d6＝0.97～1.03，d7＝1.52～1.58，d8＝1.42～1.48，d3-2＝1.21～1.31，d3＝0.02～0.14，age为年龄。
  7. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第四舒张压校正变量b4和第四收缩压校正变量a4通过以下公式计算得到：
    若ks-t-toe>0.8，则a4＝b4＝ks-t-toe-0.8；
    若ks-t-toe≤0.8，则a4＝b4＝0；
    其中，若tmax-toe≥tch-toe，则
    Figure PCTCN2017098155-appb-100020
    否则
    Figure PCTCN2017098155-appb-100021
  8. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第五舒张压校正变量b5和第五收缩压校正变量a5通过以下公式计算得到：
    若ks-m-toe<d9，则a5＝b5＝0；
    若ks-m-toe≥d9且ks-t-toe≥0.8，则a5＝b5＝ks-m-toe-d9；
    若ks-m-toe≥d9且ks-t-toe<0.8，则a5＝b5＝(ks-m-toe-d9)/2；
    其中，d9＝0.67～0.73，
    Figure PCTCN2017098155-appb-100022
  9. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第 六舒张压校正变量b6和第六收缩压校正变量a6通过以下公式计算得到：
    若ks-m-toe-ear<1.0，则a6＝b6＝0；
    当ks-m-toe-ear>1.08，则c6＝1.08，
    此时，
    若ts>220且ksd-m-0>0.88，则a6＝b6＝c6-1.0，
    若ts<160或ksd-m-0<0.80，则a6＝b6＝(c6-1.0)×0.34，
    若160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝(c6-1.0)×0.67；
    当1.0≤ks-m-toe-ear≤1.08，则c6＝ks-m-toe-ear-1.0，
    此时，
    若ts>220且ksd-m-0>0.88，则a6＝b6＝c6，
    若ts≤160或ksd-m-0≤0.80，则a6＝b6＝c6×0.34，
    若160<ts≤220或0.80<ksd-m-0≤0.88，则a6＝b6＝c6×0.67；
    其中，
    Figure PCTCN2017098155-appb-100023
  10. 根据权利要求2所述脉搏波传播时间的校正方法，其特征在于，所述第七舒张压校正变量b7和第七收缩压校正变量a7通过以下公式计算得到：
    若kts-toe-ear<1.0，则a7＝b7＝0；
    当kts-toe-ear>1.08，则c7＝1.08，
    此时，
    若ts>220且ksd-m-0>0.88，则a7＝b7＝c7-1.0，
    若ts<160或ksd-m-0<0.80，则a7＝b7＝(c7-1.0)×0.34，
    若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝(c7-1.0)×0.67；
    当1.0≤kts-toe-ear≤1.08，则c7＝kts-toe-ear-1.0，
    此时，
    若ts>220并且ksd-m-0>0.88，则a7＝b7＝c7，
    若ts≤160或ksd-m-0≤0.80，则a7＝b7＝c7×0.34，
    若160<ts≤220或0.80<ksd-m-0≤0.88，则a7＝b7＝c7×0.67；
    其中，
    Figure PCTCN2017098155-appb-100024
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