CN100548212C - Noninvasive intracranial pressure monitoring equipment - Google Patents
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- CN100548212C CN100548212C CNB200710062835XA CN200710062835A CN100548212C CN 100548212 C CN100548212 C CN 100548212C CN B200710062835X A CNB200710062835X A CN B200710062835XA CN 200710062835 A CN200710062835 A CN 200710062835A CN 100548212 C CN100548212 C CN 100548212C
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Abstract
The present invention relates to a kind of Noninvasive intracranial pressure monitoring equipment, it includes: data acquisition unit is the transcranial doppler instrument; Data transmission device, the analog signal conversion that is used for data acquisition unit is a digital signal; The computational analysis device is a computer that is provided with data analysis software, and it receives the signal of data transmission device output, and can be by the data among the network call data base; Display device is used to show the analysis result of computational analysis device; Input-output equipment is used for the analysis result that input operation is instructed and exported the computational analysis device.The present invention can realize long-term continuous detecting, and not only detection approach is convenient, and conclusion is reliable and certainty of measurement is high.
Description
Technical field
The present invention relates to intracranial pressure monitoring equipment, be meant a kind of Noninvasive intracranial pressure monitoring equipment especially based on transcranial doppler.
Background technology
Intracranial pressure (intracranial pressure, ICP) increase be clinical in common syndrome, ICP increases can make the patient disturbance of consciousness occur, cerebral hernia appears in severe patient, and threat to life at short notice.Therefore, the ICP monitoring is the important prerequisite of cranium disease of brain treatment.The ICP monitoring can help to judge traumatic brain injury or other intracranial lesions patient's the order of severity, helps the early discovery intracranial spaceoccupying lesion, instructs the treatment selection of reduction ICP etc.In addition, the ICP monitoring also can assist to diagnose brain death.
The ICP monitoring of adopting clinically mostly is invasive method, and ICP detection method the earliest is the lumbar puncture manometry and is leveraged to the present.Since this method measured for the dynamic changing process of instantaneous ICP non-pressure and be subject to multiple factor and disturb, therefore many at present is purpose with the treatment.Nineteen fifty-one begins application side ventricular puncture method and directly measures ICP, and nineteen sixty realizes having the continuous ICP monitoring of wound.After this, there are the theory and the method for wound property ICP monitoring constantly to develop.Owing to there is wound monitoring can reflect the ICP level more exactly, therefore to the diagnosis of intracranial hypertension disease with treat significant.At present, have wound ICP monitor to possess multiple transducer, except that Intraventricular ICP monitoring, occurred in exterior dura, the brain essence again and multi-functional ICP probe, transducer also develops to miniaturization.But owing to there is the wound monitoring to exist technical conditions to require height, trivial operations, complication more (intracranial infection, cerebrospinal leak, intracranial hemorrhage, cerebral hernia etc.; Total incidence rate of various complication is 10-25%) and be not suitable for drawbacks such as long term monitoring, so range of application is restricted, and only uses in the part patient of neurosurgery.The patient that present most ICP increases still continues to use clinical experience and infers patient's intracranial pressure, and this must cause state of an illness judgement to lose accurately and fall the use confusion of cranium pressing thing.
In order to enlarge the range of application of ICP monitoring, seek noinvasive, monitoring method is badly in need of by clinical treatment accurately.In recent years, the research of the correlation theory of non-invasive monitoring and instrument development has report more, and has some noinvasive ICP monitoring equipments to drop into clinical use, but makes its application scale minimum because of monitoring accuracy, the reasons such as limitation of monitoring approach.Present noinvasive ICP monitoring technology comprises following five kinds:
1, flash visual evoked potential (f-VEP) detects ICP: when ICP raises, (N2 is a kind of composition in the f-VEP waveform in the N2 prolongation of latency of f-VEP, found when the prolongation of latency of N2 ripple occurring, show the infringement of the pathways for vision that a variety of causes causes, increase comprising ICP), N2 incubation period and ICP are proportionate, and (cerebral perfusiong pressure CPP) is negative correlation with cerebral perfusion pressure.The limitation of this method is: (1) is as ICP＞300mmH
2During O, f-VEP is subject to the influence with brain metabolism related factors, all can exert an influence to it as partial pressure of carbon dioxide in arterial blood, art pO2, hypotension, pH value etc.The general metabolism disorder that some disease causes also can influence f-VEP, as hepatic encephalopathy.(2) there is influence in ocular disease such as severe visual obstacle and retinal hemorrhage to f-VEP.(3) damage of vision pathway also can influence f-VEP, and as bilateral frontal lobe hematoma, commotio retinae wound, camera oculi posterior hematocele, contusion of optic nerve and the compressing of intracranial space occupying lesion kitchen range, when destroying pathways for vision, the f-VEP detected value is apparently higher than true horizon.(4) waveform does not appear in part deep coma patient and brain death person f-VEP.(5) f-VEP is influenced by age factor also incubation period, and the patient can prolong with advancing age incubation period more than 60 years old.Therefore, f-VEP non-invasive monitoring ICP still has a lot of problems to remain to be furtherd investigate, as: accuracy has much room for improvement, and the different sick f-VEP curves of planting have difference, and as the non-invasive monitoring method, which the influence factor of f-VEP monitoring ICP has, and how to control etc.Though the noinvasive ICP monitor based on this method comes into operation, influenced its application scale because of there being above major defect.
2, bioelectrical impedance analysis detects ICP: electric impedance analyzer is measured and is shown that brain impedance impulse wave amplitude just often has bigger increase than ICP when high ICP, have dependency between ICP and the brain impedance.Therefore, the size of brain impedance pulse amplitude can be used as the basis for estimation whether ICP increases.But this method is because following former thereby can not accurately measure the ICP value: (1) causes the reason complexity of impedance variation, except principal elements such as cerebrospinal fluid, cerebral blood flow, the conductivity variations of other parts tissue also can influence the Electric Field Distribution of brain, makes impedance measurement that certain difference be arranged inevitably.(2) brain impedance and ICP do not contact directly, different patients, and the different state of an illness, the difference of volume compensatory capacity, the resistance value of measuring when ICP is identical is also made a world of difference.(3) be subject to factor affecting such as intracranial hemorrhage, scalp hematoma, fracture of skull, skull thickness.So present clinical practice small scale, prospect is brightless.
3, retinal venous pressure detects ICP: this method proposed in nineteen twenty-five, estimated ICP with retinal venous pressure, utilized suction cup negative-pressure type ophthalmodynamometry to measure central vein of retina and pressed.Compare the relation that ICP and central vein of retina are pressed, both have tangible linear correlation.This method is the convenience of measuring moment ICP, practicality, detection method repeatably, but is not suitable for long term monitoring, and the scope of application is restricted, therefore obtains to pay attention to always, also fails to come into operation.
4, ear drum membrane detects ICP: the human body subarachnoid space can link to each other with the spatia perilymphaticum of internal ear by aquaeductus cochleae, and therefore, ICP changes can influence internal ear.The otoacoustic emission that the internal ear outer hair cell produces (otoacoustic emissions, OAE) especially distortion product otoacoustic emissions (distortionproduct otoacoustic e missions DPOAES) can be used as the method that a kind of Noninvasive detects ICP.But this method also only is a kind of theoretic method at present, and its accuracy and feasibility are still needed and further studied.
5, (Transcranial Doppler TCD) detects intracranial pressure (ICP) method, and its principle is: the cerebral hemodynamic when TCD presses by observing high cranium changes estimates ICP to transcranial doppler.Cerebral perfusion pressure (CPP) is that (mean systemic arterial pressure mSAP) deducts ICP, that is: CPP=mSAP-ICP to the average body arterial pressure.(cerebral blood folw's cerebral blood flow CBF) is directly proportional with CPP, and (cerebrovascularresistance CVR) is inversely proportional to, i.e. CBF=(mSAP-ICP)/CVR with cerebral vascular resistance.When the automatic regulatory function of cerebrovascular exists, ICP raises, and CPP reduces, the expansion of brain small artery, CVR reduces to keep brain blood for constant, this moment diastolic pressure (diastolic blood pressure, DBP) (systolic blood pressure SBP) descends obviously than systolic pressure, so pulse pressure difference increases, and the pulsatility index of reflection pulse pressure difference (pulsatility index, PI), (resistance index RI) increases drag index.When ICP continues to increase, the automatic regulatory function of cerebrovascular goes down, cerebral circulation slows down, CBF reduces, systole blood flow rate (systolic velocity, Vs), end diastolic velocity (diastolic velocity, Vd), (mean flow velocity Vm) all reduces mean blood flow velocity.Above-mentioned cerebral hemodynamic parameter (PI, RI, Vs, Vd, Vm) changed and quantitative simulation ICP when TCD just increased with detection ICP.The "black box" scale-model investigation show when ICP increases as with the cerebral hemodynamic parameter that detects through TCD as input, with ICP as outfan and when ignoring the detailed process that ICP changes, close with the mimic ICP of mathematical model with actual measurement ICP result, on mimic ICP curve even the distinguishable waveform that influences that goes out P﹠R.This method is the research emphasis in current this field in the world, but does not have sophisticated instrument for clinical use to emerge as yet at present.
Summary of the invention
At the problems referred to above, main purpose of the present invention is to provide a kind of Noninvasive intracranial pressure monitoring equipment, it has certainty of measurement more accurately, and the monitoring approach is convenient, reliable, but the long-time continuous monitoring also can be understood the state of intracranial Hemodynamics such as cerebral perfusion pressure, cerebral blood flow, cerebral vascular resistance in the monitoring intracranial pressure, and the latter is selected by intracranial hypertension patient's therapeutic scheme and prognosis is judged most important too.
For achieving the above object, the present invention by the following technical solutions: a kind of Noninvasive intracranial pressure monitoring equipment is characterized in that including: data acquisition unit is the transcranial doppler instrument; Data transmission device, the analog signal conversion that is used for described data acquisition unit is a digital signal; The computational analysis device is a computer that is provided with data analysis software, and it receives the signal of described data transmission device output, and can be by the data among the network call data base; Display device is used to show the analysis result of described computational analysis device; Input-output equipment is used for the analysis result that input operation is instructed and exported described computational analysis device.
Described computational analysis device comprises data acquisition module, data processing module and data outputting module, finishes the output of the calling of data, computing, checking and conclusion.
Described data acquisition module is used for receiving the data of described data collecting system and calls data from described data base, imports described data processing module; Described data processing module comprises cerebrospinal fluid kinetics module, cerebral hemodynamic and intracranial pressure relationship module, summarizing module and data verification module; Described cerebrospinal fluid kinetics module is imported its computation model with various parametric data and is handled, and obtains cerebrospinal fluid and generates and resistance to outflow value and intracranial compliance value, and the data that obtain are imported described summarizing module; Preset the model of cerebral perfusion pressure, cerebral blood flow velocity and regulatory mechanism thereof in described cerebral hemodynamic and the intracranial pressure relationship module, constitute the adaptive control system of a certain amount of estimation intracranial pressure; Be provided with total model in the described summarizing module, the cerebrospinal fluid that described cerebrospinal fluid kinetics module is calculated generates and absorbs the numerical value of resistance and intracranial compliance, with cerebral perfusion pressure, the cerebral blood flow velocity set up by described cerebral hemodynamic and intracranial pressure relationship module with regulate data automatically and incorporate total model, draw intracranial pressure numerical value; The precision of the intracranial pressure data that described data verification module is used to verify that described summarizing module draws, and will import described data outputting module by the data of checking; Described data outputting module is exported to described display device and input-output equipment with the analysis result of described data processing module.
Adopt technique scheme, the present invention has the following advantages: 1, the present invention gathers patient's cerebral blood flow data by transcranial doppler, has reduced the wound to sufferer, can alleviate the misery of sufferer, and help the sufferer rehabilitation.2, the present invention utilizes transcranial doppler to detect the blood flow signal of patient's brain trunk, and goes out the intracranial pressure data by Computing in real time, can realize the needs of long-term continuous detecting clinically.3, the present invention only needs to gather patient's cerebral blood flow data by transcranial doppler and can detect intracranial pressure, and not only detection approach is convenient, and conclusion is reliable and certainty of measurement is high.4, the present invention can reflect the dynamic change of cerebral blood flow, and whether observation cerebral blood flow self regulatory mechanism is perfect, is convenient to the doctor and in time takes the treatment measure according to patient's situation, makes treatment more timely, reaches better effect.5, the present invention helps the doctor accurately to judge patient's prognosis or brain death.
Description of drawings
Fig. 1 is that structure of the present invention is formed sketch map
Fig. 2 is a system block diagram of the present invention
Fig. 3 is the module map of computational analysis device of the present invention
Fig. 4 is the schematic diagram of cerebral hemodynamic of the present invention and intracranial pressure estimation
Fig. 5 is a flow chart of the present invention
Fig. 6 is a first embodiment of the invention according to monitoring curve and the simulation curve contrast figure that cerebrospinal fluid generates and the mathematical model of resistance to outflow obtains
Fig. 7 monitoring curve and simulation curve contrast figure that to be second embodiment of the invention obtain according to the mathematical model of intracranial compliance and intracranial pressure relation
Fig. 8 is that curve chart is implemented in cerebral hemodynamic of the present invention and the monitoring of intracranial pressure relation
Fig. 9 is that the present invention is real-time, curve is implemented in the Noninvasive intracranial pressure monitoring
The specific embodiment
In order to describe principle of the present invention, characteristics and effect in detail, now be described as follows according to preferred embodiment of the present invention and conjunction with figs.:
As Fig. 1～shown in Figure 3, Noninvasive intracranial pressure monitoring equipment provided by the present invention, be a kind of employing transcranial doppler (Transcranial Doppler, TCD) monitoring equipment of detection intracranial pressure (ICP) comprises data acquisition unit 1, data transmission device 2, computational analysis device 3, display device 4 and input-output equipment 5.
Data processing module 32 comprises cerebrospinal fluid kinetics module 321, cerebral hemodynamic and intracranial pressure relationship module 322, summarizing module 323 and data verification module 324.According to the ICP dynamic analysis, cerebrospinal fluid kinetics and cerebral hemodynamic are respectively the key factor that forms ICP and determine the ICP level, therefore built-in model will be set up separately the sub-model relevant with ICP at first respectively in cerebrospinal fluid kinetics module 321 and cerebral hemodynamic and the intracranial pressure relationship module 322, gather then to the summarizing module 323 of total model (being final mask) of estimating ICP to estimate the ICP value.
Comprise again in the cerebrospinal fluid kinetics module 321 that wherein cerebrospinal fluid generates and resistance to outflow computing module 325 and intracranial compliance computing module 326.
Cerebrospinal fluid generates and the computation model of resistance to outflow computing module 325 is:
R＝P
0t/PVI?log[P
(t)/P
p×(P
p-P
0)/(P
(t)-P
0)]
Wherein R is that cerebrospinal fluid generates and resistance to outflow P
0Be intracranial initial pressure, P
(t)Be the pressure in a certain moment of intracranial, P
pFor peak pressure power, the PVI of intracranial is the pressure-volume index, be the conventional parametric data of from hospital database, calling in.
The computation model of intracranial compliance computing module 326 is:
C＝1/KP＝0.4343(PVI)/P
K wherein
EBe the intracranial coefficient of elasticity.
Cerebrospinal fluid kinetics module 321 is by importing conventional parametric data such as ICP, pressure-volume index data such as (PVI) each computation model and handle, obtaining cerebrospinal fluid generates and resistance to outflow value and intracranial compliance value, then these numerical value are added summarizing module 323, to finish the calculating of ICP.
Preset the cerebral perfusion pressure set up according to the ICP dynamical mechanism in cerebral hemodynamic and the intracranial pressure relationship module 322 (computing formula as described above: CPP=mSAP-ICP), the model of cerebral blood flow velocity and regulatory mechanism thereof, as shown in Figure 4, this three constitutes an adaptive control system when the quantitative estimation that participates in ICP.
Wherein: ABP is aforesaid average body arterial pressure (mSAP) for the average body arterial pressure is; Matrix A and the vectorial B of AB during for the automatic adjustment state of estimation; NICP is a Noninvasive intracranial pressure.
TCD can accurately be described in blood flow rate in the short term variations and the relation on the mean arterial pressure numerical value, and it shows can provide information for the power amount fk in the impulse Response Function appraising model, that is expresses fk with the characteristic of some TCD.Be the relation of linear model between the eigenvalue TCDn of these power amount fk and m TCD:
f
j＝A
j0*TCD
0+A
j1TCD
1+…+A
jm-1*TCD
m-1+B
j，j＝0，1，2，…n-1.
With its form of being write as matrix be exactly:
Be matrix A and commensurability B.
As shown in Figure 4, the estimation process that noinvasive is measured ICP is to begin from ABP, the TCD data of record simultaneously, utilize then model assessment ICP numerical value and and the ICP of actual measurement compare.
The operating procedure of cerebral hemodynamic and intracranial pressure relationship module 322 is:
Step 1:mSAP assignment is given the impulse Response Function computation model, sets up the relation of mSAP and ICP, and the impulse Response Function computation model is:
ICP
k＝f
0*ABP
k+f
1*ABP
k-1+…+f
23*ABP
k-23+f
24*ABP
k-24
Step 2:FV (TCD character numerical value: V
S, V
d, V
M, RI, PI etc.) assignment gives and to regulate volt attitude appraising model AB automatically and state value is composed to the impulse Response Function computation model.Automatically the appraising model of adjustment state is:
Step 3: the calculating of regulatory function automatically comprises quantitative Analysis and the calculating of regulatory function state automatically that cerebrovascular is regulated:
1) cerebrovascular is regulated and (is contained cerebral blood flow adjusting and CO automatically
2The regulatory mechanism model) quantitative Analysis:
Cerebral blood flow is regulated and CO automatically
2Adjusting will change cerebrovascular compliance and resistance, and cerebrovascular bore and blood flow, blood flow rate are changed, and the increasing or reduce of final decision ICP, and regulate model to be:
The cerebrovascular adaptation computation model:
Wherein, kcpa is a constant parameter, and it is inversely proportional to the center gradient (centralslope) of the sigmoid curve of regulating the blood flow increase and decrease; Cpa and Δ Cpa are the central value and the amplitude of sigmoid curve.CBF descends and CO
2Increased pressure causes that vasodilation companion compliance raises, ICP raises; Otherwise CBF raises or CO
2Pressure descends and causes that vasoconstriction companion compliance descends, ICP descends.
The cerebral vascular resistance computation model is:
Wherein, k
RIt is constant parameter.The square value of Cpan has been included in the molecule of equation, makes the fluid resistance under the base state not rely on blood volume.
2) calculating of regulatory function state automatically:
Whether increasing property of ICP disease causes the change of cerebral hemodynamic (CBF, CPP, TCD detect data etc.) and and then influences the state that ICP depends on automatic regulatory function.Automatically normally then the cerebral blood flow maintenance is constant for regulatory function, and the ICP change is little.Otherwise the infringement of regulatory function will cause the cerebral hemodynamic disorder and accompany ICP to increase automatically.Automatically the regulatory function state is determined by the order of severity of patient's brain diseases, so the quantitative assessment of its state both shown the disease of patient order of severity, and the while also will determine the level of ICP.
Automatically the computational methods of regulatory function state are as follows:
At first establish the matrix A and the vectorial B of the automatic regulatory function state of decision:
Again with the nICP value (Noninvasive intracranial pressure: non-invasive ICP, nICP) send AB back to and calculate and adjust instant automatic adjustment state continuously.
Cerebral hemodynamic and intracranial pressure relationship module 322 through the estimation equation that draws nICP after the computing of above-mentioned 3 steps are:
ICP
t＝c(1)*ABP
t+c(2)*PI
t+c(3)*RI
t+c(4)*CO2
t+c(5)*ABP
t-1+μ
t
μ
t＝c(6)*μ
t-1+∈
t
As shown in Figure 4, cerebral hemodynamic and intracranial pressure relationship module 322 noinvasive estimate that the ICP value is based on the method for transfer function and is subjected to cerebral hemodynamic parameter and the control of regulatory function state automatically.It is the response value of system that the ICP signal is construed to, and input signal is average body arterial pressure (mSAP), and the conversion of mSAP → ICP promptly is expressed as an impulse Response Function, that is the process of mSAP → impulse Response Function → ICP.Cerebral hemodynamic information (the V that while is detected through TCD
S, V
d, V
M, RI, PI) and the cerebrovascular regulatory mechanism (regulate automatically and CO
2Adjusting) also incorporates the estimation that participates in the ICP value in the model.When mSAP, TCD data and automatic regulatory function state participated in the ICP estimation, three's combined effect was: 1, mSAP real-time, that import continuously and TCD data obtain real-time, successive ICP value output after the calculating of impulse Response Function value; 2, the computational process of real-time, successive mSAP → impulse Response Function → ICP has improved the output accuracy of model under the adjustment of automatic adjustment state; 3, be based on physiology and the pathophysiology basis of ICP because of the model modeling principle, more than selected variable be the key variables of output ICP value, so under the prerequisite that guarantees the model output accuracy, simplified model structure and computational process, adapted to the requirement of clinical monitoring to instantaneity.
Calculate in built-in each model in conventional parametric data input cerebral hemodynamic of the cerebral hemodynamic data that TCD gathered and patient and the intracranial pressure relationship module 322, for the calculating of the ICP numerical solution of summarizing module 323 provides the data foundation.
The calculating data input summarizing module 323 of cerebrospinal fluid kinetics module 321 and cerebral hemodynamic and intracranial pressure relationship module 322.Be provided with total model in the summarizing module 323, the cerebrospinal fluid that cerebrospinal fluid kinetics module 321 is calculated generates and absorbs the numerical value of resistance and intracranial compliance, the equation that forms ICP with the factor participations such as cerebral perfusion pressure, cerebral blood flow velocity and automatic adjusting of being set up by cerebral hemodynamic and intracranial pressure relationship module 322 incorporates total model, can draw the numerical solution of patient ICP, instruct and theoretical foundation for clinical definite therapeutic scheme provides.
Total model in the summarizing module 323 is:
ICP＝0.849*ABP-44.755*PI+36.342*RI-1.043*CO2+0.121*ABP(-1)+[AR(1)＝0.984]
The data that summarizing module 323 draws also need the precision through data verification module 324 verification msgs.Insert hospital overall data storehouse, the ICP that is exported with the method for least square check and the precision of other data are also compared with the historical data in the hospital overall data storehouse.When precision then is considered as entering following output module 33 by check in range of error, otherwise return data processing module 32 is revised parameters and is recomputated.Modification will (comprise automatic adjusting of cerebral blood flow and CO by the parameter value of adjusting in cerebrospinal fluid generation and absorption resistance and the intracranial compliance equation with automatic the adjusting according at cerebrospinal fluid kinetics module 321 and the cerebrospinal fluid generation that obtains and the regulatory mechanism equation of absorption resistance and intracranial compliance equation and cerebral blood flow velocity and cerebral perfusion pressure and intracranial pressure relation in cerebral hemodynamic and intracranial pressure relationship module 322
2Regulate) parameter value, model is failed to adapt to the error in data that patient individual difference's difference caused revise, that is real-time update data return data processing module 32 recomputates.
The result is shown by display device 4 according to data and other form (as providing preliminary treatment suggestion) of the curve chart of reflection ICP value, ICP and cerebral blood flow relation, analysis, comparison by data outputting module 33 through the final data of data verification module 324 checking, and by input-output equipment 5 output test datas and feed back in the hospital database.Thus, the present invention both can call the historical summary in the hospital database, also the patient ICP data of monitoring gained can be imported in the hospital database, was convenient to use when the medical worker of section office works out therapeutic scheme.
Display device of the present invention is general computer monitor, and input-output equipment is any input-output equipment that can be connected with computer, as keyboard, memory device and PRN device etc.
As shown in Figure 5, work process of the present invention is as follows:
At first, receive blood flow signal from data transmission device 2, and call in patient's conventional parameter and patient information from hospital overall data storehouse by the measured patient's intracranial trunk of transcranial doppler 11 by data acquisition module 31.Afterwards, in the cerebrospinal fluid kinetics module 321 and cerebral hemodynamic and intracranial pressure relationship module 322 of data acquisition module 31 with these data input data processing modules 32, generate by cerebrospinal fluid respectively and absorb resistance computation model, intracranial compliance computation model and cerebral blood flow velocity, cerebral perfusion pressure and regulatory mechanism model thereof and calculate respectively, obtain the data that cerebrospinal fluid generated and absorbed resistance, intracranial compliance, cerebral hemodynamic and intracranial pressure relation according to the computing formula that presets.
Above gained data input summarizing module 323 draws the numerical solution of patient ICP, the numerical solution of this ICP is checked the precision of ICP through data verification methods such as method of least square in data verification module 324, as then entering data outputting module 33 by check, the record that comprises image output and data, wherein image mainly shows the relation of ICP change curve and ICP and cerebral hemodynamic and the relation of ICP and other data, and numerical data mainly is the numerical solution of ICP etc.The gained data are stored in hospital overall data storehouse simultaneously.Otherwise return data processing module 32 is revised parameter and is recomputated.
The medicine principle of institute of the present invention foundation is:
1, ICP increases the regulation and control that cause cerebral hemodynamic variation, the amplitude of its variation also to be subjected to intracranial compliance, cerebrospinal fluid generation simultaneously and absorb resistance, the automatic regulatory function state of brain.
2, when ICP increases, TCD can capture the variation of cerebral hemodynamic, that is: V sensitively
MSlow down, RI, PI raise.V
M, RI, PI and ICP have good quantitative relationship, this quantitative relationship can use mathematical model method accurately to express.The measuring and calculating that in the model cerebrospinal fluid is generated and absorb resistance, intracranial compliance, the automatic regulatory function state of brain can obviously improve the precision of ICP output valve.
3, TCD is the instrument that external noinvasive detects cerebral hemodynamic, therefore based on the ICP monitoring equipment of TCD can be in real time, noinvasive, obtain the ICP value continuously.
Each computation model that presets in the data processing module of the present invention is through following experimental verification:
Embodiment 1:
Determine that cerebrospinal fluid generates and the mathematical model of resistance to outflow is:
R＝P
0t/PVI?log[P
(t)/P
p×(P
p-P
0)/(P
(t)-P
0)]
The measured figure of present embodiment as shown in Figure 6, abscissa is the time in the figure, vertical coordinate is an intracranial pressure, and the representative of asteroid among the figure has the ICP data and curves of wound monitor actual measurement, the ICP data that on behalf of the present invention, block curve estimate according to the mathematical model of cerebrospinal fluid generation and resistance to outflow.The quantitative relationship that shows time dependent cerebrospinal fluid generation and resistance to outflow and intracranial pressure.R in the equation is for generating and the absorption resistance; PVI is the pressure-volume index, expression pressure and volumetrical corresponding relation; P
0Be initial intracranial pressure; P
pBe the intracranial peak pressure.As shown in Figure 6, in the present embodiment, the ICP curve result that equation simulation obtains with have the resulting curve fit of wound monitoring good.
The generation of normal brain spinal fluid and outflow keep balance, and it is normal to keep intracranial pressure with this.ICP increases and causes resistance to outflow to increase, and the increase of resistance to outflow make conversely ICP more shape increase, the relation of this resistance and pressure is one of factor of decision intracranial pressure, and the two have linear character also can be through the calculating quantificational expression of model.This modelling is used for calculating generation and absorbs resistance, incorporates total model behind its parameter value of model assessment, participates in calculating the intracranial pressure value.
Embodiment 2:
The mathematical model of determining the intracranial compliance is:
C＝1/KP＝0.4343(PVI)/P
In the formula: C is the intracranial compliance; K is the intracranial coefficient of elasticity
Brain is in the rigidity cranial cavity, and the increase of the certain cubical content of cranial cavity content can make intracranial pressure remain unchanged, and this is the intracranial compliance.If but cranial capacity further increases, then compliance descends, intracranial hypertension, so the relation of the two is one of factor of decision intracranial pressure.The quantitative relationship of compliance and intracranial pressure can be with this mathematics model representation, in data handling procedure, in cerebrospinal fluid kinetics module conventional parametric data such as pressure-volume index input computation models such as (PVI) are handled, obtain intracranial compliance value, after this value incorporates total model, participate in calculating the intracranial pressure value.As shown in Figure 7, abscissa is a volume in the figure, and vertical coordinate is the logarithm of intracranial pressure, and by curve among the figure as can be known, along with the volumetrical increase of intracranial, compliance reduces gradually, and intracranial pressure increases gradually.As shown in Figure 7, the ICP curve result that equation simulation obtains in the present embodiment with have the resulting curve fit of wound monitoring good.
Embodiment 3:
The model of determining cerebral hemodynamic and intracranial pressure relation is:
ICP
t＝c(1)*ABP
t+c(2)*PI
t+c(3)*RI
t+c(4)*CO2
t+c(5)*ABP
t-1+μ
t
μ
t＝c(6)*μ
t-1+∈
t
This calculating formula selects first phase delay and the single order autoregression of topmost response magnitude ABP to obtain as Disturbance by the data sequence being set up the parameter c (1) that autoregressive time series models obtain basic parameter again.
The simulation curve figure of model as shown in Figure 8.
Component in the rigidity cranial cavity is cerebral tissue, cerebrospinal fluid and blood, and wherein the increase of arbitrary component all can cause increasing of intracranial pressure, and what of intracranial blood volume cerebral hemodynamic regulate and control, and therefore is the key factor of decision intracranial pressure.This model contains the principal element of influential cerebral hemodynamic.As shown in Figure 8, fit satisfaction through the cranium pressure value of modeling and the monitor value that the wound ICP (monitor intracranial pressure monitor) is arranged, this had both shown and had had the quantitative relationship of determining between cerebral hemodynamic and the intracranial pressure, also show selected variable in the model accurately and pivotal role.
Embodiment 4:
The model of noinvasive ICP monitoring (total model) in real time:
ICP＝0.849*ABP-44.755*PI+36.342*RI-1.043*CO2+0.121*ABP(-1)+[AR(1)＝0.984]
This model is to have taken all factors into consideration each the ICP constituent element in cerebrospinal fluid kinetics module 321 and cerebral hemodynamic and the intracranial pressure relationship module 322 and the result of calculation in each module brought into, sets up in real time, noinvasive, exports total model of ICP value continuously.Instrument monitoring and model calculation carry out respectively simultaneously in this embodiment operating process.From the trend analysis of curve, measured value, the analogue value and predictive value do not have and depart from, and model especially in advance and accurately predicted the change direction of ICP.Because the variable in the model all screens key variables that get so that modeling curve fit perfection based on sophisticated theory of medicine or from experiment.
Shown by the foregoing description: 1, institute of the present invention established model meets real intracranial pressure kinetics; 2, model has had clinical value.
In sum, the ICP monitoring method based on TCD of the present invention has the following advantages than other method: 1, No wound; 2, more accurately certainty of measurement is arranged; 3, monitoring approach is convenient, reliable; But 4 continuous monitorings; 5, can reflect the dynamic change of brain blood flow; 6, the state of observable brain blood flow self-correcting mechanism; 7, intracranial pressure, The monitoring same period of brain blood flow and automatic adjustment state helps guiding clinical treatment and judges that more accurately the patient is pre-After.
Claims (1)
1, a kind of Noninvasive intracranial pressure monitoring equipment is characterized in that including:
Data acquisition unit is the transcranial doppler instrument;
Data transmission device, the analog signal conversion that is used for described data acquisition unit is a digital signal;
The computational analysis device is a computer that is provided with data analysis software, and it receives the signal of described data transmission device output, and can be by the data among the network call data base; Described computational analysis device comprises data acquisition module, data processing module and data outputting module, finishes the output of the calling of data, computing, checking and conclusion;
Described data acquisition module is used for receiving the data of described data acquisition unit and calls data from described data base, imports described data processing module;
Described data processing module comprises cerebrospinal fluid kinetics module, cerebral hemodynamic and intracranial pressure relationship module, summarizing module and data verification module; Described cerebrospinal fluid kinetics module is imported its computation model with various parametric data and is handled, and obtains cerebrospinal fluid and generates and resistance to outflow value and intracranial compliance value, and the data that obtain are imported described summarizing module; Preset the model of cerebral perfusion pressure, cerebral blood flow velocity and regulatory mechanism thereof in described cerebral hemodynamic and the intracranial pressure relationship module, constitute the adaptive control system of a certain amount of estimation intracranial pressure; Be provided with total model in the described summarizing module, the cerebrospinal fluid that described cerebrospinal fluid kinetics module is calculated generates and absorbs the numerical value of resistance and intracranial compliance, with cerebral perfusion pressure, the cerebral blood flow velocity set up by described cerebral hemodynamic and intracranial pressure relationship module with regulate data automatically and incorporate total model, draw intracranial pressure numerical value; The precision of the intracranial pressure data that described data verification module is used to verify that described summarizing module draws, and will import described data outputting module by the data of checking;
Described data outputting module is exported to display device and input-output equipment with the analysis result of described data processing module;
Display device is used to show the analysis result of described computational analysis device;
Input-output equipment is used for the analysis result that input operation is instructed and exported described computational analysis device.
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| CN101627905B (en) * | 2009-07-30 | 2011-08-31 | 季忠 | Noninvasive integrative monitoring analytical method and noninvasive integrative monitoring analytic device for intracranial pressure |
| CN102370475B (en) * | 2011-07-28 | 2013-07-10 | 梁莹 | Method for measuring cerebral vertebra-basilar artery hemodynamic characteristics |
| CN102429651B (en) * | 2011-08-15 | 2013-10-30 | 重庆大学 | Multi-parameter-based intracranial pressure noninvasive detection method and device |
| US9826934B2 (en) | 2011-09-19 | 2017-11-28 | Braincare Desenvolvimento E Inovação Tecnológica Ltda | Non-invasive intracranial pressure system |
| CN102670252B (en) * | 2012-05-31 | 2013-11-27 | 重庆朗普科技有限公司 | Intracranial pressure non-invasive measuring method and system |
| CN103654760B (en) * | 2012-09-10 | 2016-08-03 | 焦文华 | Noninvasive intracranial pressure measuring method and the Noninvasive intracranial pressure analyser of application the method |
| CZ306105B6 (en) * | 2014-10-11 | 2016-08-03 | Linet Spol. S.R.O. | Device for and method of measuring intracranial pressure |
| CN110507307B (en) * | 2019-08-30 | 2021-12-28 | 重庆博恩富克医疗设备有限公司 | Noninvasive intracranial pressure monitoring device and method |
| CN111631699A (en) * | 2020-05-18 | 2020-09-08 | 华南理工大学 | Arterial blood pressure target value range evaluation system for keeping cerebral blood flow stable |
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| US5951477A (en) * | 1997-09-11 | 1999-09-14 | Uab Vittamed | Method and apparatus for determining the pressure inside the brain |
| US6086533A (en) * | 1998-06-12 | 2000-07-11 | Children's Medical Center Corporation | Non-invasive in vivo pressure measurement |
| WO2004107963A2 (en) * | 2003-06-03 | 2004-12-16 | Allez Physionix Limited | Non-invasive determination of intracranial pressure via acoustic transducers |
| CN2726531Y (en) * | 2004-08-05 | 2005-09-21 | 陕西一方科技发展有限公司 | Non-invasive intracranial pressure detector |
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