Method and device for determining at least one physiological parameter
20170340218 · 2017-11-30
Inventors
Cpc classification
A61B5/02255
HUMAN NECESSITIES
International classification
A61B5/00
HUMAN NECESSITIES
Abstract
The method serves to determine at least one physiological parameter of a patient. A pulse measurement signal of a pulse pressure wave propagating within the blood vessels and emanating from the heart is acquired at a pulse measurement point. A corrected pulse measurement signal is produced from the acquired pulse measurement signal by means of signal processing. The at least one physiological parameter is ascertained on the basis of the corrected pulse measurement signal. For the purposes of producing the corrected pulse measurement signal, the acquired pulse measurement signal is subjected to adaptive filtering with a dynamically adapting filter characteristic in order to compensate the influence of a reflected component of the pulse pressure wave.
Claims
1-18. (canceled)
19. A method for determining at least one physiological parameter of a patient, in which a) a pulse measurement signal of a pulse pressure wave propagating within the blood vessels and emanating from the heart is acquired at a pulse measurement point, b) a corrected pulse measurement signal is produced from the acquired pulse measurement signal by means of signal processing, and c) the at least one physiological parameter is ascertained on the basis of the corrected pulse measurement signal, wherein d) the acquired pulse measurement signal, for the purposes of producing the corrected pulse measurement signal, is subjected to adaptive filtering with a dynamically adapting filter characteristic in order to compensate the influence of a reflected component of the pulse pressure wave.
20. A method as claimed in claim 19, wherein the acquired pulse measurement signal is decomposed into measurement sections which can respectively be assigned to a heartbeat, a corrected section is ascertained from each measurement section by means of adaptive filtering, and the corrected sections thus produced are composed to form the corrected pulse measurement signal.
21. A method as claimed in claim 20, wherein the relevant measurement section of the acquired pulse measurement signal is converted into an initial frequency signal by means of a transformation into the frequency domain, the initial frequency signal is used for adapting the filter characteristic and then subjected to adaptive filtering with the adapted filter characteristic, wherein a corrected frequency signal is formed, said corrected frequency signal being converted into the corrected section by means of a back transformation into the time domain.
22. A method as claimed in claim 19, wherein the adaptive filtering is carried out as adaptive low-pass filtering with a variable low-pass cutoff frequency.
23. A method as claimed in claim 21, wherein the adaptive filtering is carried out as adaptive low-pass filtering with a variable low-pass cutoff frequency, the amplitude maxima of the initial frequency signal are determined, and the current value of the low-pass cutoff frequency is ascertained from the quotient of the second amplitude maximum to the third amplitude maximum in order to adapt the filter characteristic.
24. A method as claimed in claim 23, wherein a frequency value of the second amplitude maximum is used as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise a frequency value of the third amplitude maximum is used as current value of the low-pass cutoff frequency, wherein the quotient threshold lies in the range between 2.0 and 3.5.
25. A method as claimed in claim 23, wherein a frequency value of the second amplitude maximum is used as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise a frequency value of the third amplitude maximum is used as current value of the low-pass cutoff frequency, wherein the quotient threshold lies in the range between 2.5 and 3.0.
26. A method as claimed in claim 23, wherein a frequency value of the second amplitude maximum is used as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise a frequency value of the third amplitude maximum is used as current value of the low-pass cutoff frequency, wherein the quotient threshold lies at 2.8.
27. A method as claimed in claim 19, wherein it is used during a calibration.
28. A method as claimed in claim 19, wherein the reflected component of the pulse pressure wave is ascertained as a difference signal corresponding to a difference between the acquired pulse measurement signal and the corrected pulse measurement signal.
29. A method as claimed in claim 28, wherein the reflected component of the pulse pressure wave is evaluated separately.
30. A method as claimed in claim 28, wherein the reflected component of the pulse pressure wave is evaluated separately in order to obtain information at least one of in respect of the speed of the pulse pressure wave, in respect of the pulse transit time between the heart and the pulse measurement point, in respect of static properties of the cardiac system and vessel system of the patient, in respect of dynamic properties of the cardiac system and vessel system of the patient, in respect of the compliance of the vessels of the patient and in respect of the pre-ejection period
31. A method as claimed in claim 19, wherein the corrected pulse measurement signal is used to determine at least one of the physiological parameters of the group containing a blood pressure prevailing at the pulse measurement point, a central blood pressure, a plethysmogram in the proximity of the heart, static properties of the cardiac system and vessel system of the patient, dynamic properties of the cardiac system and vessel system of the patient and the compliance of the vessels of the patient and the pre-ejection period.
32. A device for determining at least one physiological parameter of a patient, comprising a) a pulse sensor for acquiring a pulse measurement signal of a pulse pressure wave which, emanating from the heart, propagates within the blood vessels up to a pulse measurement point at which the pulse sensor is arranged, and b) an evaluation unit for ascertaining a corrected pulse measurement signal from the acquired pulse measurement signal by means of signal processing and for ascertaining the at least one physiological parameter on the basis of the corrected pulse measurement signal, wherein c) the evaluation unit is configured, for the purposes of producing the corrected pulse measurement signal, to subject the acquired pulse measurement signal to adaptive filtering with a dynamically adapting filter characteristic in order to compensate the influence of a reflected component of the pulse pressure wave.
33. A device as claimed in claim 32, wherein the evaluation unit is configured to decompose the acquired pulse measurement signal into measurement sections which can respectively be assigned to a heartbeat, ascertain a corrected section from each measurement section by means of adaptive filtering, and compose the corrected sections thus produced to form the corrected pulse measurement signal.
34. A device as claimed in claim 33, wherein the evaluation unit is configured to convert the relevant measurement section of the acquired pulse measurement signal into an initial frequency signal by means of a transformation into the frequency domain, use the initial frequency signal for adapting the filter characteristic and then subject said initial frequency signal to adaptive filtering with the adapted filter characteristic, wherein a corrected frequency signal is formed, and the evaluation unit is further configured to convert the corrected frequency signal into the corrected section by means of a back transformation into the time domain.
35. A device as claimed in claim 32, wherein the evaluation unit is configured to carry out the adaptive filtering as adaptive low-pass filtering with a variable low-pass cutoff frequency.
36. A device as claimed in claim 34, wherein the evaluation unit is configured to carry out the adaptive filtering as adaptive low-pass filtering with a variable low-pass cutoff frequency, determine the amplitude maxima of the initial frequency signal, and ascertain the current value of the low-pass cutoff frequency from the quotient of the second amplitude maximum to the third amplitude maximum in order to adapt the filter characteristic.
37. A device as claimed in claim 36, wherein the evaluation unit is configured to use a frequency value of the second amplitude maximum as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise use a frequency value of the third amplitude maximum (21) as current value of the low-pass cutoff frequency, wherein the quotient threshold lies in the range between 2.0 and 3.5.
38. A device as claimed in claim 36, wherein the evaluation unit is configured to use a frequency value of the second amplitude maximum as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise use a frequency value of the third amplitude maximum as current value of the low-pass cutoff frequency, wherein the quotient threshold lies in the range between 2.5 and 3.0.
39. A device as claimed in claim 36, wherein the evaluation unit is configured to use a frequency value of the second amplitude maximum as current value of the low-pass cutoff frequency if the quotient of the second amplitude maximum to the third amplitude maximum at most equals a quotient threshold, and otherwise use a frequency value of the third amplitude maximum as current value of the low-pass cutoff frequency, wherein the quotient threshold lies at 2.8.
40. A device as claimed in claim 32, wherein the evaluation unit is configured to perform ascertaining the corrected pulse measurement signal and ascertaining the at least one physiological parameter on the basis of the corrected pulse measurement signal during a calibration of the device.
41. A device as claimed in claim 32, wherein the evaluation unit is configured to ascertain the reflected component of the pulse pressure wave as a difference signal corresponding to a difference between the acquired pulse measurement signal and the corrected pulse measurement signal.
42. A device as claimed in claim 41, wherein the evaluation unit is configured to separately evaluate the reflected component.
43. A device as claimed in claim 41, wherein the evaluation unit is configured to separately evaluate the reflected component in order to obtain information at least one of in respect of the speed of the pulse pressure wave, in respect of the pulse transit time between the heart and the pulse measurement point, in respect of static properties of the cardiac system and vessel system of the patient, in respect of the speed of the pulse pressure wave, one of in respect of the pulse transit time between the heart and the pulse measurement point and in respect of dynamic properties of the cardiac system and vessel system of the patient and in respect of the compliance of the vessels of the patient and in respect of the pre-ejection period.
44. A device as claimed in claim 32, wherein the evaluation unit is configured to use the corrected pulse measurement signal to determine at least one of the physiological parameters of the group containing a blood pressure prevailing at the pulse measurement point, a central blood pressure, a plethysmogram in the proximity of the heart, static properties of the cardiac system and vessel system of the patient, dynamic properties of the cardiac system and vessel system of the patient, the compliance of the vessels of the patient and the pre-ejection period.
Description
BRIEF DESCRIPTION OF THE DRAWING
[0029]
[0030]
[0031]
[0032]
[0033]
DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0034] Parts corresponding to one another have been provided with the same reference signs in
[0035] As an example of a device for acquiring a physiological parameter,
[0036] The blood pressure measuring device 1 contains an ECG sensor 3 comprising at least two recording electrodes, a pulse sensor 4, in particular in the form of a pulse oximeter or a photoplethysmographic sensor, and an optional body position sensor 5, in particular in the form of a 3-D acceleration sensor, which are connected to an evaluation unit 6. The evaluation unit 6 comprises a plurality of components. In addition to a first calculation unit 7 and an optional second calculation unit 7a (which is therefore only plotted using dashed lines in
[0037] A calibration unit 12 comprising a conventional blood pressure sensor 13 may be connected, at least temporarily, to the (optionally also multipart) evaluation unit 6. In the exemplary embodiment, the blood pressure sensor 13 is embodied as a Riva-Rocci blood pressure sensor comprising an inflatable arm cuff 14. A calibration blood pressure value P.sub.cal ascertained during a calibration measurement by means of the blood pressure sensor 13 and the arm cuff 14 is forwarded to the evaluation unit 6.
[0038] In the exemplary embodiment in accordance with
[0039] The functionality of the blood pressure measuring device 1 during normal operation emerges from the diagrams reproduced in
[0040] A transit time T of the pulse pressure wave between the heart of the patient 2 and the pulse measurement point 15 is ascertained from the electric measurement signal EM and the pulse measurement signal PM in the evaluation unit 6, in particular in the first calculation unit 7 and the optional second calculation unit 7a. The time difference between the time of the so-called R-wave in the electric measurement signal EM and the time of the maximum gradient in the pulse measurement signal PM is used as transit time T. In order to ascertain the last-mentioned time more easily, the time derivative of the pulse measurement signal PM is formed (see the lowermost diagram in
[0041] By means of the functional relationship explained in DE 10 2005 014 048 B4, a current blood pressure P is calculated from the ascertained transit time T in the calculation unit 7, taking into account further parameters. Thus, acquiring the time of the maximum gradient in the pulse measurement signal PM as exactly as possible is also decisive for exactly ascertaining the current value of the blood pressure P. It was found that this time cannot readily be uniquely ascertained in all constellations. This applies, in particular, if the original pulse pressure wave, i.e. the pulse pressure wave emanating from the heart, has superposed thereon a reflected or returning pulse pressure wave. Such a returning pulse pressure wave may form on account of reflections at transition regions of vessel structures and/or as a result of hydrodynamic effects. The form of the reflected pulse pressure wave may differ from that of the original pulse pressure wave depending on the vessel properties of the patient.
[0042] A distinction should be made between the constellations reproduced by the signal curves in accordance with
[0043] In order to exclude these negative effects on the measurement accuracy, the blood pressure measuring device 1 comprises a compensation of the adverse influence of the reflected pulse pressure wave 17. In particular, the evaluation unit 6 is configured to carry out this compensation. A correction algorithm is implemented in the evaluation unit 6, said correction algorithm removing the ambiguity in relation to the time of the steepest gradient in the first rising flank of the pulse measurement signal PM. This correction algorithm is based on the discovery that higher frequency components are generated by the superposition of the reflected pulse pressure wave 17 on the original pulse pressure wave 16. Accordingly, the correction algorithm comprises adaptive frequency filtering which removes a determined higher frequency component of the pulse measurement signal PM depending on the current constellation—which, in particular, is also identified by the correction algorithm—such that said higher frequency component is not taken into account for the further signal evaluation, in particular within the scope of ascertaining the time of the maximum gradient in the first flank of the pulse measurement signal PM. A corrected pulse measurement signal PK is produced within the scope of the correction algorithm, said corrected pulse measurement signal substantially only comprising frequency components which are directly correlated with the original pulse pressure wave 16.
[0044] In the exemplary embodiment, this correction algorithm is realized as follows. After digitizing the recorded measurement signal, a portion which can be assigned to a heartbeat is in each case extracted from the pulse measurement signal PM as originally acquired and said portion is subjected to the actual signal correction. By way of example, the extracted portion is transformed into the frequency domain by means of a discrete Fourier transform (DFT). In order to obtain a desired frequency resolution, for example of approximately 0.5 Hz, the extracted portion of the acquired and digitized measurement signal PM is complemented with zeros at the end where necessary. The frequency signal resulting after the time-frequency transformation (=initial frequency signal) comprises a spectral amplitude component and a spectral phase component. Initially, a frequency spectrum of the amplitude component is ascertained for further evaluation purposes. An example of an amplitude spectrum AS resulting in the process is reproduced in the normalized signal curve which is plotted against the frequency f in accordance with
[0045] As already mentioned, the correction algorithm constitutes adaptive filtering which, in particular, has a filter characteristic which is adaptable to the current conditions. The filter characteristic is adapted on the basis of the detected maxima 19 to 24 of the amplitude spectrum AS, in particular on the basis of the second maximum 20 and third maximum 21. To this end, the amplitude value of the second maximum 20 is divided by the amplitude value of the third maximum 21. Thereafter, a check is carried out as to whether the quotient thus ascertained lies above a threshold of approximately 2.8. If this is the case, all frequency components up to and including the frequency value of the third maximum 21 are taken into account. Otherwise, i.e. if the quotient is less than or equal to the specified threshold, only frequency components up to and including the frequency value of the second maximum 20 are taken into account. The threshold may also be referred to as quotient threshold. Thus, the correction algorithm may be understood to be an adaptive low-pass filter with a variable low-pass cutoff frequency. The value of the low-pass cutoff frequency currently used for the low-pass filtering is determined by the currently prevalent conditions in this case. Even though the amplitude spectrum AS is resorted to when setting the current filter characteristic, the low-pass filtering per se acts both on the amplitude component and on the phase component of the portion of the pulse measurement signal PM transformed into the frequency domain.
[0046] Amplitude and phase components having a frequency value of at most that of the second maximum 20 of the amplitude spectrum AS are thus always taken into account. The reason lies in the discovery that, in addition to the fundamental wave, the underlying frequency components arising from damping and reflections in the vessel are also of decisive importance for the form of the original pulse pressure wave 16.
[0047] However, the current vessel state is also subject to brief activations of the autonomous nervous system. These are expressed in a vasoconstriction, leading to stiffening of the vessel walls. In order to suitably take into account these influences which at least have also been caused by the activity of the autonomous nervous system, it is expedient also to take into account higher frequency components as well, namely, in particular, up to the third maximum 21 of the amplitude spectrum AS. It was recognized that the ratio of the amplitudes of the second maximum 20 to that of the third maximum 21, as specified above, forms a good estimate for the activity of the autonomous nervous system and for other physiological conditions. Thus, in this respect, it is possible to assume, to a good approximation, that a relevant activity of the autonomous nervous system is present if the ratio lies above the aforementioned threshold. In this case, as explained above, the correction algorithm considers more frequency components within the scope of adaptive filtering.
[0048] After the low-pass cutoff frequency of the adaptive filtering has been set in accordance with the aforementioned provisions, the filtering is carried out. Here, all amplitude and phase components lying at a higher frequency than the ascertained low-pass cutoff frequency are deleted or set to zero. The residual spectrum frequency-filtered in the process(=corrected frequency signal), said residual spectrum comprising both amplitude and phase components, is thereafter transformed back into the time domain, for example by means of an inverse Fourier transform, in order thus to obtain a portion of the corrected pulse measurement signal PK. By putting together the individual corrected portions, which are thus ascertained and in each case assigned to a heartbeat, a continuous curve of the corrected pulse measurement signal PK is obtained. Since ascertaining the corrected pulse measurement signal PK is connected to a certain amount of computational outlay, use may be made of the optional second calculation unit 7a where necessary. In particular, this may be a powerful computer. However, in principle, it is also possible for all calculations for ascertaining the corrected pulse measurement signal PK to be carried out in only a single calculation unit, namely in the first calculation unit 7.
[0049] In addition to the originally acquired pulse measurement signal PM, the diagram in accordance with
[0050] The individual portions of the pulse measurement signal PM as originally captured, which can respectively be assigned to a heartbeat, are subjected to the correction algorithm in the same manner. The corrected portions are then composed to form an overall curve of the corrected pulse measurement signal PK.
[0051] The difference signal D which, in addition to the already mentioned formation of the difference between the pulse measurement signal PM as originally acquired and the corrected pulse measurement signal PK in the time domain, may also alternatively be generated by a back transformation from the frequency domain into the time domain of the frequency components which were actually deleted or not taken into account in the aforementioned adaptive filtering is obtained as a byproduct. The difference signal D describes the returning pulse pressure wave 17. Further analyses may be carried out on the basis of the difference signal D. Thus, it is possible to obtain additional information about the state of the vessel system, for example on the basis of form and relative position of the reflected pulse pressure wave 17. Moreover, the corrected pulse measurement signal PK describes the state of the vessel system more directly than the originally captured pulse measurement signal PM, which constitutes a superposition with the component that can be traced back to the reflected pulse pressure wave 17. Consequently, the corrected pulse measurement signal PK may, additionally or alternatively, also be used for further analyses in addition to the difference signal D.
[0052] Additional information, for example in respect of the pulse wave speed and in respect of other vessel properties, such as e.g. the compliance of the vessels, may be obtained during the further analyses of the reflected pulse pressure wave 17, in particular on the basis of the difference signal D. Moreover, it is possible to estimate dynamic parameters of the cardiac system and vessel system, which dynamic parameters may then, in turn, be used for further improving the pulse wave analysis. In particular, it is then also possible to compensate the pre-ejection period (PEP), at least to a certain extent.
[0053] On account of the compensation of the reflected pulse pressure wave 17, the corrected pulse measurement signal PK reproduces the pulse pressure wave 16 originally produced by the heart much more realistically than the pulse measurement signal PM acquired far away from the heart at an extremity—at a finger in the shown exemplary embodiment. Consequently, statements in respect of the form of the pulse pressure wave 16 in the vicinity of the heart may be made on the basis of the corrected pulse measurement signal PK. This is because, at least at the beginning, there is no superposition with reflected components in the vicinity of the heart.
[0054] Moreover, the corrected pulse measurement signal PK allows an improved estimation of the central blood pressure P, i.e. of the blood pressure prevalent in the vicinity of the heart. Directly acquiring the blood pressure P in the vicinity of the heart is not possible, or at least not possible without significant outlay.
[0055] Thus, the blood pressure measuring device 1 and, in particular, the correction algorithm implemented in the evaluation unit 6 are very advantageous. The implemented adaptive filter dynamically adapts the filter characteristic thereof to the physiological conditions of the patient 2 and, in particular, to the autonomous activation thereof. The adaptive filtering thus undertaken achieves at least a significant attenuation of the adverse influences of the reflecting pulse pressure wave 17, as a result of which the blood pressure P may be ascertained more accurately. The correction algorithm may be used both during a calibration and during the actual measurement operation of the blood pressure measuring device 1.
[0056] As explained above, the compensation method however also offers numerous other options for acquiring different physiological parameters, such as e.g. the speed of the pulse pressure wave, static and/or dynamic properties of the cardiac system and vessel system, including the compliance of the vessels and the pre-ejection period. Hence, the described correction algorithm may be advantageously used not only in conjunction with a blood pressure measurement, but also when acquiring further physiological parameters. In this respect, the blood pressure measuring device 1 described above should only be understood to be exemplary. The correction algorithm may be transferred analogously to other acquisition methods and acquisition devices. The advantages described above also take