基于上臂袖带振荡波估测动脉僵硬度的理论方法及临床实验  

Theoretical Method and Clinical Experiments for Estimating Arterial Stiffness Based on Upper-Arm Cuff Oscillometric Wave

作　　者：张絮洁 章亚平 殷兆芳[3] 覃开蓉 梁夫友[1] ZHANG Xujie;ZHANG Yaping;YIN Zhaofang;QIN Kairong;LIANG Fuyou(School of Naval Architecture,Ocean&Civil Engineering,Shanghai Jiao Tong University,Shanghai 200240,China;Department of Cardiology,Shanghai Sixth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Cardiology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;;School of Optoelectronic Engineering and Instrumentation Science,Dalian University of Technology,Dalian Liaoning 116024,China)

机构地区：[1]上海交通大学船舶海洋与建筑工程学院,上海200240 [2]上海交通大学医学院附属上海第六人民医院心内科,上海200233 [3]上海交通大学医学院附属上海第九人民医院心内科,上海200011 [4]大连理工大学光电工程与仪器科学学院,辽宁大连116024

出　　处：《中国医疗设备》2018年第4期22-28,共7页China Medical Devices

基　　金：国家自然科学基金(31370948)

摘　　要：目的检验一款动脉脉波检测仪(PASESA AVE-1500)利用上臂袖带振荡波估测中心动脉僵硬度的有效性并分析其影响因素。方法构建循环系统—上臂袖带的耦合模型,模拟动脉脉波检测仪的测量过程,研究利用袖带振荡波特征估测中心动脉僵硬度的方法,并通过数值实验评估心血管参数对估测精度的影响;进一步使用该动脉脉波检测仪开展临床实验(238例),验证测量指标的有效性。结果基于计算模型的理论研究发现,袖带振荡波微分波形中的第二谷值与第一峰值之比(|V2|/|P1|)与中心动脉僵硬度正相关,同时,|V2|/|P1|随着心脏收缩功能的减弱而增大,而受外周血管总阻抗和肱动脉僵硬度的影响相对较小。临床研究发现,动脉波速指数(AVI)的测量值在心血管疾病患者组与健康受试者组间有显著差异性(P<0.0001),与肱—踝脉搏波传导速度(ba PWV)的组间差异趋势一致(P<0.0001),且AVI与ba PWV(r=0.656,P<0.0001,n=238)和年龄(r=0.525,P<0.0001,n=170)均呈显著的正相关关系。结论通过分析上臂袖带振荡波的波形特征,能够得到反映中心动脉壁力学特性的指标,从而实现对中心动脉僵硬度的无创、快速检测。Objective To examine the validity of an upper-arm cuff-based pulse wave device(PASESA AVE-1500)on assessing central arterial stiffness based on oscillometric waves,and analyze the related influential factors.Methods A computational model of the cardiovascular system coupled with an upper-arm oscillometric cuff was constructed and applied to simulate the measurement process of the pulse wave device.With the model,a theoretical study for assessing central arterial stiffness based on the characteristics of cuff oscillometric wave was performed,followed by a series of numerical experiments aimed to quantify the sensitivity of the assessment to various cardiovascular parameters.Furthermore,the validity of the pulse wave device was examined by clinical experiments.Results The computational model-based theoretical study revealed that the ratio of the second valley to the first peak(|V2|/|P1|)on the time-differentiated cuff wave correlated positively with the stiffness of central arteries.Subsequent numerical experiments showed that|V2|/|P1|increased with the impairment of cardiac systolic function,but was relatively less influenced by the total peripheral vascular resistance and the stiffness of the brachial artery.The clinical study demonstrated that the measured pulse velocity index(AVI)differed significantly between the patient group with cardiovascular diseases(n=68)and the healthy subject group(n=170)(P<0.0001),which was consistent with the inter-group difference observed for brachial-ankle pulse wave velocity(baPWV)(P<0.0001).In addition,AVI was found to correlate significantly with both baPWV(r=0.656,P<0.0001)and age(r=0.525,P<0.0001).Conclusion The mechanical property of central arteries can be obtained by analyzing the oscillometric wave of an upper-arm cuff,which makes it possible to noninvasively and rapidly assess central arterial stiffness.

关 键 词：上臂袖带振荡波 动脉僵硬度 循环系统—袖带耦合模型 动脉脉波检测仪 

分 类 号：Q66[生物学—生物物理学]