基于示波法和光电容积脉搏波描记法的动脉顺应性动态检测仪

A new device for arterial compliance dynamic detection based on oscillometry and photoelectric plethysmography

目的针对目前静态检测方法血压依赖性造成的敏感性不足和需要血压校正的问题,找到一种对动脉亚临床病变引起的弹性减退更敏感且无需血压校正的指标,并设计一种适用于家庭和社区诊所的新型动脉顺应性动态检测仪器。方法对动脉加压导致了透壁压减小和顺应性非线性增加,同时也导致了脉搏波传递时间(pulse transit time,PTT)非线性增大。基于示波法血压测量和光电容积脉搏波描记法(photoelectric plethysmography,PPG)设计了检测仪器,实现了对肱动脉加压动态检测,并在不同透壁压下对高血压组和对照组脉搏波传递时间增量进行测量。结果由高到低预设3个透壁压,即8.00、6.67、5.33kPa(60、50、40mmHg),加压所导致的高血压组PTT增量总体均值和标准差分别为(3.7±2.1)、(8.5±3.2)、(13.1±3.5)ms,而对照组相应的总体均值和标准差分别为(5.4±2.2)、(12.5±2.8)、(19.3±3.1)ms。在相同透壁压下,两组之间差异有统计学意义(P<0.01)。实验结果表明,随着透壁压的减小,虽然两组脉搏波传递时间均增加,但两组的差异也越来越大。选择透壁压为5.33kPa(40mmHg)时脉搏波传递时间增量ΔPTT40为更敏感的动脉弹性指标,它与收缩压负相关(r=-0.73,P<0.01),与舒张压负相关(r=-0.54,P<0.01),与脉压负相关(r=-0.49,P<0.01)。结论虽然ΔPTT40具有明显的血压相关性,但它是动态检测的结果,通过对动脉施加外在作用力,拉大了高血压中、低危险患者与健康人之间的组间统计学差异,能够更敏感地分辨动脉亚临床病变引起的动脉弹性减退,比较好地解决了静态检测方法血压依赖性造成的敏感性不足和需要血压校正的问题。所设计的仪器操作简便,有望在早期的动脉亚临床病变的诊断及监测方面发挥作用,并应用于社区和家庭心血管疾病的预防检查。

Objective Aiming at limitation of inadequate of sensitivity and blood pressure emendation of static arterial elasticity indexes caused by blood pressure dependent property,to find a more sensitive index for arterial elasticity decrease caused by arterial subclinical disease,and design a new arterial compliance dynamic detection device applicable in family and community. Methods Pressing brachial artery resulted in transmural pressure decreasing and nonlinear increment of arterial compliance. Meanwhile,pulse transit time （PTT） also increased nonlinearly. Based upon oscillometric arterial pressure measurement and photoelectric plethysmography,a new arterial compliance detection device was developed. This device could realize pressing brachial artery and dynamic detection of the increment of PTT under different transmural pressure for hypertension group and control group. Results Three transmural pressures eg. 8.00,6.67 and 5.33 kPa （60,50 and 40 mmHg） were preset and the mean and standard deviation values of PTT increment in hypertension group were（3.7 ± 2.1 ） ms, （8.5 ± 3.2） ms and （ 13.1 ± 3.5） ms respectively. While in control group were（5.4 ± 2,2） ms, （12.5 ± 2.8） ms and（19.3 ± 3.1 ） ms respectively. There was significant difference between 2 groups under the same transmural pressure. As the transmural pressure decreasing,PTT in hypertension group and control group were both increasing. The PTT increment under 5.33 kPa （40 mmHg） transmural pressure was defined as APTF40 and selected as a much more sensitive arterial compliance index. The △PTT40 was negatively correlated with systolic pressure （r = -0.73,P〈 0.01） ,diastolic pressure （r = -0.54,P〈 0.01） and pulse pressure （r = -0.49,P〈 0.01）.Conclusion Although △PTY40 is markedly correlated with blood pressure, but it is a result of dynamic detection ,which enlarges the statistical difference between hypertension group and control group. This index can more sensitively distinguish the decrease of arterial compliance in subclinical arterial disease,and effectively resolve the problems eg. limitations of inadequate of sensitivity and blood pressure emendation of static arterial elasticity indexes caused by blood pressure dependent property. The new developed device is easy to operate and can be detecting and monitoring the early stage arterial subclinical dysfunction. Thus it is applicable in family and community for preventing cardiovascular disease.