AED中识别算法的研究和对实施低能量除颤的探讨
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摘要
心室纤颤是最恶性的心律失常。除颤时间对除颤成功率有着至关重要的影响。而大部分室颤病人的发病地点是在医院外,往往无法及时获得救治。自动体外除颤器(AED)的出现使早期除颤成为可能。
为了让没有丰富急救经验的公众方便使用AED实施早期除颤,高准确率的可电击复律心律识别算法是关键。美国心脏协会(AHA)建议将心律分成三大类:Shockable Rhythm(ShR),Non-Shockable Rhythm(NShR)和Intermediate Rhythm。AED中可电击复律心律识别算法必须对ShR有高的灵敏度,对NShR有高的特异性。本文着眼于分类性能优越、计算量小的新特征的设计,提出了归一化等电位线时长的多种度量,栅条投影变异度的两种度量和斜率变异度的两种度量。为了合理地评价和比较不同算法的分类性能,本文使用在AED算法研究领域内被广泛认可的MIT Database、CU Database和VF Database作为测试样本集,选择ROC曲线下面积(AUC)作为主要性能评价指标。对已有报道的HILB算法、最大Lyapunov指数算法,和由本文提出的栅条投影变异度类算法(Shadow类算法)、斜率变异度类算法(Slope Variability类算法)、多种归一化等电位线时长的度量进行了测试。结果显示,Shadow类算法和Slope Variability类算法表现出更优的分类性能和更少的计算时间,而且达到AHA所建议的AED决策的性能要求。同时,本文设定测试条件时尽量与领域内已有工作保持一致,从而使研究成果能被其他学者更好地使用。
电击除颤方法在临床使用中还存在一些缺点,降低除颤能量是克服这些缺点的有效途径。如果在保证除颤成功率的前提下能降低除颤能量,就可以减小电击除颤对人体的伤害、减轻病人的痛苦,对于植入式心律转复除颤器(ICD)还能延长电池的使用寿命。所以,研究低能量的除颤方法具有重要的实际意义。本文基于人体电导体对于中低频电流可视为纯阻性导体的特点,推想在体外除颤、半体内半体外除颤的情况下,除颤阈值与总脉宽之间的关系应该同心肌组织刺激阈值与刺激脉冲持续时间之间的关系一致。由心肌组织的能量阈值与脉冲宽度的关系又可推导出,在时值处会得到最小能量阈值这一结论。据此推想,体外除颤或半体内半体外除颤同样存在对应着最小能量阈值的总脉冲宽度。为了验证以上猜想,本文以双相指数截尾波为基础,进行了7例动物实验。通过对实验数据的分析,得出以下结论:半体内半体外除颤情况下,脉宽-阈值关系仍然比较符合心肌组织的脉宽-刺激阈值关系,而且3ms+1ms+3ms的波形设置与5ms+1ms+5ms的波形设置相比,电量阈值和能量阈值更低,而电压阈值相近。
最后,本文提出了自动体外除颤器设备的设计方案与研制成果,可用于算法验证和低能量除颤方法研究的动物实验,也是对开发自主知识产权的AED的尝试。
Ventricular Fibrillation(VF) is the most malignant arrhythmia.Most cases of ventricular fibrillation occur out of the hospital.These patients often die because they fail to obtain treatments in time.The emergence of Automatic External Defibrillator(AED) makes it possible to treat these patients in time.
To make the AEDs easy to use by the public who is not familiar with emergency treatment and ECG analysis,it is critical to have an accurate shockable rhythm recognition algorithm.The American Heart Association (AHA) divides the cardiac rhythms into three categories:Shockable Rhythm (ShR),Non-Shockable Rhythm(NShR) and Intermediate Rhythm.High sensitivity for ShR and high specificity for NShR are required for the shockable rhythm recognition algorithm in AEDs.Focusing on the design of novel feature algorithm with excellent performance of classification and short calculation time,this article proposes several measurements for the Normalized Isoelectric Potential,two measuments for the shadow variability and two measurements for the slope variability.To test and compare the performances among different algorithms fairly,the MIT Database,the CU Database and the VF Database,which are widely accepted in the field of AED algorithms researches,are used as the testing data sets in this article.And the area under the ROC curve(AUC) is selected as the main performance evaluation parameter.The HILB algorithm and the Largest Lyapunov Index algorithm that were reported by other researchers, two algorithms using shadow variability,two algorithms using slope variability and several measurements for the Normalized Isoelectric Potential that are proposed in this article,have all been tested.The results show that the algorithms using shadow variability and the algorithms using slope variability give a better performance and need less calculation time,and they exceed the performance required by the AHA's recommendations.Besides,in order to make the results in this article able to be used better by the other researchers,the test condition is conformed to that condition used by the other works in this research field.
The defibrillation method using electrical shock has shortcomings in the clinical uses,and decreasing the shock energy will help to overcome these shortcomings.If energy is reduced while defibrillation success rate is insured,there would be less damage to the body,and patients would suffer less.Besides,the service life of the batteries in ICD can be prolonged.Therefore,the research of low energy defibrillate method is of great meaning.Based on the fact that the body can be considered as an impedance conductor to a medium or low frequency current,this article supposes that the relation between defibrillation threshold and total pulse width in the condition of semi-external defibrillation is similar to the relation between the stimulation threshold and stimulation duration in the condition of tissue stimulation.And the result that the minimum energy threshold occurs at the chronaxie can be concluded from the relation between the stimulation threshold and stimulation duration. So this article supposes ulteriorly that there is a proper total pulse width at which the minimum energy threshold for external/ semi-external defibrillation.To prove these supposes,7 animal trials were carried out based on BTE waveform.With the analysis of the data got in the trials, the article concludes that the relation of the pulse duration versus the threshold for the semi-external defibrillation is similar to the relation of the pulse duration versus the threshold for the cardiac muscle tissue, and compared to the 5ms+1ms+5ms waveform,the 3ms+1ms+3ms waveform needs lower threshold of both electric quantity and energy and needs similar threshold of voltage meanwhile.
Finally,this article proposes design scheme and development results of AED device that can be used in the animal trials to validate algorithms and to research low energy defibrillation method.That's also the attempts to develop AED with independent intellectual property.
为了让没有丰富急救经验的公众方便使用AED实施早期除颤,高准确率的可电击复律心律识别算法是关键。美国心脏协会(AHA)建议将心律分成三大类:Shockable Rhythm(ShR),Non-Shockable Rhythm(NShR)和Intermediate Rhythm。AED中可电击复律心律识别算法必须对ShR有高的灵敏度,对NShR有高的特异性。本文着眼于分类性能优越、计算量小的新特征的设计,提出了归一化等电位线时长的多种度量,栅条投影变异度的两种度量和斜率变异度的两种度量。为了合理地评价和比较不同算法的分类性能,本文使用在AED算法研究领域内被广泛认可的MIT Database、CU Database和VF Database作为测试样本集,选择ROC曲线下面积(AUC)作为主要性能评价指标。对已有报道的HILB算法、最大Lyapunov指数算法,和由本文提出的栅条投影变异度类算法(Shadow类算法)、斜率变异度类算法(Slope Variability类算法)、多种归一化等电位线时长的度量进行了测试。结果显示,Shadow类算法和Slope Variability类算法表现出更优的分类性能和更少的计算时间,而且达到AHA所建议的AED决策的性能要求。同时,本文设定测试条件时尽量与领域内已有工作保持一致,从而使研究成果能被其他学者更好地使用。
电击除颤方法在临床使用中还存在一些缺点,降低除颤能量是克服这些缺点的有效途径。如果在保证除颤成功率的前提下能降低除颤能量,就可以减小电击除颤对人体的伤害、减轻病人的痛苦,对于植入式心律转复除颤器(ICD)还能延长电池的使用寿命。所以,研究低能量的除颤方法具有重要的实际意义。本文基于人体电导体对于中低频电流可视为纯阻性导体的特点,推想在体外除颤、半体内半体外除颤的情况下,除颤阈值与总脉宽之间的关系应该同心肌组织刺激阈值与刺激脉冲持续时间之间的关系一致。由心肌组织的能量阈值与脉冲宽度的关系又可推导出,在时值处会得到最小能量阈值这一结论。据此推想,体外除颤或半体内半体外除颤同样存在对应着最小能量阈值的总脉冲宽度。为了验证以上猜想,本文以双相指数截尾波为基础,进行了7例动物实验。通过对实验数据的分析,得出以下结论:半体内半体外除颤情况下,脉宽-阈值关系仍然比较符合心肌组织的脉宽-刺激阈值关系,而且3ms+1ms+3ms的波形设置与5ms+1ms+5ms的波形设置相比,电量阈值和能量阈值更低,而电压阈值相近。
最后,本文提出了自动体外除颤器设备的设计方案与研制成果,可用于算法验证和低能量除颤方法研究的动物实验,也是对开发自主知识产权的AED的尝试。
Ventricular Fibrillation(VF) is the most malignant arrhythmia.Most cases of ventricular fibrillation occur out of the hospital.These patients often die because they fail to obtain treatments in time.The emergence of Automatic External Defibrillator(AED) makes it possible to treat these patients in time.
To make the AEDs easy to use by the public who is not familiar with emergency treatment and ECG analysis,it is critical to have an accurate shockable rhythm recognition algorithm.The American Heart Association (AHA) divides the cardiac rhythms into three categories:Shockable Rhythm (ShR),Non-Shockable Rhythm(NShR) and Intermediate Rhythm.High sensitivity for ShR and high specificity for NShR are required for the shockable rhythm recognition algorithm in AEDs.Focusing on the design of novel feature algorithm with excellent performance of classification and short calculation time,this article proposes several measurements for the Normalized Isoelectric Potential,two measuments for the shadow variability and two measurements for the slope variability.To test and compare the performances among different algorithms fairly,the MIT Database,the CU Database and the VF Database,which are widely accepted in the field of AED algorithms researches,are used as the testing data sets in this article.And the area under the ROC curve(AUC) is selected as the main performance evaluation parameter.The HILB algorithm and the Largest Lyapunov Index algorithm that were reported by other researchers, two algorithms using shadow variability,two algorithms using slope variability and several measurements for the Normalized Isoelectric Potential that are proposed in this article,have all been tested.The results show that the algorithms using shadow variability and the algorithms using slope variability give a better performance and need less calculation time,and they exceed the performance required by the AHA's recommendations.Besides,in order to make the results in this article able to be used better by the other researchers,the test condition is conformed to that condition used by the other works in this research field.
The defibrillation method using electrical shock has shortcomings in the clinical uses,and decreasing the shock energy will help to overcome these shortcomings.If energy is reduced while defibrillation success rate is insured,there would be less damage to the body,and patients would suffer less.Besides,the service life of the batteries in ICD can be prolonged.Therefore,the research of low energy defibrillate method is of great meaning.Based on the fact that the body can be considered as an impedance conductor to a medium or low frequency current,this article supposes that the relation between defibrillation threshold and total pulse width in the condition of semi-external defibrillation is similar to the relation between the stimulation threshold and stimulation duration in the condition of tissue stimulation.And the result that the minimum energy threshold occurs at the chronaxie can be concluded from the relation between the stimulation threshold and stimulation duration. So this article supposes ulteriorly that there is a proper total pulse width at which the minimum energy threshold for external/ semi-external defibrillation.To prove these supposes,7 animal trials were carried out based on BTE waveform.With the analysis of the data got in the trials, the article concludes that the relation of the pulse duration versus the threshold for the semi-external defibrillation is similar to the relation of the pulse duration versus the threshold for the cardiac muscle tissue, and compared to the 5ms+1ms+5ms waveform,the 3ms+1ms+3ms waveform needs lower threshold of both electric quantity and energy and needs similar threshold of voltage meanwhile.
Finally,this article proposes design scheme and development results of AED device that can be used in the animal trials to validate algorithms and to research low energy defibrillation method.That's also the attempts to develop AED with independent intellectual property.
引文
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