同步量測心電圖和脈波儀器之設計製作 和心率變異度與血壓變異度之分析

Design and Development of a Simultaneous Measuring Electrocardiogram and Blood Pressure System for Analysis of Heart Rate Variability and Blood Pressure Variability

姚景升(Jing-Shang Yao)

指導教授 ： 張炎林

中原大學/工學院/醫學工程研究所/碩士(2002年)

https://doi.org/10.6840/cycu200200433

摘要

心率變異與血壓變異會因為生理的循環迴饋系統受血管壓力接收器及化學接收器等因素調變，使兩者的變化未必是呈現一致性的增加或減少。因疾病或手術或藥物的使用，會使心率變異度與血壓變異度有不一致，甚至是不規則性的變化。
本研究的目的主要是設計製作一套結合心電圖與血壓訊號的量測系統，將心電圖與血壓變化做同步的信號輸出，以做為心率變異度與血壓變異度的研究工具。
本研究自行設計製作的量測儀器，心電圖量測方面為第二導程的訊號，包含四個主要電路:儀表放大器，濾波器，點拒濾波器與後級放大器。血壓訊號量測方面由左手手腕上的氣囊量測，接至脈波電路內的壓力感測器，經由儀表放大器、交流訊號放大器再經由後級放大器輸出。結果顯示本量測儀器同時量測所得之心電圖與血壓訊號均可進行變異度分析。
同步量測所得的訊號經由NI-DAQ類比信號擷取卡送入電腦，以LabView的程式接收資料作即時顯示、資料儲存與波形瀏覽。將心電圖與脈壓訊號的資料，以Excel分析，可求出相對應之R、P波，以及計算出R-RI間期、P-PI間期與R-P(R wave to left wrist pulse)間期時間。以EZ-HRV應用程式做時域分析與頻域分析的比較；時域分析包括平均值(mean)、標準差(SD)和相鄰間期差異的均方根(rmsSD)；頻域分析使用快速傅立葉轉換做變異度的功率頻譜分析，包含標準化低頻功率(nLFP：0.04 to 0.15 Hz)，標準化高頻功率(nHFP：0.15 to 0.40 Hz)，頻譜總功率 (TF：0.00 to 0.4HZ)和低頻除以高頻的功率比值(LHR)來顯示自主神經系統之交感神經與副交感神經的活化現象。
實驗對象是十位正常人及三位腦中風病人，腦中風病人都是因高血壓而導致左腦腦血管出血，右側肢體偏癱。正常人與腦中風病人坐姿與躺姿下同步量測心電圖與脈波，然後進行心率變異度及血壓變異度的時域及頻域分析。另外，腦中風病人在進行針灸治療前與治療後，亦進行心率變異度及血壓變異度的時域及頻域分析，探討針灸對腦中風病人自主神經活化的影響。
量測結果顯示正常人的心率變異度與血壓變異度差異性無論在坐姿或躺姿下，皆小於腦中風病人。正常人躺姿下的心率變異度與血壓變異度差異性小於坐姿，腦中風病人則不一定。
腦中風病人的心率變異度和血壓變異度在針灸治療期間，會有一致性的變化。三位病人接受治療後，LHR有固定的變化，顯示交感與副交感神經調控上的變化。
用本量測系統同時量測心率變異與血壓變異，可得到正常人與患有心血管疾病病人間的差異。分析比較其差異性以及量測心血管疾病病人進行治療前與治療後，血壓變異度與心率變異度的變化，或許可做為臨床上評估心血管疾病病人病情嚴重程度及癒後的指標，達到輔助醫療的目的。並且由此系統的建立與資料的分析，提供做為心率變異與血壓變異量測的研究工具。

關鍵字

血壓變異度 ； 自主神經系統 ； 交感神經 ； 副交感神經 ； 心率變異度

並列摘要

The heart rate variability (HRV) and the blood pressure variability (BPV) are affected by the feedback system of the physiologic circulation, as baroreceptor, chemical receptor, etc. It will not only cause an increase or reduction of these both in the meantime. It maybe cause a discordant change for disease, or surgery, or medicine use.
The aim of this study is design a measuring system that combine electrocardiograph (EKG) and blood pressure measurement, and measure EKG and blood pressure signal simultaneously, for use as a tool to study HRV and BPV.
This research design and develop the measuring instrument that the EKG signal is measured from LeadⅡ.This part includes four main electric circuits: an instrument amplifier, filters, a point sinking filter, and an amplifier to output. The blood pressure signal is measured form the wrist-cuff around the left wrist, connect to pressure sensor. Then this signal gets through a instrument amplifier, an AC amplifier, and a amplifier to output. The results show EKG and blood pressure signals measured simultaneously by this measuring instrument can be analysed.
These signals connect to an A/D convert card (NI DAQ-1200). With the program “Labview” receives and show signals in real-time, storages data and browses wave form. EKG and blood pressure signals , with the program Excel to calculate, obtain the R wave related to P wave, R-R interval, P-P interval and R-P (R wave to left wrist pulse)interval. With EZ- HRV the applied program used to compare temporal and frequency analysis; Temporal analysis includes mean, SD, rmsSD; The frequency analysis use power spectral analysis by use of the FFT method, including normalized low frequency power(nLFP: 0.04 to 0.15 Hz), normalized high frequency power(nHFP:0.15 to 0.4 Hz), total power of the power spectral(TF:0 to 0.4 HZ) and ratio of low frequency power and high frequency power(LHR) to indicate the information in sympathetic and parasympathetic activity of automatic nerve system.
The subjects are ten normal persons and three stroke patients those the left brain blood vessel bled all because of hypertension, the right side of the body is partial paralyze. Compare temporal and frequency analysis of HRV and BPV between normal persons and stroke patients with sitting and laying posture. To research temporal and frequency analysis of the HRV and BPV when stroke patients accept acupuncture. Also discuss the influence of acupuncture to stroke patients’ autonomic nerve activity.
The measured results show the differences between HRV and BPV no matter at sitting or laying posture, the normal persons’ are smaller than stroke patients’. The differences between HRV and BPV of normal persons with laying posture is smaller than sitting posture, but stroke patients’ is uncertainly.
HRV and BPV of the stroke patients during the acupuncture show consistent variety. After curing, LHR of these three patients all present varieties, show the change of the balance between sympathetic and parasympathetic.
Use this measurement system to measure heart rate and blood pressure simultaneously, obtain the differences between normal persons and patients have cardiovascular disease. Analysis and compare the differences between HRV and BPV of the patients have cardiovascular disease during the treatment, can probably be used as an index to evaluate the efforts of curing. For the system establishes and the analysis of the data, provide a tool to study HRV and BPV.

並列關鍵字

sympathetic ； blood pressure variability ； parasympathetic ； heart rate variability ； automatic nerve system

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