CN106730350B - It is a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping - Google Patents

It is a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping Download PDF

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CN106730350B
CN106730350B CN201611034440.4A CN201611034440A CN106730350B CN 106730350 B CN106730350 B CN 106730350B CN 201611034440 A CN201611034440 A CN 201611034440A CN 106730350 B CN106730350 B CN 106730350B
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impedance
blood phase
damping
waveform
value
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CN106730350A (en
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陈翔
杨华奎
李津
金华
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Xian Jiaotong University
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
    • A61N1/36521—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure the parameter being derived from measurement of an electrical impedance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/37—Monitoring; Protecting
    • A61N1/3702—Physiological parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/37—Monitoring; Protecting
    • A61N1/3706—Pacemaker parameters

Abstract

The present invention provides a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping comprising, ventricle standard pacing electrode acquires ventricular impedance waveform；The system carries out peak point to acquisition waveform and valley point detects；The system judges whether wrong waveform to per cardiac cycle measurement result: if wrong waveform, then giving up this segment data, resurveys intracardiac impedance waveform；Correct then impedance waveform values progress baseline adjustment according to the peak point and valley point detected, to measuring per cardiac cycle；Impedance waveform after the system is adjusted impedance waveform values baseline integrates, and finds out and penetrate blood phase impedance damping；The system judges whether continuous work timing reaches 24 hours, if having reach 24 hours, then blood phase impedance damping upper lower limit value and automatic reaction coefficient are once penetrated in adjustment；Current pacing frequency is determined if 24 hours discontented.

Description

It is a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping
Technical field
The invention belongs to biomedical engineering fields, are related to a kind of frequency self-adaption method of pacemaker, specially It is a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping.
Background technique
Since cardiac pacing art comes out, pacemaker has in Physiological Pacing and the adaptive aspect of pace-making frequency Significant progress proposes body in succession and moves acceleration, blood temperature, pH value of blood, QT interphase, minute ventilation, intra-ventricle A series of adaptive perceptual parameters of pace-making frequency such as impedance are such as burnt to need in face of the movement of varying strength and other metabolism Consider, stress and fever etc. whens imitate the function of normal heart sinoatrial node as naturally as possible, thus being provided for body and When, while suitable blood supply reduce pacemaker pulse granting, reduce pacemaker operating power consumption, extend the heart The working life of dirty pacemaker.
Compared with perception body moves the open cycle system of the parameters such as acceleration, the frequency of perception intra-ventricle impedance parameter is adaptively Unified aspect accordingly makes accordingly cardiac pacing frequency by the myocardial contraction force information of often fighting of impedance transducer detection user Adjustment adjust mean arterial blood pressure, and then influence the myocardial contractive power of often fighting of heart, most end form to change cardiac output At a closed loop frequency self-adaption regulation system, not only have a good frequency governing response to exercise load, and to mood and Psychological pressure also has good frequency governing response；On the other hand, the frequency Adaptable System for perceiving intra-ventricle impedance parameter can Directly use standard pace-making sensing electrode as impedance transducer, sensor and electrode system without using additional designs System, not only reduces the complexity and cost of system, and improve the reliability of system；In the common of above-mentioned two aspects factor Under the influence of, the frequency Adaptable System of perception intra-ventricle impedance parameter has clinically obtained preferable application at present.These are Core algorithm used in uniting mainly has half period activity algorithms, pre-ejection algorithm, room property muscular strength parameter algorithm etc..
United States Patent (USP) 7,062,326 discloses the frequency adaptive algorithm based on half period movement parameter, wherein the half period Movement parameter is defined as first half cardiac cycle impedance waveform and axis of abscissas is formed by area and entire cardiac cycle Impedance Wave Shape and axis of abscissas are formed by the ratio of area, i.e., first half cardiac cycle impedance waveform area is divided by entire cardiac cycle impedance Waveform area.As the ratio of area, half period movement parameter can reduce noise and artefact well, especially local artefact Influence.Meanwhile it calculating when often fighting half period movement parameter with the minimum value of current cardiac cycle impedance waveform as baseline value Waveform has been carried out to go baseline correction, therefore has also had preferable anti-interference to baseline drift.But in practical application, due to Heart is mainly reflected in the response of load and penetrates the blood phase, and first half cardiac cycle used in the method can not accurately correspond to and penetrate blood Phase, therefore measurement parameter is difficult to embody the variation for myocardial contractive power of often fighting well.
Document (Schaldach M.Systolic time intervals as a control of rate adaptive pacing.Century.Proceedings of the International Conference of the IEEE Engineering in.1989:1407-1410vol.5.) it discloses the frequency based on pre-ejection parameter and adaptively calculates Method, wherein pre-ejection refers in per cardiac cycle since sequences of ventricular depolarization to the time interval ventricular ejection, that is to say R Wave starts to the Time Intervals between impedance waveform first derivative maximum of points.Under normal physiological condition, pre-ejection with handed over The heart rate of sense nerve control has very strong correlation: when changes in heart rate is caused by sympathetic modulation, pre-ejection is several It is unaffected；And increasing sympathetic nerve activity or increase preload can all cause pre-ejection to shorten.When heart rate is constant, physiology Or psychological pressure can shorten pre-ejection, show to the increased demand of cardiac output, therefore pre-ejection can be used and risen The automatic adjusument for frequency of fighting.But it is lower in impedance waveform sampling rate in practical applications, by pacemaker power consumption limit When, the determination of pre-ejection terminal can have biggish error, directly affect the accuracy of algorithm.
Document (Schaldach M, Hutten H.Intracardiac Impedance to Determine Sympathetic Activity in Rate Responsive Pacing.Pacing&Clinical Electrophysiology, 1992,15 (11Pt 2): 1778-86.) to disclose the frequency based on room property muscular strength parameter adaptive Algorithm defines the slope for the ventricular impedance wavy curve that pacemaker impulse is provided in the area-of-interest of a 24ms after 100ms Value is room property muscular strength parameter, and adjusts pacing frequency according to room property muscular strength parameter.But in practical applications, due to region of interest Domain window is very short, therefore more demanding to the sample rate of impedance waveform, is inevitably limited by pacemaker power consumption.
In conclusion being limited by pacemaker power consumption, the frequency adaptive algorithm of perception intra-ventricle impedance parameter is adopted Sample rate should be as low as possible, and higher accuracy is still able to maintain in low sampling rate, this becomes in practical applications is difficult to reconcile Contradiction.
Summary of the invention
Aiming at the problems existing in the prior art, the present invention provides a kind of based on the pacemaker for penetrating blood phase impedance damping Pacing frequency Adaptable System penetrates the blood phase by the accurate determination of extraction detection of the characteristic point to longer window phase internal impedance waveform Time Intervals, and then accurate evaluation of the realization to myocardial contractive power under lower sample rate.
The present invention is to be achieved through the following technical solutions:
It is a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping,
Ventricle standard pacing electrode acquires several groups ventricular impedance measured value in per cardiac cycle, constitutes ventricular impedance wave Shape；
The system carries out peak point to per cardiac cycle ventricular impedance waveform and valley point detects；
The system is made whether as the judgement of wrong waveform per cardiac cycle measurement result；If wrong waveform, then give up This segment data is abandoned, ventricular impedance waveform is resurveyed；If precision waveform, then the peak point and valley point that basis detects, with The valley of per cardiac cycle is baseline, is adjusted to the impedance waveform values baseline measured per cardiac cycle；
Impedance waveform after the system is adjusted impedance waveform values baseline integrates, and range of integration is respectively peak It is worth point moment and valley point moment；It obtains penetrating the resistance of blood phase divided by the blood phase Time Intervals of penetrating obtained by precision waveform with integrated value again Anti- index；
The system judges whether the timing of pacemaker continuous work reaches a duty cycle, if having reached a job Period, then according to the counting Data-Statistics of pacemaker in a upper duty cycle, blood phase impedance damping bound is once penetrated in adjustment Value and automatic reaction coefficient, the calculating parameter as pacing frequency current in current operating cycle；
If a not up to duty cycle, according to program-controlled parameter, current calculating parameter and the adjusting of blood phase impedance damping is penetrated Current pacing frequency.
Preferably, 50ms is to during 300ms after acquiring ventricular pacemaking or perception event using ventricle standard pacing electrode Impedance waveform values measure one group every fixed measurement interphase, measure several groups altogether, every group of measurement measure respectively forward impedance with Negative sense impedance is each primary, takes and measures average value twice as every group of impedance measurements.
Preferably, the described system, which carries out the specific method that peak point is detected with valley point to impedance waveform, is, current to hinder The point that anti-value is greater than the two neighboring impedance value in front and back is peak point；Present impedance value be less than the two neighboring impedance value in front and back point be Valley point.
Preferably, the criterion of the wrong waveform specifically:
If there are multiple valley points or preceding half of measurement period, there is only a valley point and paddy in preceding half of measurement period Value point to entire measurement period terminates that there are multiple peak points, then measured impedance waveform is wrong waveform；
If valley point is not present in preceding half of measurement period, using first measured value as valley point, if valley point is to whole A measurement period terminates that peak point is not present, then using the last one measured value as peak point.
Preferably, it is penetrated start time blood phase according to detection valley point moment correspondence, peak value point moment is corresponding, which to penetrate the blood phase, terminates Moment is obtained penetrating blood phase Time Intervals by the time interval between peak value point moment and valley point moment.
Preferably, the method being adjusted to the impedance waveform values baseline measured per cardiac cycle is with per cardiac cycle Valley be baseline, each impedance measurements subtract valley as measured value adjusted.
Preferably, the impedance waveform after being adjusted to impedance waveform values baseline integrates, and specific method is by formula (1) (2) provide:
Wherein, (min) p indicates valley point moment, and (max) p indicates peak value point moment, and blood is penetrated in (max) p- (min) p expression Phase Time Intervals, ZiIndicate that baseline i-th of impedance measurements adjusted, S are the integrated values for penetrating blood phase impedance waveform, EI is to penetrate Blood phase impedance damping.
Preferably, adjustment once penetrates blood phase impedance damping upper lower limit value and automatic reaction coefficient the specific method is as follows,
Step 7.1, after pacemaker is program-controlled for the first time for frequency adaptive model in 15 minutes, user is kept Level reposes state, and during this period of time pacing frequency remains 10BPM higher than program-controlled basic pace-making frequency, takes in this period All mean values for penetrating blood phase impedance damping being calculated by aforesaid operations are removed the limit as blood phase impedance damping lower limit value is penetrated 2 times of value are used as and penetrate blood phase impedance damping upper limit value；
Step 7.2, it calculates per cardiac cycle and once penetrates blood phase impedance damping, cardiac cycle counter is 1 time cumulative；Currently penetrate It is 1 time cumulative that blood phase impedance damping is greater than upper limit counter when penetrating blood phase impedance damping upper limit value；It is small currently to penetrate blood phase impedance damping Lower limit counter is 1 time cumulative when penetrating blood phase impedance damping lower limit value；After every 24 hour adjustment, upper limit counter, lower limit meter Number device and cardiac cycle counter are resetted and are started counting again；
Step 7.3, individual count device value was once counted in every 24 hours, calculates the super of bound by formula (3) (4) Limit rate:
Wherein, RupIt is super upper limit rate, RdownIt is super lower limit rate, CounterUp is upper limit counter, CounterDown is lower limit counter, and CounterCardiac is cardiac cycle counter；
Step 7.4, work as RupWhen > 0.1%, penetrates blood phase impedance damping upper limit value and increase by 5%, RupWhen < 0.01%, the blood phase is penetrated Impedance damping upper limit value reduces 0.5%；Work as RdownWhen > 0.1%, penetrates blood phase impedance damping lower limit value and reduce by 5%, Rdown< 0.01% When, it penetrates blood phase impedance damping lower limit value and increases by 0.5%.
Preferably, adjusting current pacing frequency, the specific method is as follows,
Step 8.1, by program-controlled parameter and obtain penetrate blood phase impedance damping and what is obtained penetrates on blood phase impedance damping Lower limit value calculates current ideal pace-making frequency:
Wherein, HRidealIt is current ideal pacing frequency, BR is program-controlled basic pace-making frequency, and MR is that program-controlled maximum rises Rich frequency, EI is currently to penetrate blood phase impedance damping, EIminAnd EImaxIt is the determining blood phase impedance damping lower limit value and upper penetrated respectively Limit value, ARF are automatic reaction coefficients, are rule of thumb adjusted；
Step 8.2, work as HRidealWhen greater than current pace-making frequency, current pacing frequency is used as currently practical after adding 2BPM It fights frequency；Work as HRidealWhen less than current pace-making frequency, current pacing frequency is used as currently practical pacing frequency after subtracting 1BPM.
Further, the initial value of automatic reaction coefficient ARF is 1.0, and when 24 is small, interior pacing frequency 80% is distributed in program-controlled When below heart rate equalization point, ARF=ARF ÷ 1.05；Otherwise ARF=ARF × 1.10.
Compared with prior art, the invention has the following beneficial technical effects:
Blood phase impedance damping is penetrated, the ratio for being defined as the integrated value for penetrating blood phase impedance waveform and penetrating blood phase Time Intervals, with Blood phase impedance damping construction frequency adaptive algorithm is penetrated, automatic adjusument is carried out to pacemaker pacing frequency.Due to penetrating blood It is contacted between phase impedance and myocardial contractive power with close, the present invention is adaptively calculated with penetrating blood phase impedance damping construction frequency Method carries out automatic adjusument to pacemaker pacing frequency, passes through mentioning for the characteristic point to longer window phase internal impedance waveform It takes the accurate determination of detection to penetrate blood phase Time Intervals, and then can realize accurately commenting to myocardial contractive power under lower sample rate Estimate.Lance that can to a certain extent between balance frequency adaptive algorithm sample rate and algorithm evaluation myocardial contractive power accuracy Shield.
The present invention sense adaptive as pacing frequency by the ratio penetrated blood phase impedance integral with penetrate blood phase Time Intervals Know parameter, can preferably inhibit the influence of noise and artefact to myocardial contractive power accurate evaluation；By with per cardiac cycle Valley (minimum value of namely per cardiac cycle herein) carries out baseline adjustment to impedance waveform, can preferably inhibit baseline The influence drifted about to the accurate evaluation of myocardial contractive power；Simultaneously in wider window phase (50ms after pace-making or perception event To the time interval of about 250ms between 300ms) in time blood phase penetrated with the accurate determination of extraction detection of the characteristic point of impedance waveform Interphase reduces requirement of the pace-making frequency adaptive algorithm to sample rate.
The present invention is conducive to perceive the popularization and application of the frequency adaptive algorithm of intra-ventricle impedance parameter, is conducive to use Person, which provides, more meets physiological property, pacing frequency automatic adjusument function closer to normal sinus node function, is conducive to Medical treatment cost is reduced, the reliability of Implanted cardiac pacemaker is increased.
Detailed description of the invention
Fig. 1 is the flow diagram of system described in present example.
Impedance waveform comparison diagram Fig. 2 measured when being movement and tranquillization in present example.
Fig. 3 is to penetrate blood phase impedance damping schematic diagram in present example.
Fig. 4 is the linear fit relation schematic diagram that blood phase impedance damping and sports level are penetrated in present example.
Specific embodiment
Below with reference to specific embodiment, the present invention is described in further detail, it is described be explanation of the invention and It is not to limit.
The present invention is in order to solve in existing pacemaker, the frequency adaptive algorithm sampling of perception intra-ventricle impedance parameter Contradiction between rate and algorithm evaluation myocardial contractive power accuracy is proposed for the requirement of accurate description myocardial contraction force parameter The parameter and frequency Adaptable System of one perception ventricle internal impedance.
Inventive point of the invention is: to penetrate blood phase impedance damping construction frequency adaptive algorithm, rising to pacemaker Frequency of fighting carries out automatic adjusument, penetrates blood by the accurate determination of extraction detection of the characteristic point to longer window phase internal impedance waveform Phase Time Intervals, and then accurate evaluation of the realization to myocardial contractive power under lower sample rate.Preferably balance frequency certainly Contradiction between adaptive algorithm sample rate and algorithm evaluation myocardial contractive power accuracy.
Referring to Fig. 1, of the invention based on the cardiac pacing frequency Adaptable System for penetrating blood phase impedance damping includes following streams Journey:
Per cardiac cycle is using 50ms after ventricle standard pacing electrode acquisition ventricular pacemaking or perception event to during 300ms Impedance measurements, constitute ventricular impedance waveform, it is preferable that every 16ms measurement interphase measure one group, measure 16 groups altogether, often Measurement forward impedance and negative sense impedance are each primary respectively for group measurement, take twice measurement average value as this group of impedance measurements；
Peak point and valley point detection are carried out to resulting per cardiac cycle ventricular impedance waveform；
Wrong waveform is judged whether to gained cardiac cycle measurement result: if measured impedance waveform is wrong waveform, Then give up this segment data, returns to acquisition ventricular impedance waveform；Otherwise impedance measurement waveform is precision waveform, carries out baseline tune It is whole；
According to the peak point and valley point detected, baseline tune is carried out to the impedance waveform values measured the cardiac cycle It is whole；It is as shown in Figure 2 through baseline Impedance Wave shape adjusted, it is seen that the impedance waveform of motion state and resting state is in peak valley value difference There is notable difference with penetrating on blood phase Time Intervals, the peak valley value difference of motion state is larger, and it is shorter to penetrate blood phase Time Intervals；
Baseline impedance waveform adjusted is integrated, when range of integration is respectively peak value point moment and valley point It carves；It obtains penetrating blood phase impedance damping divided by blood phase Time Intervals are penetrated with integrated value again；As shown in Figure 3；
Judge whether the timing of pacemaker continuous work reaches a duty cycle, if having reached a duty cycle, Then every 24 hour adjustment once penetrates blood phase impedance damping bound and automatic reaction coefficient, determines in current operating cycle and currently rises The calculating parameter for frequency of fighting；
If a not up to duty cycle, current pacing frequency is adjusted according to blood phase impedance damping is penetrated, determines current rise It fights frequency；Preferably, the rhythm and pace of moving things is changed according to human body diel movement in 24 hours, substantially per period exercise load and metabolic demand round the clock Quite, the duty cycle is chosen for 24 hours.
In above scheme, the specific method that peak point and valley point detection are carried out to impedance waveform is present impedance value Point greater than the two neighboring impedance value in front and back is peak point；The point that present impedance value is less than the two neighboring impedance value in front and back is valley Point；
The criterion of the mistake waveform specifically: if there are multiple valley points or preceding half of surveys in preceding half of measurement period Though measuring the period there is only a valley point but valley point to entire measurement period terminating that there are multiple peak points, then measured impedance Waveform is wrong waveform；
If valley point is not present in preceding half of measurement period, using first measured value as valley point, if valley point is to whole A measurement period terminates that peak point is not present, then using the last one measured value as peak point；
Detection valley point moment correspondence is penetrated start time blood phase, and peak value point moment correspondence penetrates finish time blood phase, peak point Time interval between moment and valley point moment is to penetrate blood phase Time Intervals；
The method being adjusted to the impedance waveform values baseline measured per cardiac cycle is with the valley of per cardiac cycle For baseline, each impedance measurements subtract valley as measured value adjusted.
Impedance waveform after being adjusted to impedance waveform values baseline integrates, and specific method is given by formula (1) (2) Out:
Wherein, (min) p indicates valley point moment, and (max) p indicates peak value point moment, and blood is penetrated in (max) p- (min) p expression Phase Time Intervals, ZiIndicate that baseline i-th of impedance measurements adjusted, S are the integrated values for penetrating blood phase impedance waveform, EI is to penetrate Blood phase impedance damping.
The adjustment once penetrates blood phase impedance damping upper lower limit value and the specific method of automatic reaction coefficient is, rises in heart Device of fighting is program-controlled for the first time in 15 minutes after frequency adaptive model, and user's holding level reposes state, in this period Interior pacing frequency remains than program-controlled basic pacing frequency 10BPM higher, takes and is calculated in this period by aforesaid operations Blood phase impedance damping lower limit value is penetrated in all mean values conducts for penetrating blood phase impedance damping, and the impedance of blood phase is penetrated in 2 times of conducts for removing limit value Index upper limit value.Hereafter, it calculates per cardiac cycle and once penetrates blood phase impedance damping, cardiac cycle counter is 1 time cumulative；Currently penetrate It is 1 time cumulative that blood phase impedance damping is greater than upper limit counter when penetrating blood phase impedance damping upper limit value；It is small currently to penetrate blood phase impedance damping Lower limit counter is 1 time cumulative when penetrating blood phase impedance damping lower limit value；Counter Value was once counted in every 24 hours, by public affairs The rate that transfinites of formula (3) (4) calculating bound:
Wherein, RupIt is super upper limit rate, RdownIt is super lower limit rate, CounterUp is upper limit counter, CounterDown is lower limit counter, and CounterCardiac is cardiac cycle counter.Work as Rup> 0.1% When, it penetrates blood phase impedance damping upper limit value and increases by 5%, RupWhen < 0.01%, penetrates blood phase impedance damping upper limit value and reduce 0.5%；When RdownWhen > 0.1%, penetrates blood phase impedance damping lower limit value and reduce by 5%, RdownWhen < 0.01%, the increasing of blood phase impedance damping lower limit value is penetrated Add 0.5%.After every 24 hour adjustment, upper limit counter, lower limit counter and cardiac cycle counter reset simultaneously Restart to count.
The specific method for adjusting current pacing frequency is, by program-controlled parameter and it is described penetrate blood phase impedance damping and The blood phase impedance damping upper lower limit value of penetrating calculates current ideal pace-making frequency:
Wherein, HRidealIt is current ideal pacing frequency, BR is program-controlled basic pace-making frequency, and MR is that program-controlled maximum rises Rich frequency, EI is currently to penetrate blood phase impedance damping, EIminAnd EImaxIt is to penetrate blood phase impedance damping lower limit value and upper limit value respectively, ARF is automatic reaction coefficient, is rule of thumb adjusted, it is preferable that initial value 1.0, when 24 is small, interior pacing frequency 80% is distributed When below program-controlled heart rate equalization point, ARF=ARF ÷ 1.05；Otherwise ARF=ARF × 1.10.Work as HRidealGreater than current pace-making When frequency, current pacing frequency adds 2BPM；Work as HRidealWhen less than current pace-making frequency, current pacing frequency subtracts 1BPM；Wherein increase The few speed of addition and subtraction can be adjusted by program-controlled parameter setting.
Fig. 4 gives the linear fit penetrated between blood phase impedance damping and sports level, it is shown that penetrate blood phase impedance damping with Good linear correlation between sports level.

Claims (10)

1. a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, which is characterized in that
Ventricle standard pacing electrode acquires several groups ventricular impedance measured value in per cardiac cycle, constitutes ventricular impedance waveform；
The system carries out peak point to per cardiac cycle ventricular impedance waveform and valley point detects；
The system is made whether as the judgement of wrong waveform per cardiac cycle measurement result；If wrong waveform, then give up this Segment data resurveys ventricular impedance waveform；If precision waveform, then according to the peak point and valley point detected, with every heart The valley in dynamic period is baseline, is adjusted to the impedance waveform values baseline measured per cardiac cycle；
Impedance waveform after the system is adjusted impedance waveform values baseline integrates, and range of integration is respectively peak point Moment and valley point moment；It is obtained penetrating the impedance of blood phase and referred to divided by the blood phase Time Intervals of penetrating obtained by precision waveform with integrated value again Number；
The system judges whether the timing of pacemaker continuous work reaches a duty cycle,
If having reached a duty cycle, according to the counting Data-Statistics of pacemaker in a upper duty cycle, adjustment is primary Blood phase impedance damping upper lower limit value and automatic reaction coefficient are penetrated, the calculating as pacing frequency current in current operating cycle is joined Number；
If a not up to duty cycle, according to program-controlled parameter, current calculating parameter and the adjusting of blood phase impedance damping is penetrated currently Pacing frequency.
2. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, using 50ms after ventricle standard pacing electrode acquisition ventricular pacemaking or perception event to the impedance during 300ms Waveform values measure one group every fixed measurement interphase, measure several groups altogether, every group of measurement measures forward impedance and negative sense respectively Impedance is each primary, takes and measures average value twice as every group of impedance measurements.
3. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, it is present impedance value that the described system, which carries out the specific method that peak point is detected with valley point to impedance waveform, Point greater than the two neighboring impedance value in front and back is peak point；The point that present impedance value is less than the two neighboring impedance value in front and back is valley Point.
4. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, the criterion of the mistake waveform specifically:
If there are multiple valley points or preceding half of measurement period, there is only a valley point and valley points in preceding half of measurement period Terminate that there are multiple peak points to entire measurement period, then measured impedance waveform is wrong waveform；
If valley point is not present in preceding half of measurement period, using first measured value as valley point, if valley point is surveyed to entire It measures end cycle and peak point is not present, then using the last one measured value as peak point.
5. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, being penetrated start time blood phase according to detection valley point moment correspondence, peak value point moment correspondence penetrates finish time blood phase, It is obtained penetrating blood phase Time Intervals by the time interval between peak value point moment and valley point moment.
6. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, the method being adjusted to the impedance waveform values baseline measured per cardiac cycle is with the paddy of per cardiac cycle Value is baseline, and each impedance measurements subtract valley as measured value adjusted.
7. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, the impedance waveform after being adjusted to impedance waveform values baseline integrates, specific method is by formula (1) (2) it provides:
Wherein, (min) p indicates valley point moment, and (max) p indicates peak value point moment, when the blood phase is penetrated in (max) p- (min) p expression Between interphase, ZiIndicate that baseline i-th of impedance measurements adjusted, S are the integrated values for penetrating blood phase impedance waveform, EI is to penetrate the blood phase Impedance damping.
8. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, adjustment once penetrates blood phase impedance damping upper lower limit value and automatic reaction coefficient, the specific method is as follows,
Step 7.1, after pacemaker is program-controlled for the first time for frequency adaptive model in 15 minutes, user keeps horizontal Repose state, and during this period of time pacing frequency remains 10BPM higher than program-controlled basic pace-making frequency, takes in this period and passes through All mean values for penetrating blood phase impedance damping being calculated remove 2 times of conducts of limit value as blood phase impedance damping lower limit value is penetrated Penetrate blood phase impedance damping upper limit value；
Step 7.2, it calculates per cardiac cycle and once penetrates blood phase impedance damping, cardiac cycle counter is 1 time cumulative；Currently penetrate the blood phase It is 1 time cumulative that impedance damping is greater than upper limit counter when penetrating blood phase impedance damping upper limit value；Currently penetrate blood phase impedance damping be less than penetrate Lower limit counter is 1 time cumulative when blood phase impedance damping lower limit value；After every 24 hour adjustment, upper limit counter, lower limit counter And cardiac cycle counter is resetted and is started counting again；
Step 7.3, individual count device value was once counted in every 24 hours, calculates transfiniting for bound by formula (3) (4) Rate:
Wherein, RupIt is super upper limit rate, RdownIt is super lower limit rate, CounterUp is upper limit counter, CounterDown It is lower limit counter, CounterCardiac is cardiac cycle counter；
Step 7.4, work as RupWhen > 0.1%, penetrates blood phase impedance damping upper limit value and increase by 5%, RupWhen < 0.01%, penetrates the impedance of blood phase and refer to Number upper limit value reduces 0.5%；Work as RdownWhen > 0.1%, penetrates blood phase impedance damping lower limit value and reduce by 5%, RdownWhen < 0.01%, penetrate Blood phase impedance damping lower limit value increases by 0.5%.
9. it is as described in claim 1 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, adjusting current pacing frequency, the specific method is as follows,
Step 8.1, it by program-controlled parameter and described penetrate blood phase impedance damping and described penetrates blood phase impedance damping upper lower limit value meter Calculate current ideal pace-making frequency:
Wherein, HRidealIt is current ideal pacing frequency, BR is program-controlled basic pace-making frequency, and MR is program-controlled maximum pace-making frequency Rate, EI are currently to penetrate blood phase impedance damping, EIminAnd EImaxBe respectively it is described penetrate blood phase impedance damping lower limit value and upper limit value, ARF is automatic reaction coefficient, is rule of thumb adjusted；
Step 8.2, work as HRidealWhen greater than current pace-making frequency, current pacing frequency is used as currently practical pace-making frequency after adding 2BPM Rate；Work as HRidealWhen less than current pace-making frequency, current pacing frequency is used as currently practical pacing frequency after subtracting 1BPM.
10. it is as claimed in claim 9 a kind of based on the pacemaker pacing frequency Adaptable System for penetrating blood phase impedance damping, It is characterized in that, the initial value of automatic reaction coefficient ARF is 1.0, when 24 is small, interior pacing frequency 80% is distributed in program-controlled heart rate When below equalization point, ARF=ARF ÷ 1.05；Otherwise ARF=ARF × 1.10.
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