CN114521894B - Blood oxygen saturation monitoring and liver function testing system based on central venous catheter - Google Patents
Blood oxygen saturation monitoring and liver function testing system based on central venous catheter Download PDFInfo
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- 239000008280 blood Substances 0.000 title claims abstract description 81
- 210000004369 blood Anatomy 0.000 title claims abstract description 81
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 title claims abstract description 75
- 239000001301 oxygen Substances 0.000 title claims abstract description 75
- 229910052760 oxygen Inorganic materials 0.000 title claims abstract description 75
- 238000012544 monitoring process Methods 0.000 title claims abstract description 35
- 230000003908 liver function Effects 0.000 title claims abstract description 31
- 238000012360 testing method Methods 0.000 title claims abstract description 21
- MOFVSTNWEDAEEK-UHFFFAOYSA-M indocyanine green Chemical compound [Na+].[O-]S(=O)(=O)CCCCN1C2=CC=C3C=CC=CC3=C2C(C)(C)C1=CC=CC=CC=CC1=[N+](CCCCS([O-])(=O)=O)C2=CC=C(C=CC=C3)C3=C2C1(C)C MOFVSTNWEDAEEK-UHFFFAOYSA-M 0.000 claims abstract description 158
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- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
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Abstract
The invention provides a blood oxygen saturation monitoring and liver function testing system based on a central venous catheter, which at least comprises the central venous catheter and a photoelectric module, wherein a catheter body in the central venous catheter is of a multi-cavity structure, an independent dye injection cavity and an optical fiber cavity are arranged in the catheter body, and a dye injection channel and a dye injection connector which are communicated with the dye injection cavity and an optical fiber connector which is connected with an optical fiber in the optical fiber cavity are connected above the catheter body through a fixed bracket; the photoelectric module is connected with an optical fiber connector in the multi-cavity central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit. The system can obtain the blood oxygen saturation of central vein and the pressure of central vein of a patient at the same time through one puncture implantation, is provided with a special channel for the injection of indocyanine green, and helps to evaluate the liver function of the patient by monitoring the concentration change in a period of time after ICG injection.
Description
Technical Field
The invention provides a system capable of simultaneously monitoring blood oxygen saturation and liver function test based on a central venous catheter, and belongs to the technical field of medical appliances.
Background
Along with the development of science and technology and the progress of applied medicine, minimally invasive treatment is widely applied to clinical medicine, and medical staff can more accurately obtain physiological characteristic parameters of patients through minimally invasive technology, so that the course and physiological state of the patients can be judged more quickly and accurately, and a treatment scheme can be adopted more timely and effectively.
Clinically, mixed venous blood oxygen saturation (SvO 2 ) Can reflect systemic venous oxygenation, but requires indwelling pulmonary artery catheter, while central venous oxygen saturation (ScvO 2 ) Obtained by a central venous catheter indwelling in the vena cava at the right atrial level, a good correlation and correspondence between the two has been observed in a wide range of clinical practices, and the use of a less invasive monitoring technique for SvO has been practiced in the last decade 2 Monitoring for transition to ScvO 2 Has become a trend. Traditional methods of venous blood oxygen saturation monitoring require blood samples to be drawn for colorimetry or blood gas analysis in vitro to obtain results, although accurate, continuous monitoring cannot be achieved. In most severe patients, the ScvO needs to be monitored in real time 2 When ScvO 2 <At 60%, patient mortality increases significantly, and traditional vital signs suggest that tissue hypoxia is too late. By integrating fiber optic measurement techniques in the central vein, real-time changes in oxygen supply balance can be found, and continuous real-time tracking of therapeutic effects can significantly reduce complications and mortality.
Meanwhile, the diagnostic medicine indocyanine green (ICG) is injected into a blood vessel, the concentration change of the ICG is measured to calculate ICG clearance rate, and the method can be used as a dynamic index for observing the whole liver function and liver blood flow perfusion, can help doctors judge whether the patient has liver insufficiency, whether the residual liver function can maintain the planned excision operation, whether liver dysfunction can be caused after operation or not, and the like, can rapidly detect liver hypoperfusion in ICU application, predicts survival rate, and indicates intervention measures when the clearance rate is lower than 16%/Min. The indocyanine green concentration value is measured in a traditional mode by adopting one side arm for intravenous injection and another side arm for blood drawing test after 15 minutes, and the indocyanine green clearance rate is calculated for 15 minutes. The central vein catheterization is mostly needed for severe patients, and through ICG injection and blood drawing detection, the concentration change curve (shown in figure 1) of the whole process of ICG injection to complete excretion can be measured, the required clearance indexes of 5 minutes, 10 minutes, 15 minutes and the like are calculated, and the continuous liver function index and the change trend during the measurement period are obtained.
However, in the current art, when blood oxygen saturation monitoring and liver function testing are performed by separate devices (including a catheter and a monitoring device), for patients who need to perform blood oxygen saturation monitoring and liver function testing at the same time, the number of punctures and consumed medical consumables are increased intangibly, resulting in increased pain of the patients and increased treatment cost.
Disclosure of Invention
The invention solves the defects in the background technology and provides a blood oxygen saturation monitoring and liver function testing system based on a central venous catheter. When a medical staff needs to perform minimally invasive central vein puncture on a patient to obtain more physiological characteristics of the patient, the system can obtain the central vein blood oxygen saturation and the central vein pressure of the patient simultaneously through one puncture placement, is provided with a special channel for indocyanine green (ICG) injection, and helps to evaluate the liver function of the patient by monitoring the concentration change (the plasma clearance rate of ICG) in a period of time after ICG injection.
The technical scheme adopted for achieving the purposes of the invention is as follows:
the blood oxygen saturation monitoring and liver function testing system based on the central venous catheter at least comprises the central venous catheter and a photoelectric module, wherein a catheter body in the central venous catheter is of a multi-cavity structure, an independent dye injection cavity and an optical fiber cavity are arranged in the catheter body, a dye injection channel and a dye injection connector which are communicated with the dye injection cavity are connected above the catheter body through a fixed bracket, and an optical fiber connector which is connected with an optical fiber in the optical fiber cavity;
the photoelectric module is connected with an optical fiber connector in the multi-cavity central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light of at least three wave bands, the AD sampling unit is used for performing signal conversion, the calculating unit calculates digital signals converted in the AD sampling unit and transmits calculation results to the communication unit, and the communication unit is in communication connection with terminal equipment;
two calculation modes are arranged in the calculation unit: a blood oxygen saturation monitoring mode without dye injection, and a blood oxygen saturation monitoring liver function test mode with dye injection.
In particular, the wavelength which the transmitting unit and the receiving unit can transmit and receive is in particular λ 1 ＝660nm，λ 2 ＝805nm，λ 3 =940 nm, the stain is indocyanine green ICG.
Specifically, the specific calculation method under the blood oxygen saturation monitoring mode without the injected coloring agent is as follows:
in this mode only reduced hemoglobin Hb and oxygenated hemoglobin HbO are considered 2 Is at two wavelengths lambda 1 And lambda is 2 Lower absorption coefficientAnd->The method comprises the following steps:
and then further calculated by a dual wavelength method:
the above formula is taken into the defined formula of blood oxygen saturation:
ScvO 2 ＝[C HbO2 *100]/[C HbO2 +C Hb ]
due to selection of lambda 1 At 660nm, the band lambda 2 =805 nm is oxygen and hemoglobin HbO 2 Equivalent intersection point of absorbance coefficient curve of reduced hemoglobin Hb, namely epsilon λ2 HbO2 ＝ε λ2 Hb Thus, it is further deduced that:
in the above formula, scvO 2 Central venous oxygen saturation (%), epsilon λ1 Hb 、ε λ1 HbO2 、ε λ2 Hb 、ε λ2 HbO2 All are constants obtained by adopting a time domain or frequency domain spectrum analysis method, C HbO2 Concentration of oxyhemoglobin, C Hb Reduced hemoglobin concentration, D λ1 、D λ2 Is obtained by measuring the light intensity.
Specifically, the specific calculation method under the blood oxygen saturation monitoring and liver function test mode of the injected coloring agent is as follows:
when ICG is injected, the absorption wave peak value is 805nm, and the absorption of 660nm wavelength is also influenced, so that 940nm wavelength is not influenced; d of 940nm wavelength which is not affected needs to be selected λ3 Calculate the corresponding D Lambda 2 correction Then eliminate D λ2 After correcting the influence, the ICG concentration is calculated, and then the D after eliminating the ICG influence is calculated λ1 correction The blood oxygen saturation can be calculated last.
(1): after ICG injection with D λ3 Calculate the corresponding D Lambda 2 correction Value of
First, when indocyanine green ICG is not injected, according to the wave band lambda 2 =805 nm and λ 3 =940 nm, D is derived using the dual wavelength method λ2 And D λ3 Is linear with respect to the ratio of oxygen saturation:
D λ3 /D λ2 ＝ε λ3 Hb /ε λ2 Hb+ (ε λ3 HbO2 /ε λ2 Hb -ε λ3 Hb /ε λ2 Hb )ScvO 2
further utilizing theoretical value to simplify calculation to obtain band lambda 2 =805 nm and λ 3 Change relation of reflected light intensity of hemoglobin of 940 nm:
D λ2 ＝D λ3 /[1-K 2 *(ScvO 2 -51)]
using D as currently measured λ3 And the last calculation result of the blood oxygen saturation concentration before the indocyanine green ICG injection is obtained:
D lambda 2 correction ＝D λ3 /[1-K 2 *(ScvO 2 -51)]；
(2): liver function calculation
Liver function was measured using indocyanine green clearance assay, wavelength lambda after indocyanine green ICG injection 2 The absorption coefficient =805 nm increases the effect of the indocyanine green ICG absorption peak, i.e.
μ 0 Lambda 2 correction ＝ε λ2 Hb C Hb +ε λ2 HbO2 C HbO2 +ε λ2 ICG C ICG
And then according to the following formula:
D λ2 ＝(ε λ2 Hb C Hb +ε λ2 Hb C HbO2 +ε λ2 ICG C ICG )*K
D lambda 2 correction ＝(ε λ2 b C Hb +ε λ2 Hb C HbO2 +ε λ2 HbO2 C HbO2 )*K
The two formulas are subtracted to obtain:
D λ2 -D lambda 2 correction ＝ε λ2 ICG C ICG * K, performing K; in this formula, K is a constant, so as to further calculate:
C ICG ＝(D λ2 -D lambda 2 correction )/ε λ2 ICG K, thereby calculating the real-time concentration C of indocyanine green ICG ICG ；
The calculation result is put into the following formula: rn=c n /C 0 *100％；
Further, it is derived that: r is R n ＝(D λ2 -D Lambda 2 correction ) n /(D λ2 -D Lambda 2 correction ) 0 *100％；
In the above formula: epsilon λ2 ICG Rn is the residual rate of indocyanine green ICG in blood after n minutes, C n Is the ICG concentration of indocyanine green after n minutes, C 0 Indocyanine green ICG concentration at time base 0 after ICG injection; wherein (D) λ2 -D Lambda 2 correction ) n Sum (D) λ2 -D Lambda 2 correction ) 0 The change rate D of the reflected light intensity measured at n minutes and 0 minutes respectively λ2 And corrected D Lambda 2 correction Is a difference in (2);
(3): blood oxygen saturation calculation after indocyanine green ICG injection
After indocyanine green ICG injection, the absorption coefficient for wavelength λ1=660 nm also increases the effect of ICG absorption:
μ 0 λ1 ＝ε λ1 Hb C Hb +ε λ1 HbO2 C HbO2 +ε λ1 ICG C ICG
D λ1 ＝(ε λ1 Hb C Hb +ε λ1 Hb C HbO2 +ε λ1 ICG C ICG )*K
rate of change D of reflected light intensity after ICG cancellation λ1 correction Comprises Hb and HbO only 2 Is defined by:
D λ1 correction ＝(ε λ1 Hb C Hb +ε λ1 Hb C HbO2 )*K
＝D λ1 -ε λ1 ICG C ICG *K
ICG concentration C calculated by substituting liver function ICG ：
D λ1 correction ＝D λ1 -ε λ1 ICG *(D λ2 -D Lambda 2 correction )/ε λ2 ICG
The corrected central venous oxygen saturation scvO is calculated by the following formula 2 correction ：
Specifically, the inner wall of the dye injection channel is coated with a light-proof coating, or the dye injection channel is made of a colored material.
Specifically, the catheter body in the central venous catheter is of a four-cavity structure, a pressure measurement cavity and an infusion cavity are arranged in addition to the dye injection cavity and the optical fiber cavity, the pressure measurement cavity is used for penetrating a guide wire to guide the catheter to be placed in during puncture, and the pressure measurement cavity is connected with invasive blood pressure measurement equipment after the guide wire is pulled out after the puncture is finished so as to measure central venous blood pressure; the transfusion cavity is used for blood sampling and transfusion; the upper part of the catheter body is connected with a pressure measuring channel and a pressure measuring joint which are communicated with the pressure measuring cavity through a fixed bracket, and an infusion channel and an infusion joint which are communicated with the infusion cavity.
Specifically, the outlets of the optical fiber cavity and the pressure measuring cavity are positioned at the far end of the catheter body, and the outlets of the infusion cavity and the dye injection cavity are positioned at the near end of the catheter body.
Specifically, the dye injection joint, the pressure measurement joint and the infusion joint are all standard luer joints.
Specifically, the terminal device is a monitor, and the monitor controls the photoelectric module through the digital communication interface, and is used for setting the intensity and the time-sharing frequency of the light radiation output by each wavelength, receiving the received light intensity of each wavelength, which is fed back by analysis, and intelligently adjusting the luminous light intensity to obtain the optimal measurement result.
Specifically, the monitor has a man-machine interface interaction function, and can input calibration parameters and display blood oxygen saturation measurement results and a stain concentration change curve in real time.
The inventive principle of the present application is as follows: according to applicant's study of spectroscopic analysis, the analysis was performed from oxyhemoglobin (HbO 2 ) The absorption spectrum curves (shown in figure 2) of the reduced hemoglobin (Hb) and the indocyanine green (ICG) show that the absorption of the three spectra are obviously different, and the three wavelengths are adopted to simultaneously measure the blood oxygen saturation and the ICG concentration. At 805nm wavelength at Hb and HbO 2 The equivalent point of the absorption coefficient of the two is not changed along with the change of the blood oxygen saturation, and the wavelength measurement is hardly influenced by other substances in blood, so that the method is an ideal reference wavelength for measuring the blood oxygen saturation by adopting double wavelengths. The absorption peak of ICG is just 805nm, the absorption coefficient is far greater than that of hemoglobin, and the measurement data of the wavelength after ICG is injected can not be directly used for calculating the blood oxygen saturation, and the measurement data can be applied to ICG concentration measurement, and meanwhile, the influence of the hemoglobin component in the wavelength also needs to be eliminated for accurately measuring ICG. The absorption range of optical radiation of ICG is mainly concentrated between 700-900nm, so that the absorption of test optical radiation using wavelengths outside this range is mainly affected by changes in blood oxygen saturation. Light pair HbO in the vicinity of 660nm wavelength 2 The difference between the Hb absorption coefficient and the blood is approximately maximum and is approximately 10 times different, and when the blood oxygen saturation is different, the blood is most sensitive to the change of the light absorption quantity of the wavelength; after ICG injection, it will interfere with 660nm absorbance, resulting in error in blood oxygen saturation measurement, which is eliminated after the ICG concentration is calculated.
In the 850-950 nm wavelength band, the two curves change slowly and approximately coincide, and 940nm greater than 900nm is selected as the third measurement wavelength in order to avoid the influence of ICG. HbO at 940nm wavelength 2 The absorption rate of Hb is not greatly different from the equivalent point of 805nm, the ratio of the reflected light intensity change rate of 805nm is in linear relation with the blood oxygen saturation, and the 805nm wave is calculated according to the blood oxygen saturation after ICG injection and the measured 940nm reflected light intensity change rateLong corresponding hemoglobin (Hb+HbO) 2 ) The resulting change rate of reflected light intensity was subtracted from the measured change rate of light intensity at 805nm to remove hemoglobin (Hb+HbO) 2 ) Accurate ICG concentration data can be calculated according to the corresponding absorption amount part of the sample, and ICG interference of 660nm is further corrected according to the ICG concentration to obtain hemoglobin (Hb+HbO) 2 ) The rate of change of the reflected light intensity of (c) so that the blood oxygen saturation can be calculated after ICG injection.
In summary, compared with the prior art, the blood oxygen saturation monitoring and liver function testing system based on the central venous catheter provided by the application can monitor the central venous blood oxygen saturation, central venous pressure and liver function of a patient through puncture of the central venous catheter once, so that the puncture pain of the patient is reduced, and the medical cost is reduced.
Drawings
FIG. 1 is a graph showing the concentration change of ICG during the whole period from the injection to the end of excretion in the prior art;
FIG. 2 shows oxyhemoglobin (HbO) in the summary 2 ) Absorption spectra profiles of reduced hemoglobin (Hb) and indocyanine green (ICG);
FIG. 3 is a schematic diagram of the overall structure of the test system in the embodiment;
FIG. 4 is a cross-sectional view taken along A-A of FIG. 3;
in the figure: 1-catheter body, 2-colorant injection chamber, 3-optic fibre chamber, 4-fixed bolster, 5-colorant injection passageway, 6-colorant injection joint, 7-optic fibre joint, 8-pressure measurement chamber, 9-infusion chamber, 10-pressure measurement passageway, 11-pressure measurement joint, 12-infusion passageway, 13-infusion joint.
Detailed Description
The present invention will be described in detail with reference to the drawings and examples, but the scope of the present invention is not limited to the examples.
The structure of the blood oxygen saturation monitoring and liver function testing system based on the central venous catheter provided in this embodiment is as shown in fig. 3 and 4:
the catheter body 1 in the central venous catheter is of a four-cavity structure and comprises a colorant injection cavity 2, an optical fiber cavity 3, a pressure measurement cavity 8 and an infusion cavity 9, wherein outlets of the optical fiber cavity and the pressure measurement cavity are positioned at the far end of the catheter body, and outlets of the infusion cavity and the colorant injection cavity are positioned at the near end of the catheter body. The pressure measuring cavity is used for penetrating the guide wire to guide the catheter to be placed in during puncture, and is connected with invasive blood pressure measuring equipment after the guide wire is extracted after the puncture is finished so as to measure the central venous pressure; the transfusion cavity is used for blood sampling and transfusion.
The upper part of the catheter body is connected with a dye injection channel 5 and a dye injection joint 6 which are communicated with the dye injection cavity through a fixed support 4, the inner wall of the dye injection channel is coated with a light-proof coating, or the dye injection channel is made of a colored material, and the channel is used for injecting indocyanine green, so that the interference of site light radiation is avoided, and the liver function test is completed by measuring the concentration of indocyanine green in cooperation with optical fibers in the catheter. The upper part of the catheter body is connected with an optical fiber connector 7 connected with an optical fiber in the optical fiber cavity through a fixed bracket, and the photoelectric module is connected with the optical fiber connector in the multi-cavity central venous catheter. The upper part of the catheter body is connected with a pressure measuring channel 10 and a pressure measuring joint 11 which are communicated with the pressure measuring cavity, and an infusion channel 12 and an infusion joint 13 which are communicated with the infusion cavity through a fixed bracket. The dye injection joint, the pressure measurement joint and the infusion joint are all standard luer joints.
When the catheter is used, the catheter body is placed into the central vein of a patient through puncture auxiliary instruments such as a guide wire, a puncture needle and the like, and the catheter is fixed on the body surface of the patient through the fixing support after the catheter is placed. After the catheter is fixed, the adaptive invasive blood pressure measuring device is connected, and the central venous blood is conveyed to the blood pressure measuring device through the blood pressure testing channel, so that the central venous blood pressure is monitored. After the catheter is fixed, the catheter can be connected with a related pipeline, a valve or a tee joint through an infusion channel, and the intravenous blood sampling and injection can be completed by matching with an injector and an infusion apparatus.
In a specific use link, the terminal equipment is a monitor, the monitor equipment controls the photoelectric module through the digital communication interface, sets the intensity and the time-sharing frequency of the light radiation with each wavelength output, and receives and analyzes the light radiationThe light intensity of each wavelength received by the feedback can be intelligently adjusted to obtain the optimal measurement result, and the ScvO is calculated by comparing multiple groups of data 2 And ICG concentration. The monitor has man-machine interface interaction function, and can input calibration parameters and display the ScvO in real time 2 Measurement results and ICG concentration change curves.
The photoelectric module comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light of at least three wave bands, the AD sampling unit is used for carrying out signal conversion, the calculating unit calculates digital signals converted in the AD sampling unit and transmits calculation results to the communication unit, and the communication unit is in communication connection with the terminal equipment.
Two calculation modes are arranged in the calculation unit: a blood oxygen saturation monitoring mode without dye injection, and a blood oxygen saturation monitoring liver function test mode with dye injection.
The two calculation modes will be described in detail in the present embodiment.
1. The invention uses the light radiation reflection detection mode of red light and near infrared spectrum, in biological tissue, the reflection detection mode and the transmission detection mode both accord with Lambert-Beer law, D represents the change rate of light intensity of a single wavelength, and the general light intensity change formula is:
D＝-μ 0 K (1)
μ 0 ＝εC (2)
i.e. the rate of change D of the intensity of the reflected light and the absorption coefficient mu 0 In a proportional relationship, K is a constant related to a reflecting structure of the optical system, and epsilon is the light absorption coefficient of a light absorption substance; c is the concentration of the light absorbing substance.
The light intensity change rate is according to Lambert-Beer law, the light intensity of available single wavelength is I 0 The emitted light and reflected light intensity I measured:
D＝Ln I/I 0 (3)
the system is correctly arrangedAfter initiation of the tube to the central vein and proper connection, blood gas analysis or laboratory tests can be performed by drawing central vein blood oxygen through the catheter prior to ICG infusion by inputting the ScvO on the monitoring device 2 The laboratory blood gas analysis and inspection result can calibrate the measurement system once, and further reduce the system error caused by the measurement errors of the emitted light intensity and the reflected light intensity.
In the practical application scene of the invention, the diameters of the transmitting and receiving optical fibers are within 0.5mm, the two optical fibers are directly introduced into the blood vessel along with the catheter side by side for measurement, and the reflected light path in the blood vessel is only related to blood and is not influenced by other tissue components of the human body. The measured central vein and artery of human body are different, the central vein blood pressure is lower, normal value is 5-10mmHg, the pressure wave is basically stable, the light reflection light intensity change rate does not change along with heart beat, and the value is stable.
Intensity of emitted light I at each wavelength 0 The light-emitting unit can be controlled by a photoelectric module, can be regulated in multiple stages, and has the intensity of each stage calibrated by a test, and is provided with heat preservation measures and constant temperature control for ensuring the stability.
Absorption and reduction of hemoglobin (Hb) and oxyhemoglobin (HbO) by substances such as water, cytochrome, etc. in the red and near infrared region of 600-1000nm 2 ) Much smaller than the previous one. Thus, the selected wavelength is in the near infrared region (e.g., lambda 1 ＝660nmλ 2 ＝805nmλ 3 Three beams of light at 940 nm), only reduced hemoglobin (Hb) and oxygenated hemoglobin (HbO) are considered for blood detection 2 ) The absorption coefficient at two wavelengths can be rewritten as:
by the dual wavelength method:
the above formula is taken into the defined formula of blood oxygen saturation:
ScvO 2 ＝[C HbO2 *100]/[C HbO2 +C Hb ]
wherein: scvO 2 Central venous oxygen saturation (%), C HbO2 Concentration of oxyhemoglobin, C Hb Reducing hemoglobin concentration and selecting lambda 1 660nm, lambda 2 For the equivalent intersection point (805 nm) of the absorbance curves of oxygen and hemoglobin HbO2 and reduced hemoglobin Hb, i.e. ε λ2 HbO2 ＝ε λ2 Hb And (3) obtaining:
epsilon in the formula λ1 Hb 、ε λ1 HbO2 、ε λ2 Hb 、ε λ2 HbO2 Are constants and can be obtained by adopting a time domain or frequency domain spectrum analysis method, D λ1 、D λ2 Can be obtained by measuring the light intensity.
When ICG is not injected, the above formula can be used to calculate ScvO only for monitoring blood oxygen saturation 2 。
2. Blood oxygen saturation monitoring and liver function adding test mode of dye injection
When ICG is injected, the absorption wave peak value is 805nm, and the absorption of 660nm wavelength is also influenced, so that 940nm wavelength is not influenced. D of 940nm wavelength which is not affected needs to be selected λ3 Calculate the corresponding D Lambda 2 correction Then eliminate D λ2 After correcting the influence, the ICG concentration is calculated, and then the D after eliminating the ICG influence is calculated λ1 correction The blood oxygen saturation can be calculated last.
(1): after ICG injection with D λ3 Calculate the corresponding D λ2 Correction value
The inverse at 805nmThe change of the light intensity of the light is not influenced by the change of the blood oxygen saturation, the change rate of the reflected light intensity of 940nm is slightly reduced along with the increase of the blood oxygen saturation, and D is directly used λ3 Substitute D λ2 The calculation has about 1% -5% error. According to formula (6), the band lambda is the band lambda when no ICG is injected 2 =805 nm and λ 3 Using the dual wavelength method, D can be derived =940 nm λ2 And D λ3 Is linear with respect to the ratio of oxygen saturation:
D λ3 /D λ2 ＝ε λ3 Hb /ε λ2 Hb+ (ε λ3 HbO2 /ε λ2 Hb -ε λ3 Hb /ε λ2 Hb )ScvO 2 (8)
the theoretical value can be further utilized to simplify the calculation to obtain the wave band lambda 2 =805 nm and λ 3 Change relation of reflected light intensity of 940nm hemoglobin
D λ2 ＝D λ3 /[1-K 2 *(ScvO 2 -51)] (9)
D λ3 At 940nm wavelength, substitute D λ2 At 805nm, K 2 Theoretical value about 0.1%, in practical application, blood oxygen saturation concentration value obtained by blood and qi sampling assay can be used for K 2 And (5) performing correction.
Because the saturated concentration of venous blood oxygen of human body does not change rapidly, it can be considered that the current measured D can be used after the instant of injecting ICG for several seconds λ3 And the last blood oxygen saturation concentration calculation for a few seconds before injection, gives:
D lambda 2 correction ＝D λ3 /[1-K 2 *(ScvO 2 -51)] (10)
Since the saturated concentration of venous blood does not change rapidly, the last calculated ScvO can be used every time 2 To calculate D Lambda 2 correction
(2): liver function calculation
Liver function was measured using indocyanine green clearance assay, wavelength lambda after indocyanine green ICG injection 2 Absorption coefficient of =805 nmIncreases the influence of ICG absorption peak of indocyanine green, namely
μ 0 λ2 ＝ε λ2 Hb C Hb +ε λ2 HbO2 C HbO2 +ε λ2 ICG C ICG (11)
Measuring concentration of ICG, using wavelength lambda of ICG absorption peak 2 =805 nm, need to eliminate Hb and HbO 2 According to formula (1):
D λ2 ＝(ε λ2 Hb C Hb +ε λ2 Hb C HbO2 +ε λ2 ICG C ICG )*K(12)
D lambda 2 correction ＝(ε λ2 Hb C HbO2 +ε λ2 HbO2 C HbO2 )*K (13)
Two-way subtraction
D λ2 -D Lambda 2 correction ＝ε λ2 ICG C ICG *K；
In this formula, K is a constant when the entire optical measurement structure is constant, thereby further calculating:
C ICG ＝(D λ2 -D lambda 2 correction )/ε λ2 ICG K (14)
Thereby calculating the real-time concentration C of indocyanine green ICG ICG ；
Liver function detection was achieved by monitoring the change in residual rate within 15 minutes after ICG injection:
R n ＝C n /C 0 *100％
in the above formula: epsilon λ2 ICG R is a constant obtained by using a time domain or frequency domain spectroscopic analysis method n Is the residual rate of indocyanine green ICG in the blood after n minutes, C n Is the ICG concentration of indocyanine green after n minutes, C 0 Indocyanine green ICG concentration at time base 0 after ICG injection; wherein (D) λ2 -D Lambda 2 correction ) n Sum (D) λ2 -D Lambda 2 correction ) 0 Inverse of the n minutes and 0 hours measurements, respectivelyRate of change D of the intensity of the emitted light λ2 And corrected D Lambda 2 correction Is a difference in (c).
(3): blood oxygen saturation calculation after ICG injection
Similarly, the absorption coefficient for wavelength λ1=660 nm also increases the effect of ICG absorption:
μ 0 λ1 ＝ε λ1 Hb C Hb +ε λ1 HbO2 C HbO2 +ε λ1 ICG C ICG (15)
D λ1 ＝(ε λ1 Hb C Hb +ε λ1 Hb C HbO2 +ε λ1 ICG C ICG )*K (16)
rate of change D of reflected light intensity after ICG cancellation λ1 correction Comprises Hb and HbO only 2 Part of (2)
D λ1 correction ＝(ε λ1 Hb C Hb +ε λ1 Hb C HbO2 )*K
＝D λ1 -ε λ1 ICG C ICG *K
ICG concentration C calculated by substituting liver function ICG
D λ1 correction ＝D λ1 -ε λ1 ICG *(D λ2 -D Lambda 2 correction )/ε λ2 ICG (17)
The corrected central venous oxygen saturation scvO is calculated by the following formula 2 correction ：
The present invention is not limited to the above-described embodiments, but, if various modifications or variations of the present invention are not departing from the spirit and scope of the present invention, the present invention is intended to include such modifications and variations as fall within the scope of the claims and the equivalents thereof.
Claims (6)
1. Blood oxygen saturation monitoring and liver function test system based on central venous catheter, including central venous catheter and photoelectric module, its characterized in that:
the catheter body in the central venous catheter is of a multi-cavity structure, an independent dye injection cavity and an optical fiber cavity are arranged in the catheter body, and a dye injection channel and a dye injection connector which are communicated with the dye injection cavity and an optical fiber connector which is connected with optical fibers in the optical fiber cavity are connected above the catheter body through a fixed bracket;
the photoelectric module is connected with an optical fiber connector in the central venous catheter and comprises a transmitting unit, a receiving unit, an AD sampling unit, a calculating unit and a communication unit, wherein the transmitting unit and the receiving unit can transmit and receive red light and near infrared light with at least three wavelengths, the AD sampling unit is used for performing signal conversion, the calculating unit calculates digital signals converted by the AD sampling unit and transmits calculation results to the communication unit, and the communication unit is connected with terminal equipment in a communication mode; the wavelength of which the transmitting unit and the receiving unit can transmit and receive is lambda 1 = 660 nm， λ 2 = 805 nm， λ 3 =940 nm, the dye being indocyanine green ICG;
two calculation modes are arranged in the calculation unit: the blood oxygen saturation monitoring mode without indocyanine green ICG injection and the blood oxygen saturation monitoring liver function test mode with indocyanine green ICG injection;
the specific calculation method under the blood oxygen saturation monitoring mode without indocyanine green ICG injection is as follows:
in this mode only reduced hemoglobin Hb and oxygenated hemoglobin HbO are considered 2 Is at two wavelengths lambda 1 And lambda is 2 Lower absorption coefficientAnd->The method comprises the following steps: />；
And then further calculated by a dual wavelength method:
；
the above formula is taken into the defined formula of blood oxygen saturation:；
due to selection of lambda 1 At 660nm, wavelength lambda 2 =805 nm is oxyhemoglobin HbO 2 And the equivalent intersection point of the reduced hemoglobin Hb absorption coefficient curve, namelyThus, it is further deduced that: />；
In the above formula, scvO 2 As the blood oxygen saturation of the central vein,to reduce hemoglobin at lambda 1 Absorption coefficient at wavelength, +.>Lambda is oxyhemoglobin 1 Absorption coefficient at wavelength, +.>To reduce hemoglobin at lambda 2 Absorption coefficient at wavelength, +.>Lambda is oxyhemoglobin 2 Absorption coefficient at wavelength, +.>、/>、/>、/>All are constants obtained by adopting a time domain or frequency domain spectrum analysis method; />For oxyhemoglobin concentration, C Hb To reduce the hemoglobin concentration, < > A->Is of wavelength lambda 1 The change rate of the intensity of the reflected light, +.>Is of wavelength lambda 2 The change rate of the intensity of the reflected light, +.>、/>The light intensity is measured to obtain;
the specific calculation method under the blood oxygen saturation monitoring and liver function test mode of the indocyanine green ICG injection is as follows:
(1): after injection of indocyanine green ICGCalculating the corresponding->Value of
First, when indocyanine green ICG is not injected, according to wavelength lambda 2 =805 nm and λ 3 =940 nm, derived using the dual wavelength methodAnd->Is linear with respect to the ratio of oxygen saturation: />；
Is of wavelength lambda 3 The light intensity change rate of the reflected light is obtained by measuring the light intensity;
further utilizing theoretical value to simplify calculation to obtain wavelength lambda 2 =805 nm and λ 3 Change in intensity of reflected light of hemoglobin at 940 nm: ， K 2 theoretical value about 0.1%, and the ratio of the blood oxygen saturation to K obtained according to blood gas test in practical application 2 Correcting;
using current measurementsAnd the last blood oxygen saturation calculation result before indocyanine green ICG injection is obtained:；
(2): liver function calculation
Liver function was measured using indocyanine green ICG clearance assay, wavelength lambda after indocyanine green ICG injection 2 The absorption coefficient=805 nm increases the effect of the indocyanine green ICG absorption peak, i.e.；
And then according to the following formula:，/>the two formulas are subtracted to obtain: />The method comprises the steps of carrying out a first treatment on the surface of the In this formula, K is a constant when the entire optical measurement structure is constant, thereby further calculating: />Thereby calculating the real-time concentration C of indocyanine green ICG ICG ；
The calculation result is put into the following formula:the method comprises the steps of carrying out a first treatment on the surface of the Further, it is derived that: />The method comprises the steps of carrying out a first treatment on the surface of the In the above formula: />For indocyanine green ICG at wavelength lambda 2 The light absorption coefficient is a constant obtained by adopting a time domain or frequency domain spectrum analysis method, R n Is the residual rate of indocyanine green ICG in the blood after n minutes, C n Is the ICG concentration of indocyanine green after n minutes, C 0 Indocyanine green ICG concentration at baseline 0 after indocyanine green ICG injection; wherein->Andmeasuring the light intensity change rate of the reflected light at n minutes and reference 0, respectively>And modified->Is a difference in (2);
(3): blood oxygen saturation calculation after indocyanine green ICG injection
After injection of indocyanine green ICG, the wavelength lambda 1 The absorption coefficient=660 nm also increases the effect of indocyanine green ICG absorption:；/>the method comprises the steps of carrying out a first treatment on the surface of the The rate of change of the intensity of the reflected light after elimination of indocyanine green ICG +.>Comprises Hb and HbO only 2 Is defined by: />The method comprises the steps of carrying out a first treatment on the surface of the Substituted into liver function to calculate ICG concentration C of indocyanine green ICG ：/>；
The corrected central venous oxygen saturation ScvO is calculated by the following formula 2 correction ：。
2. The central venous catheter-based blood oxygen saturation monitoring and liver function testing system of claim 1, wherein: the inner wall of the dye injection channel is coated with a light-proof coating, or the dye injection channel is made of a colored material.
3. The central venous catheter-based blood oxygen saturation monitoring and liver function testing system of claim 1, wherein: the catheter body in the central venous catheter is of a four-cavity structure, a pressure measurement cavity and an infusion cavity are arranged in addition to the dye injection cavity and the optical fiber cavity, and the pressure measurement cavity is used for penetrating a guide wire to guide the central venous catheter to be placed in during puncture and is connected with invasive blood pressure measurement equipment after the guide wire is pulled out after the puncture is finished so as to measure central venous blood pressure; the transfusion cavity is used for blood sampling and transfusion; the upper part of the catheter body is also connected with a pressure measuring channel and a pressure measuring joint which are communicated with the pressure measuring cavity, and an infusion channel and an infusion joint which are communicated with the infusion cavity through a fixed bracket.
4. The central venous catheter-based blood oxygen saturation monitoring and liver function testing system of claim 3, wherein: the outlets of the optical fiber cavity and the pressure measuring cavity are positioned at the far end of the catheter body, and the outlets of the infusion cavity and the dye injection cavity are positioned at the near end of the catheter body.
5. The central venous catheter-based blood oxygen saturation monitoring and liver function testing system of claim 3, wherein: the dye injection joint, the pressure measurement joint and the infusion joint are all standard luer joints.
6. The central venous catheter-based blood oxygen saturation monitoring and liver function testing system of claim 1, wherein: the terminal equipment is a monitor, and the monitor has a human-computer interface interaction function, and can input calibration parameters and display blood oxygen saturation measurement results and a stain concentration change curve in real time.
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| US5315995A (en) * | 1992-03-19 | 1994-05-31 | Henry Ford Hospital | Method and apparatus for continuous measurement of central venous oxygen saturation during human cardiopulmonary resuscitation and clinical shock |
| CN102488525A (en) * | 2011-12-14 | 2012-06-13 | 吉林大学 | Hepatic functional reserve detector capable of removing blood oxygen fluctuation interference |
| CN103385695A (en) * | 2013-07-19 | 2013-11-13 | 武汉昊博科技有限公司 | Multi-wavelength liver reserve function detection instrument and ICG (indocyanine green) concentration detection method |
| CN207640401U (en) * | 2017-04-17 | 2018-07-24 | 吉林大学 | A kind of noninvasive cerebral blood flow (CBF) measuring system |
| CN112903609A (en) * | 2020-10-09 | 2021-06-04 | 重庆大学 | Dual-wavelength venous blood oxygen saturation measuring method without correction |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| DE10245416B4 (en) * | 2002-09-28 | 2006-03-16 | Pulsion Medical Systems Ag | Catheter system with special fasteners |
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Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5315995A (en) * | 1992-03-19 | 1994-05-31 | Henry Ford Hospital | Method and apparatus for continuous measurement of central venous oxygen saturation during human cardiopulmonary resuscitation and clinical shock |
| CN102488525A (en) * | 2011-12-14 | 2012-06-13 | 吉林大学 | Hepatic functional reserve detector capable of removing blood oxygen fluctuation interference |
| CN103385695A (en) * | 2013-07-19 | 2013-11-13 | 武汉昊博科技有限公司 | Multi-wavelength liver reserve function detection instrument and ICG (indocyanine green) concentration detection method |
| CN207640401U (en) * | 2017-04-17 | 2018-07-24 | 吉林大学 | A kind of noninvasive cerebral blood flow (CBF) measuring system |
| CN112903609A (en) * | 2020-10-09 | 2021-06-04 | 重庆大学 | Dual-wavelength venous blood oxygen saturation measuring method without correction |
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